Clerkship pathway: a factor in certification success for international medical graduates.
OBJECTIVE
To identify factors that help predict success for international medical graduates (IMGs) who train in Canadian residency programs and pass the Canadian certification examinations.


DESIGN
A retrospective analysis of 58 variables in the files of IMGs who applied to the Collège des médecins du Québec between 2000 and 2008.


SETTING
Quebec.


PARTICIPANTS
Eight hundred ten IMGs who applied to the Collège des médecins du Québec through either the "equivalency pathway" (ie, starting training at a residency level) or the "clerkship pathway" (ie, relearning at the level of a medical student in the last 2 years of the MD diploma).


MAIN OUTCOME MEASURES
Success factors in achieving certification. Data were analyzed using descriptive statistics and ANOVA (analysis of variance).


RESULTS
International medical graduates who chose the "clerkship pathway" had greater success on certification examinations than those who started at the residency level did.


CONCLUSION
There are several factors that influence IMGs' success on certification examinations, including integration issues, the acquisition of clinical decision-making skills, and the varied educational backgrounds. These factors perhaps can be better addressed by a regular clerkship pathway, in which IMGs benefit from learner-centred teaching and have more time for reflection on and understanding of the North American approach to medical education. The clerkship pathway is a useful strategy for assuring the integration of IMGs in the North American health care system. A 2-year relearning period in medical school at a clinical clerkship level deserves careful consideration.