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.

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

Conclusions: 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.