Factors influencing United States residency interview rates among African international medical graduates

Abstract

Securing a residency position in the United States remains a significant challenge for International Medical Graduates (IMGs), particularly those from African countries. Although African IMGs contribute to approximately 25% of the U.S. physician workforce, they face unique barriers such as limited access to U.S. clinical experience, visa restrictions, and perceptions of lower-quality medical education. To enhance applicant visibility and improve equity in the selection process, the Association of American Medical Colleges (AAMC), through the Electronic Residency Application Service (ERAS), introduced program signaling and geographic preferencing. This study evaluates the impact of these mechanisms on interview outcomes for African IMGs during the 2023–2024 and 2024–2025 residency application cycles. A descriptive cross-sectional study was conducted among African IMGs who participated in the 2023–2024 and 2024–2025 NRMP Match. Logistic regression analysis was used to examine the association between applicant characteristics and the likelihood of receiving an above-average number of residency interviews. A total of 222 respondents participated, with most from Nigeria (77.7%), followed by Ghana, Cameroon, and other countries. The most preferred regions were Middle Atlantic (44.6%), East North Central (35.9%), and South Atlantic (29.2%). Applicants signaled an average of 12.5 programs and received 5.1 interview invitations on average. Of these, 2.9 interviews came from programs in preferred regions. On average, 2.1 interviews came from signaled programs within preferred regions, while 1.3 were from signaled programs outside those regions. Factors influencing program signaling included historical acceptance of African IMGs (73.9%), geographic preference (48.2%), and networking (38.7%). Higher interview rates were associated with recent graduation (≤ 5 years), no USMLE step failures, and Step 2 CK scores ≥ 249. Program signaling and geographic preferencing allowed applicants to express interest more directly but did not independently improve interview outcomes. Enhancing match success for African IMGs will require targeted strategies, including greater access to U.S. clinical experiences and strengthened USMLE preparation support.