In 2008, one of this paper’s coauthors (G.P.V.) created an international exchange program between the University of Rochester School of Medicine and Dentistry, Rochester, New York, while serving as an Associate Professor, and the Universidad Nacional Mayor de San Marcos, San Fernando School of Medicine (UNMSM), Lima, Peru. After completing high school in Lima, Dr Velarde fled Peru with her family during a time of political turmoil but always thought of giving back to her native country. The international exchange program between these 2 institutions became a plausible way to accomplish this goal.

The UNMSM was chosen as the exchange partner due to its excellent educational record of accomplishment. Founded in 1551 and recognized as the “Dean University of the Americas” and the top public university in Peru, the UNMSM is the only Peruvian university to have a Nobel Prize laureate among its alumni. San Fernando School of Medicine has a 7-year medical school curriculum (including 1 year of internship). With its rigorous and extremely competitive admission process, the school only accepts the top 150 of its 58,000 applicants every year.

The goals of the international exchange program were 4-fold: 1) to broaden the exposure of U.S. medical students interested in learning about global health and alternate models of care; 2) to create opportunities for Peruvian medical students to complete clinical rotations in a leading American institution; 3) to promote tolerance and acceptance of diverse cultures; and 4) to positively affect the community by serving as mentors and teachers for future students.

After the first Peruvian medical students rotated at the University of Rochester School of Medicine and Dentistry (including one of the authors of this paper, K.B.J.), these students decided to join forces with other students who had rotated at Weill Cornell Medicine and established the Student Exchange Division at San Fernando School of Medicine. This division promoted the existing exchange programs among medical students and selected prospective students based on English proficiency, clinical and community service track record, and interviews. The division also found host families for U.S. students and fostered a philosophy of reciprocity whereby each student who was able to complete the rotation was responsible for coaching the next one (“Hoy por ti, mañana por mi”—“Today for you, tomorrow for me”). Peruvian students who benefited from the exchange program became part of the selection committee upon graduation, making the initiative sustainable.

As of 2022, a total of 51 Peruvian students have completed the exchange program. Of these, 12 applied and matched with U.S. residency and fellowship programs, including 4 in cardiovascular medicine and 1 in advanced cardiac imaging (via a radiology training pathway). Three of the physicians in cardiovascular medicine were women and received recognitions such as: Alpha Omega Alpha Honor Society Membership, American Heart Association Young Investigator Award finalist, American Association of Medical Colleges–Building the Next Generation of Academic Physicians Leadership Award, and Fellow of the Year Award. Our data cannot be extrapolated to a national level to anticipate the impact of international exchange programs on “brain drain.” However, we recognize that factors other than having completed an exchange program play a role in actual physician migration. Therefore, despite the intention of 42% among Peruvian recent medical graduates to migrate,  93% of Peruvian medical graduates remain in Peru.

International medical school exchange programs are also beneficial to U.S. medical students. They offer an excellent opportunity for personal growth by exposing them to a new culture, language, and different medical system. They help medical students cultivate and improve cross-cultural communication skills, which can play a key role in delivering equitable care. These programs provide the optimal environment to build the foundation for true cultural sensitivity and competency.

Similarly, the immersion of international medical students into U.S. culture provides an opportunity for the students to not only appreciate American values but additionally explore how the United States also faces health care disparities. The results of this international exchange program show that engaging students in the pipeline early can get talented and diverse individuals interested in cardiovascular medicine, and they also reveal the impact of international medical graduates (IMGs) in the United States (Figure 1). We hypothesize that several exchange programs throughout Latin America and other parts of the world have achieved comparable results or even higher recruitment, depending on graduates’ financial resources (as the cost of applying to the U.S. residency program approximates $18,000). IMGs may return to their home countries or stay in the United States, becoming human bridges for knowledge, education, and research, and many times closing the circuit of reciprocity from afar via global health programs.

Impact of International Medical Graduates in the United States

CVD = cardiovascular disease.

During the COVID-19 pandemic, nearly all of these exchange programs became inactive or transformed into virtual experiences as international travel was halted. While several exchange programs have resumed, there is currently a significant challenge approaching: the Educational Commission for Foreign Medical Graduates has announced that the initial implementation of the International Accreditation Policy will begin in 2024. In this policy, international medical school accreditation will be sought via a recognized agency in an effort to promote global standards for the evaluation of undergraduate medical education. Worldwide, there are 57 countries with agencies able to provide this accreditation, with only 5 in the Americas: the Mexican Board for Accreditation of Medical Education, the Accreditation System of Medicine Courses in Brazil, the Caribbean Accreditation Authority for Education in Medicine and Other Health Professions, the Grenada Medical and Dental Council, and the Accreditation Commission on Colleges of Medicine.

This initial policy implementation will not preclude IMGs from unaccredited schools from becoming certified by the Educational Commission for Foreign Medical Graduates and applying for residency in the United States in 2024. However, we believe they will be significantly affected, as the perception by program directors will vary depending on accreditation status. Several barriers for accreditation of public medical schools in Peru (among other Latin American schools) are in place, including funding (need to seek accreditation with the closest internationally accredited agencies in Brazil or Mexico), political instability (which threatens its own national accreditation body, the National Superintendent of Education), and bureaucracy (which limits accomplishing goals within deadlines). With these barriers in mind, we encourage the following: 1) international public medical schools should seek accreditation early; 2) U.S. program directors should holistically review each applicant, recognizing that talent can be found even in the most remote latitudes; and 3) the public, scientific, and medical communities should recognize and respect IMGs and their invaluable contributions to the field of cardiology.

This article is reproduced from JACC journals.

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