More than 100 medical schools in the Caribbean, one US rule that changed in 2024: ECFMG's accreditation requirement became a 'Recognized Accreditation Policy'

For an international medical graduate (IMG) wanting to practise in the United States, certification by the Educational Commission for Foreign Medical Graduates (ECFMG) is the gateway to the USMLE and the residency Match. Which schools qualify matters to thousands of students, nowhere more than in the Caribbean, where offshore schools exist largely to serve the US pipeline.

According to a perspective article published on 10 May 2025 in Advances in Medical Education and Practice by two authors at Avalon University School of Medicine in Curaçao, the ECFMG announced in 2010 that from 2023 applicants would have to be graduates of a medical school accredited by an agency recognised by the World Federation for Medical Education (WFME). In 2024 the ECFMG instead implemented a 'Recognized Accreditation Policy': IMGs 'can continue to apply for and pursue ECFMG Certification' even if their school does not meet it, and schools that do meet it receive a note under the Sponsor Notes tab of the World Directory of Medical Schools. The WFME's own accreditation page says the 2010 ECFMG initiative is 'now known as the Recognized Accreditation Policy' and that agencies holding WFME recognition status fulfil it.

The authors put the stakes in numbers. IMGs make up 27 per cent of residents in US training posts; in the 2022 Federation of State Medical Boards census Caribbean graduates were 20 per cent of licensed IMGs, just behind India's 21 per cent; more than 75 per cent of US-born IMGs came from offshore Caribbean schools; and the region has more than 100 medical schools. They also described agencies from Kyrgyzstan and Kazakhstan visiting schools in Curaçao and Dominica, the Kazakh agency now being recognised by the government of Barbados. The Curaçao Chronicle, reporting the analysis on 12 May 2025, said offshore Caribbean schools supply over 20 per cent of foreign-trained physicians in the US, that Aruba and Curaçao have no national accreditation system for medical schools, and that the researchers warned of 'a real risk of uncontrolled proliferation of low-quality schools'.

Accreditation status no longer bars a school's graduates from ECFMG certification, but it is now flagged, school by school, in the World Directory. The authors' concern is that the incentive which pushed Caribbean schools to seek accreditation after 2010 has weakened, leaving the applicant to judge a school's quality.

Before paying a deposit to any Caribbean school, open its entry in the World Directory of Medical Schools and read the Sponsor Notes tab, which records whether the school meets ECFMG's policy. Check which agency accredits the school and whether that agency holds WFME recognition. A recruiter's assurance that graduates 'can sit the USMLE' is not the same as the school meeting the policy, and programme directors will know the difference.