MD, DO or Caribbean MD
Three routes to a US residency, with different odds.
How US MD, US DO and Caribbean medical schools compare on who they admit, the exams on the way and how graduates fare in the Match, and what to check before you choose a Caribbean school.
The three routes side by side
| US MD | US DO | Caribbean MD | |
|---|---|---|---|
| Who enrols | Mean MCAT 512.1, mean GPA 3.81 (2025 to 2026 matriculants) Source | Mean MCAT 502.95, mean GPA 3.62 (2025 entering students) Source | No national average. Ross publishes 493 and 3.32 for its 2025 to 2026 direct admits; the others publish none Source |
| How you apply | AMCAS for most schools; TMDSAS in Texas | AACOMAS | Directly to each school, with rolling admissions and several start dates a year |
| Degree and training | Allopathic MD; four years in the US | Osteopathic DO, adding osteopathic manipulative treatment; four years in the US | MD; basic sciences on the island, clinical years mostly at US hospitals |
| Licensing exams | USMLE Steps 1, 2 CK and 3 | COMLEX-USA; many students also take the USMLE | USMLE Steps 1 and 2 CK, plus ECFMG certification before residency Source |
| 2026 Match rate (PGY-1) | 93.5% of US MD seniors Source | 93.2% of US DO seniors Source | 70% of US citizen international graduates; 56.4% of non-US citizen international graduates Source |
Four phases from premed to the Match
The same four phases on every route; the differences sit in phase four. The exams and licensing guide covers each exam in depth.
Phase 1
Premed and applying
- Common prerequisites: a year each of biology, general chemistry, organic chemistry and physics with labs, plus biochemistry and English. Check each school's list.
- US MD schools take applications through AMCAS (TMDSAS in Texas) and DO schools through AACOMAS, both opening in the spring before the year you start.
- Caribbean schools take applications directly and start classes several times a year; each school's start dates are in the table below.
Phase 2
Basic sciences and the first board exam
- Years one and two: anatomy, physiology, pathology, pharmacology and biochemistry, organised by organ system at most schools.
- USMLE Step 1 has been pass or fail since January 26, 2022. Source
- COMLEX-USA Level 1 has been pass or fail since May 2022; many DO students also take Step 1 to widen their residency options. Source
Phase 3
Clinical years and the second board exam
- Core clerkships in internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry and family medicine, then electives and sub-internships.
- US students apply for away rotations through VSLO. The AAMC is not taking new VSLO applications from institutions outside the US, so ask a Caribbean school how it arranges electives at US hospitals. Source
- USMLE Step 2 CK or COMLEX Level 2-CE. Step 2 CK is scored, and residency programs read the number closely.
Phase 4
Residency application and the Match
- ERAS: applicants could submit to programs from September 2, 2026 for residencies starting in 2027. Source
- Caribbean graduates need ECFMG certification: pass Step 1 and Step 2 CK and meet a clinical and communication skills pathway that includes OET Medicine. Source
- Interviews run through the fall and winter, rank lists close in late winter and results arrive on Match Day in March.
Before you choose a Caribbean school
Schools differ widely. These checks separate the ones that prepare you for a US residency from the ones that leave it to chance.
- Accreditation
- Look for an accreditor recognized by the World Federation for Medical Education. CAAM-HP and ACCM, which accredit many Caribbean schools, are both recognized. Source
- World Directory listing
- The school's World Directory entry should carry an ECFMG sponsor note covering your graduation year. Since November 2024 the entry also notes whether the accreditor is recognized; that note does not itself change ECFMG eligibility. Source
- State licensure
- California recognizes international schools that ECFMG has found substantially equivalent and that appear in the World Directory, rather than reviewing schools itself. Texas checks graduates against its own equivalence rules. New York approves international schools for long clinical clerkships in the state. Check the state where you plan to practise. Source
- Federal loans
- US students can use federal Direct Loans only at foreign schools approved for them, which must keep first-time USMLE pass rates of at least 75%. Federal loan limits for new graduate borrowers changed on July 1, 2026. Source
- Clinical rotations
- Ask where core rotations happen, whether they are at hospitals with ACGME-accredited residency programs, and how often students move between sites.
- Outcomes
- Ask for first-time pass rates on Step 1 and Step 2 CK, the share of entering students who graduate, and residency placement for recent classes, with how each is counted.
More on licensing in each state: Texas Medical Board. Accreditation notes in each school's listing: World Directory.
What four schools publish about themselves
St. George's, Ross, AUC and Saba each take part in federal Direct Loans and publish outcomes. Listing them is not an endorsement.
| School | Published outcomes | Federal loans | Start dates |
|---|---|---|---|
| St. George's University (Grenada) | Federal Direct Loans Source | January, April, August Source | |
| Ross University School of Medicine (Barbados) | Federal Direct Loans Source | January, May, September Source | |
| American University of the Caribbean (Sint Maarten) | Federal Direct Loans Source | January, May, September Source | |
| Saba University School of Medicine (Saba) | Federal Direct Loans Source | January, May, September Source |
Schools report these figures themselves and count them differently: some report a single year, others several, some count only students who sat the exam. Compare like with like, and ask each school how its figures are calculated.
Official resources
- AMCAS
AAMC
The application for most US MD schools.
- AACOMAS
AACOM
The application for US DO schools.
- ECFMG certification
ECFMG (Intealth)
Certification for international medical graduates, required before US residency.
- USMLE
FSMB and NBME
The licensing exams for MD and international graduates.
- COMLEX-USA
NBOME
The licensing exams for DO graduates.
- NRMP
The Match
The residency match, its calendar and results.
- World Directory of Medical Schools
WDOMS
A school's listing, accreditation note and ECFMG sponsor note.
- WFME recognized agencies
WFME
Accreditors recognized by the World Federation for Medical Education.