Direct-Application Clinical Elective Pathways for International Medical Students in the United States: A Systematic Environmental Scan

Background: International medical graduates constitute a substantial share of the United States physician workforce, particularly in general internal medicine. The AAMC Visiting Student Learning Opportunities (VSLO) platform coordinates visiting placements only for students whose home institution holds network membership; others depend on what each host institution publishes about independent application. Objective: To identify publicly documented direct-application clinical elective pathways for international medical students, and whether the information needed to apply can be verified from institutions' published materials. Design: Systematic environmental scan of institutional documents, with criteria specified in advance, duplicate independent screening, third-reviewer adjudication, and standardized extraction requiring documentary support. Searching March to April 2024; re-verification June 2026. Participants: Four published, dated rosters accessed 27 March 2024: the Liaison Committee on Medical Education directory (158), the American Osteopathic Association directory (66 entries), the U.S. News Best Hospitals Honor Roll (23), and VSLO resources (56). Main Measures: Institution type, VSLO affiliation, documented USMLE, English-language and life-support requirements, application fee, four-week tuition, and whether each variable was published. Key Results: Of 303 records, 252 unique programs were screened, 20 met criteria, and 19 retained a verifiable pathway. Thirteen (68.4%) were medical school based and 12 (63.2%) participated in VSLO while also accepting direct applications. Eight (42.1%) documented a Step 1 requirement, one (5.3%) Step 2, ten (52.6%) English-language testing, and three (15.8%) life-support certification. Cost information was available for 18 of 19 (94.7%): tuition ranged from $0 to $6,200 (median $3,000) and fees from $0 to $525 (median $175). Six institutions published insufficient information; three supplied it on request. Programs spanned 13 states. Conclusions: Documented pathways were few, heterogeneous in prerequisite, and frequently costly, and for some programs key information could not be verified from published sources. The design records what institutions publish, not what they require.