Foreign Medical Graduates take certification exams through the ECFMG (Educational Commision for Foreign Medical Graduations). As seen in this breakdown of the
United States Medical Licensing Exam , Foreign Medical Graduates have less than 1/2 the pass rate as US medical graduates. Cuba has a 25% pass rate on the first attempt ( Seywell RM, Studnick J, Bean JA, Ludke R. A performance comparison: USMG-FMG house staff physicians. Amer. Journal Public Health 1980;70(1):23-28.)