In my understanding, cali approval is only important if you are a current student in a foreign med school wishing to transfer to another med school in cali. Getting accepted as a foreign transfer student to even the lowest tier med school in the US is almost impossible unless of course if you are the top 1 student of Oxford or Cambridge or you have discovered HIV/AIDS vaccine.
It is also important if you are an IMG wishing to do clerkship or residency in cali. This is very competitive. Cali clerkships are mostly set aside for students in the Caribbean and Mexico. Most US students pick cali for residency. If there are left for scramble, you will compete with Caribbean and Mexican trained IMG's. why compete for leftovers like a clerkship in Compton or residency in some hospitals in central LA neighborhood?
These are what I deem more important in selecting a foreign medical school:
Is your med school listed under IMED and WHO? IMED for ECFMG certification if you want to practice in America and WHO for volunteering around the world.
Does the hospital your school is affiliated with have cutting edge technology like computed tomography imaging, laparoscopy, cell culture, osteogenesis, medical laser, etc.? You need to be exposed into these technologies so you won't be shocked or look dumb during your residency in the US. Just imagine if you are a resident in pathology and you haven't tried or used electron microscope because what you had in your med school was the simple light ones or you haven't heard of telemicroscopy or microscopy digital imaging. that will really affect your confidence and crush your ego. this ignorance won't be a bliss.
Do you have a good hands-on and exposure in a clinical environment of varied patient population? This will boost your confidence and help you get rid of your inhibitions and phobias. It will give you a good training too in multifaceted doctor-patient interaction and bedside manners. a school hospital of 50-100 beds is not a good place to encounter patients with different cases and learn different diseases.
Does the school prepare you well in basic medical sciences in your first two or three years in the program enough to get above average USMLE 1 score? By the way, you can challenge USMLE 1 after you complete all basic sciences. You don't have to wait after graduation. This is good because those courses/lessons/theories/books are still fresh in your mind.
Does your program have adequate time spent in all clinical rotations? More time spent on patients/hospitals, more clinical knowledge gained. that is if you are not wasting your time.
Will your professors expose or involve you in their research? This is good for resume building. Even if your job under your professor is just to collect patients' data like their names and addresses, take it. You can rename that job to sound clinical in your resume as "clinical data analyst," "clinical case specialist" or simply "clinical research assistant." This is not lying. You are part of a research team, where you happen to have no job specification.
Will the last two or three years of your program really give you a very good clinical knowledge important in USMLE 2? This is where, if you are a student pastry chef, you prove that you can do an almost perfect meringue, and that you are indeed a well-trained chef.
Now, the rotation or clerkship. I would finish all my rotation in my school outside of the US. Then do a 12-week rotation in the US. If you are willing to pay, you can do clerkship anywhere as long as you pass USMLE 1 and/or USMLE 2. Harvard Medical Center, for instance, charges like 10 grand for a 12-week clerkship.
American hospitals are too malpractice lawsuit-conscious. I don't think if they will ever allow you to deliver a baby, not just assist, during your rotation. i heard third year med students in asia and mexico are allowed to perform even c-section and other minor surgeries. those clinical experiences are rare in the US. so finishing a full rotation outside the US is an advantage indeed if you think of medical knowledge and clinical experiences.
For me, US clerkship is important for showing off your clinical knowledge and for your resume. This is the best way to prove to the americans that you are not a product of a medical diploma mill abroad. Rotate only in clinical courses where you can outstandingly show off your clinical skills. For instance, if you are lucky, you can stitch a patient's cut under a US doc's supervision. Your suturing skills and how clean you work, meaning blood, puss, dirty gauze and cottons are not all over, will impress your supervising surgeon. that is one letter of recommendation or preference already that will back you up in your residency application.
Psychiatry is good too. This is a good area where you can literally display your skills in patient charting and patient psychiatric profiling. If you are lucky again, maybe you can discuss psychiatric stuff with your supervisor. I think in this field you can bullpooh pooh a little bit. good area to show off. Just make it sure you know what you are talking about. If you are trying to impress your supervisor about neuropsychiatry be sure that you have a good background in both neurology and psychiatry. you might end up scratching your head.
Medical services in america is patient-oriented. american doctors are paranoid of lawsuits. Bedside manners are important. My sister, who is a cardiologist in nyc, told me that they were taught in med school how to ask proper questions, gesture or touch a patient to comfort him/her, and deal with a patient according to gender, race, religion and social background. I think OB-GYNE is the best for this kind of experience. Women are very particular of bedside manners. they are very appreciative too. even for just a pap smear or a prenatal sonogram, if you treat them good, they will write or tell your supervisor how nice you are. that is indeed a plus point.
Why do you need to impress your clerkship supervisors? You need them as references for your residency. Besides, you need to let them know that you are well trained too like US graduates. american med schools and hospitals tend to look down on IMG's medical training. If they find you to be excellent, in their minds you are one of the few IMG's who should be recommended for a good residency. Residency in the US is through merit, connection and luck. it is possible to do your residency where you do your clekship. that's why you need to have a good rapport with your clerkship supevisors. They might know someone who can help you during scramble.
Which is more important: a letter of recommendation from the dean of your medical school in Poland who has published a lot on Polish medical journals or a part time lecturer/clinical supervisor in a US medical school/hospital who has not even co-publish something? Unfortunately, the latter has more weight. Swallow your pride even if your physiology professor in Poland was a Nobel nominee. That means nothing in the US.
Now after passing USMLE 1 and 2, doing your clerkship, and finishing your residency in the US like all other US-trained doctors, I don't see why you cannot practice in California. California licensing law is legislative in nature. Cali lawmakers can amend it anytime, and licensing laws are open to various interpretation and implementation. For example, the cali board says "Medical Schools Recognized by the Medical Board of California " not "Medical School Programs Recognized by the Medical Board of California." In this case, English MD programs of the cali board approved schools in Poland are not really cali board approved or disapproved because they don't need to have an approval. Cali approves med schools not MD programs.
Take the case of my primary care physician 3 years ago in orange county in southern California as an example. He got his MD from Spartan in the Caribbean. Spartan is not cali approved yet he practiced in cali. I think cali physician licensing is dealt with in a case-to-case basis. That's why it takes 8 months to process a cali physician license application. Unfortunately, only michigan accepts reciprocity
If ECFMG certified an IMG, who graduated from an obscure med school in Timbuktu, he got a very high mark on USMLE 1 and passed USMLE 2 easily, Harvard clerkship gave him good letters of recommendation, and his residency at Yale showed he is very good, what is the business of cali board to deny him a medical license? I just hate elitism.
sorry for the long rant. I just felt like writing something.