The training of graduates from foreign medical schools presents a special problem in medical education. Their presence in training programs can be regarded from two totally disparate points of view. The first view, probably most generally held, is that foreign medical graduates are less well prepared for internship and residency than their American counterparts. The difficulties imposed by language barriers, by differences in education, social customs, and values are a reality. From this perspective the foreign medical graduate is not as "desirable" a house officer as the graduate of an American medical school; programs with a large proportion of foreign medical graduates are considered less competitive, or strong, than those with fewer. Hospitals, however, need house officers to provide patient care services. Since the end of World War II there have been far more positions available than applicants. Hospitals compete strongly for these physicians, often, it must be admitted, to utilize their services for patient care rather than to provide them with an educational opportunity. The national picture over the past 20 years (Fig. 1) shows this steady trend. In 1968-1969, about one third of all house officers in the United States were foreign graduates; nearly 20% of available house officer positions were unfilled. Thus, a different but equally valid viewpoint, increasingly voiced but not frequently recognized, is that the foreign medical graduate is a vital component of our health manpower resources. The United States is heavily dependent upon the immigration of physicians to provide the health services needed by the expanding population.