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To provide a descriptive overview of international medical school graduates (IMGs), U.S. and non-U.S. citizens, who obtained their medical degrees outside of the United States and Canada, with a focus on where U.S. citizens received their medical education and how this choice has changed over time.The study group included all IMGs (n = 143,926) certified by the Educational Commission for Foreign Medical Graduates (ECFMG) from 1983–2002. Descriptive statistics were calculated, including historical certification rates for non-U.S. citizen and U.S. citizen IMGs. For IMGs who were U.S. citizens (n = 18,762), the data were summarized by medical school and country of medical school.U.S. citizens who attended medical schools abroad were more likely to attend schools in Central America and the Caribbean than in any other geographic region. There was a steady decrease in the number of U.S. citizens graduating from European medical schools. Conversely, the number graduating from medical schools in India and Israel rose. Over the period studied, the regions of Africa, Oceania, and South America graduated relatively few U.S. citizens.From 1983–2002, U.S. citizens graduated from medical schools in Central America and the Caribbean more than any other geographic region. Studying the characteristics of medical schools in this region and their similarities to U.S. medical schools, such as a four-year curriculum, may explain why U.S. citizens are attracted to this region in large numbers. Additional studies focusing on the characteristics of medical schools that train IMGs, the performance of the graduates, and their posttraining practice patterns are warranted.