I saw a report from SAEM that 17% of EM residents are IMGs. Annals of EM had a report not too long ago (within the past year) that listed the states that have IMGs in residency programs. (Sorry, I can't look up the article becuase it is burried somewhere! )If my memory is right, NY and Michigan have the most.
Plus, some interesting extracurriculum activities (2).
Then, good luck (3).
Of course, decent USMLE-1 scores (4th importance). Mechanical cut-offs are about 1 SD above the mean (235 for step 1). Below that, you need extra good luck, better connection, more interesting extracurriculum activities than the rest of the crowd. Below 200, you need a miracle.
I can tell you a hundred places that are recruiting people like you, but that wont help. You need connections. Something, someone that makes you different, standing out. You don't just "know" someone. You must "know" someone well enough to know the middle name of his / her Mom's sister. Or, find out the Residency Director and research on his undergrad, med school, before you go for interview. Never hiring a private detective, though.
On my interview, the Residency Director was more interested in my undergrad education (alumni of same school, I told him how his fraternity house was like the last time I went there), the trees he planted in the back yard still there, the frat parties that STILL offered illegal alcohol, the wide-eyed easily impressed freshman sorority sisters, etc., music instruments that we both played and music we both liked, poems, etc., than the real stuff about the residency. It was with nostalgia that we ended the interview. I could almost see tears in his eyes. At 60 people tend to look back at old college age, time, and tend to liken the young ones with what they once did, went through. It was more like a chat between old frat buddies than an interview. I was just like him some 35 years ago, he said. Next thing I knew while still being there, the on-the-spot offer, which I couldn't resist. The deal was made, the paper was signed, first interview for me, also last one.
Oh boy, how much I thank my parents for sending me to such a HUGE school, lots of alumni out there....