Grady, Canada runs a collegiate system similar to Australasia and some of the centers of excellence in Asia. Physicians are trained extremely well by world standards, generally travelling abroad to other centers of excellence to experience and lock-in the international aspects of medical quality. To practice in the US may require essentially an English language exam and a basic medical science exam, though if you are a consultant Fellow of one of the recognized colleges, doors tend to open if a particular facility or program wants you. At one stage I was privileged to work with the head of the Mayo transplant program (yeah, liver transplants) and he was trained in the collegiate system- in Australasia as it happens.