Hello there , I am an IMG at internship year at a US ACGME University programs. You are not an IMG your are still a CMG,. you have. a good chance in matching at TOP tier US academic programs in IM coming from Canada..check the nrmpl list to see how many CMGs applied and got accepted, basically all of them .. that might not be the case though for IR DERM Nurosurg and ENT. you don't ask the residency program to write your Royal college exam, you can do it when you qualify for it by having the minimum 4 years of PGY training.