OUM does not offer advanced standing because spending a minimum of four years in medical school is a licensing requirement in many countries. Four years of study is also required to receive certification from the Educational Commission for Foreign Medical Graduates (ECFMG), which graduates of foreign medical schools must obtain in order to begin a residency or obtain a medical license in most US states. Some students who graduated from Caribbean medical schools that offered advanced standing were denied medical licensure in a number of US states.