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Only if you are not full IMG.

If you are a full IMG outside the US then it doesn't matter. Most states will require you to be FCVS certified and that in turn does not scrutinize your clinical rotations outside the US whether it's core or elective rotation.

Now if you are Caribbean and you have core and electives in US then the story is different. In that case Yes, you have to do Green Book electives because otherwise many states (almost half the states) won't give you a license.

We are talking about license here of course not residency. Residency you can get without problems be it green book or blue book or whatever.
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