Medical Student Path??

Hello everyone.

I was wondering about the general system that Med students have to go through.

Let's say I've been accepted to LSMU (Lithuanian University of Health Sciences). After a 6-years English program I am getting an M.D. Degree.
This university is recognized by all EU countries and also prepare for USMLE (United States Medical Licensing Examination).

After these 6 years - if I move to the USA, or Canada - What would be my next step? Internship, Residency, Fellowship?
If it has something to do with this: I haven't chosen a specialty yet, but I'm leaning more towards Family Medicine, or Internist.
(Never quit understood the difference between them)

Thanks very much for answering! :)