If you are an international medical graduate (IMG) pursuing licensure in the United States or applying for a Post Graduate Medical Residency Training program, you will need to take the United States Medical Licensing Examination (USMLE). This comprehensive guide is specifically designed to provide foreign medical graduates with all the necessary information regarding the USMLE.
For a detailed overview of the USMLE, including eligibility requirements, registration procedures, and fee structures, please refer to our comprehensive USMLE guide. It covers all the essential aspects you need to know.
What is USMLE?
USMLE, which stands for United States Medical Licensing Examination, serves as the gateway to medical licensure in the United States. It is the essential examination required for physicians to obtain a medical license in the country. Sponsored jointly by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), the USMLE aims to establish standardized assessment criteria for allopathic physicians, ensuring consistent evaluation across all state medical boards.
The USMLE is comprised of three distinct multiple-choice tests: Step 1, Step 2 Clinical Knowledge, and Step 3. For a detailed breakdown of each step, please refer to the comprehensive information provided in the USMLE Steps section below.
What USMLE assesses?
The United States Medical Licensing Examination assesses physicians’ knowledge, concepts, and patient-centered skills important for safe and effective patient care. It evaluates their ability to apply these skills in managing health and disease. The exam aims to ensure physicians are well-equipped to provide quality care and prioritize patient needs.
What is the purpose of USMLE?
The USMLE serves as a universal benchmark for medical licensure in the United States. It is mandatory for both domestic and international graduates, ensuring that all physicians are held to the same standards of competence and knowledge. By evaluating physicians trained outside the US against the standards applied to US medical school students and graduates, the USMLE guarantees a consistent and standardized assessment process. This promotes fairness and ensures that physicians, regardless of their educational background, meet the necessary requirements for safe and effective patient care.
What is ECFMG Certification?
ECFMG Certification is a vital evaluation process for international medical graduates (IMGs) who wish to enter the U.S. healthcare system. It is a requirement set by the Accreditation Council for Graduate Medical Education (ACGME) for IMGs who want to participate in ACGME-accredited residency or fellowship programs.
Eligibility Requirements for ECFMG Certification
In order to obtain ECFMG Certification, international medical graduates (IMGs) must meet the medical science examination requirement by passing Step 1 and Step 2 Clinical Knowledge (CK) of the United States Medical Licensing Examination (USMLE). The eligibility criteria for the examination vary based on whether the applicant is an international medical school student or an international medical school graduate.
Eligibility for International Medical School Students:
- To be eligible for Step 1 and Step 2CK a medical student must be officially enrolled in a medical school outside the United States and Canada listed in the World Directory of Medical Schools.
- The medical school must have an ECFMG note stating eligibility for students and graduates to apply for ECFMG Certification and examination.
- Current enrollment status must be certified by an authorized official of the medical school.
- Must have completed at least two years of medical school, including the basic medical science component.
- Completion of core clinical clerkships before taking Step 2 CK is recommended.
Eligibility for International Medical Graduates:
- To be eligible for Step 1 and Step 2 CK a medical student must have graduated from a medical school outside the United States and Canada listed in the World Directory with ECFMG eligibility.
- The graduation year must be included in the ECFMG note on the medical school’s World Directory listing.
- Must have been awarded credit for at least four credit years by a medical school meeting ECFMG eligibility requirements.
- Certification of graduate status must be provided by an authorized official of the medical school.
For detailed information and application procedures for ECFMG Certification and the required exams, please refer to the ECFMG Information Booklet.
USMLE Registration Process
USMLE Step 1, Step 2 CK, and Step 3 are computerized exams administered at Prometric Centers.
Step 3 is only administered in the US and its territories. Locate your nearest Prometric Center by visiting their website.
Registration Routes for Different USMLE Steps:
Step 1 and Step 2 Clinical Knowledge:
- International Students of Medical Schools Outside the US/Canada: Apply through the ECFMG application website.
Step 3:
- All Medical School Graduates who have passed Step 1 and Step 2: Apply through the FSMB website.
Application and Scheduling Process:
Register through the appropriate route based on your educational background.
The application and scheduling process remains consistent across all steps of the USMLE.
- Select your preferred eligibility period for testing.
- Keep an eye on your email for the scheduling permit, which will be sent to you.
- Visit the Prometric website to schedule your exam.
For more detailed information on registration and application procedures for the USMLE, please visit their official website.
USLME Exam Fees and official links:
| Type | Fee | How to Apply |
|---|---|---|
| Application for ECFMG Certification | $160 | Online using IWA |
| Step 1 and Step 2 CK | $1,000 – Examination Fee + International Test Delivery Surcharge, if testing outside the United States and Canada | Online using IWA |
| Extension of Eligibility Period (Step 1/Step 2 CK only) | $100 per exam | Online using IWA |
| Step 1/Step 2 CK Testing Region Change | $90 per region change | Form 312 |
| Step 1/Step 2 CK Rescheduling Fee | $0 – varies (depending on exam, testing region, and date of cancellation) | Contact Prometric |
| Score Recheck (Step 1/Step 2 CK) | $80 per exam | Form 265 |
| ECFMG Exam Chart | $50 per request form (up to three copies) | Form 184 |
| ECFMG CSA History Chart | $50 per request form (up to three copies) | Form 297 |
| USMLE Transcript – Paper | $70 per request form (up to 10 transcripts) | Form 172 (requests from individuals) |
| USMLE Transcript – Electronic Transmission for ERAS | $80 per ERAS season | Online at MyERAS |
Other fees and official links to apply:
| Type | Fee | How to Apply |
|---|---|---|
| Application to a Pathway for ECFMG Certification for 2024 Match | $925 | Online using Application for Pathways for ECFMG Certification for 2024 Match |
| Medical School Transcript | $250 | N/A |
| ERAS Token | $165 | On-line using OASIS |
| Electronic Transmission of USMLE Transcript for ERAS | $80 per ERAS season | Online at MyERAS |
| Application for J-1 Visa Sponsorship | $370 ****An additional $220 SEVIS fee, payable to the Department of Homeland Security, is required of initial applicants for J-1 sponsorship. | Application Information |
| Verification to State Medical Licensing Authority | $66 | Online using CVS ON-LINE |
It is important to note that the application fee for Step 3 is non-refundable and non-transferable between eligibility periods or applications. For more information about rescheduling fees for Step 1, Step 2, and Step 3, you can visit the USMLE rescheduling fees page.
USMLE Steps and Exam Format
The USMLE consists of three multiple-choice tests: Step 1, Step 2 Clinical Knowledge, and Step 3.
USMLE Step 1 Exam Format
- Length: One-day exam
- Total Time: Approximately eight hours, including breaks
- Number of Questions: Approximately 280 multiple-choice questions
- Assessment Area: Application of important basic science concepts to clinical scenarios, focusing on underlying principles and mechanisms of health, disease, and therapy.
USMLE Step 2 Exam Format
- Length: One-day exam
- Total Time: Approximately nine hours, including breaks
- Number of Questions: Approximately 318 multiple-choice questions
- Assessment Area: Application of medical knowledge, skills, and understanding of clinical science essential for patient care, with emphasis on health promotion and disease prevention.
Also read: USMLE Preparation Tips
USMLE Step 3 Exam Format
Step 3 of the USMLE is comprised of two parts: Foundations of Independent Practice (FIP) and Advanced Clinical Medicine (ACM), which are conducted over a two-day period. This step assesses your ability to apply medical knowledge and understand biomedical and clinical science. The focus is on patient management in outpatient settings.
Day 1 – Foundations of Independent Practice (FIP)
- Length: One-day exam
- Total Time: Approximately seven hours, including breaks
- Number of Questions: Approximately 232 multiple-choice questions
- Assessment Area: Knowledge of basic medical and scientific principles essential for effective care.
Day 2 – Advanced Clinical Medicine (ACM)
- Length: One-day exam
- Total Time: Approximately nine hours, including breaks
- Number of Questions: Approximately 180 multiple-choice questions and 13 computer-based case simulations (CCS)
- Assessment Area: Application of knowledge in health and disease to patient management, focusing on ambulatory settings.
Please refer to the official USMLE website for the most up-to-date information on the exam format and content for each step.
USMLE Pass Rate for International Students
Step 1
| Examinees from Non-US/Canadian Schools | 2022 Number Tested | 2022 Percent Passing |
| 1st Takers: | 22,030 | 74% |
| Repeaters: | 2,926 | 45% |
| Total: | 24,956 | 71% |
Step 2 CK
| Examinees from Non-US/Canadian Schools | 2021-2022 Number Tested | 2021-2022 Percent Passing |
| 1st Takers: | 12,708 | 89% |
| Repeaters: | 1,369 | 57% |
| Total: | 14,077 | 86% |
Step 3
| Examinees from Non-US/Canadian Schools | 2022 Number Tested | 2022 Percent Passing |
| 1st Takers: | 10,993 | 91% |
| Repeaters: | 1,294 | 64% |
| Total: | 12,287 | 89% |
Jobs for Foreign Doctors without USMLE
If you choose not to complete the United States Medical Licensing Examination (USMLE), there are still opportunities to work in non-clinical roles. However, it’s important to recognize that your options may be limited. It’s worth noting that certain positions may still require medical licensure as a prerequisite, even for non-clinical roles. Therefore, it is advisable to explore alternative career paths and consider the specific requirements of each job opportunity.
Job Opportunities for Foreign Graduates after Successful Completion of USMLE
1. Residency Programs
Completing the USMLE opens up numerous job opportunities for foreign medical graduates, particularly in the form of residency programs. Residency programs provide hands-on training and experience in various medical specialties, allowing graduates to further develop their clinical skills and knowledge. By successfully completing the USMLE, foreign graduates become eligible to apply for residency positions and embark on their journey to become licensed physicians in the United States.
2. Hospital and Clinical Positions
Upon completing residency training, foreign graduates who have successfully passed the USMLE can explore job opportunities in hospitals and clinical settings. These positions range from primary care physicians to specialists in various fields such as internal medicine, pediatrics, surgery, obstetrics and gynecology, psychiatry, and more. Working in hospitals and clinical environments allows foreign graduates to provide direct patient care, contribute to healthcare teams, and make a significant impact on individuals’ health and well-being.
3. Academic and Research Positions
For foreign graduates interested in academia and research, successfully completing the USMLE opens doors to opportunities in academic institutions and research facilities. These positions involve teaching medical students, conducting research studies, and contributing to medical advancements. Academic and research roles enable foreign graduates to delve deeper into medical knowledge, mentor aspiring physicians, and contribute to the scientific community.
4. Private Practice and Specialty Clinics
After completing the USMLE and gaining relevant experience through residency or fellowship programs, foreign graduates have the option to establish their own private practice or join established specialty clinics. Private practice allows physicians to have more control over their patient population, treatment approaches, and work schedule. Joining specialty clinics provides opportunities to focus on specific areas of medicine and collaborate with fellow specialists to provide comprehensive healthcare services.
5. Healthcare Administration and Policy
Some foreign graduates who have successfully completed the USMLE may find themselves drawn to healthcare administration and policy roles. These positions involve managing healthcare systems, implementing policies and regulations, and improving healthcare delivery. With their medical background and understanding of patient care, foreign graduates can contribute valuable perspectives to healthcare administration and policy-making, working towards improving healthcare outcomes at a broader level.
It’s important to note that specific job opportunities may vary based on individual qualifications, experience, and personal interests. Exploring job boards, networking with professionals in the field, and utilizing resources provided by medical organizations can help foreign graduates identify suitable job openings and make informed decisions about their career paths.
Final Words
Completing the United States Medical Licensing Examination (USMLE) is essential for international medical graduates (IMGs) looking to secure job opportunities in the United States. The USMLE serves as a universal benchmark for medical licensure, ensuring that all physicians, regardless of their educational background, meet the required standards for safe and effective patient care.
By successfully passing the USMLE, foreign graduates become eligible for various career paths, including residency programs, hospital and clinical positions, academic and research roles, private practice, specialty clinics, and healthcare administration and policy positions. These opportunities allow IMGs to contribute to patient care, medical advancements, and the improvement of healthcare systems.
While there are limited non-clinical roles available without completing the USMLE, pursuing licensure significantly expands job prospects and opens doors to a broader range of opportunities, even in non-clinical settings. Whether IMGs choose to pursue clinical or non-clinical roles, the USMLE provides a solid foundation and credentials that can positively impact their career path and increase their chances of securing rewarding and impactful roles within the U.S. healthcare system.
USMLE FAQs for International Medical Graduates (IMGs)
1. What is an International Medical Graduate (IMG)?
An International Medical Graduate (IMG) is a physician who has received their medical degree from a medical school located outside of the United States or Canada.
2. Can I retake a USMLE exam if I fail?
Yes, you can retake a USMLE exam if you fail. There are certain restrictions on the number of attempts allowed for each step, and the policies may vary for international medical graduates. It’s essential to review the specific regulations and guidelines provided by the USMLE program.
3. Can IMGs take the USMLE exams?
Yes, IMGs are eligible to take the USMLE exams. The USMLE is open to both US and international medical graduates who wish to practice medicine in the United States.
4. Are there any additional requirements for IMGs to take the USMLE exams?
In addition to meeting the general eligibility requirements, IMGs may be required to submit additional documentation, such as proof of medical education and certification of English language proficiency. It’s important to review the specific requirements outlined by the Educational Commission for Foreign Medical Graduates (ECFMG) and the USMLE program.
5. Are there time limits for completing the USMLE exams?
There is no time limit for completing all three steps of the USMLE. However, keep in mind that some residency programs may have preferences or requirements regarding the maximum time elapsed since graduation or passing a specific step.
6. What is the passing score for the USMLE exams?
The passing score for each USMLE step is determined through a standardized process. The exact passing score may vary for each step and is periodically reviewed and updated. The score is usually reported as a three-digit numerical value, and the minimum passing score is typically published on the USMLE website.
7. Can I take the USMLE exams outside of the United States?
Yes, the USMLE exams are administered at various international test centers. International medical graduates have the option to take the exams in their home countries or other designated locations. It’s important to check the available test centers and schedule your exams accordingly.
8. Can I practice medicine in the United States without completing the USMLE?
The USMLE is a crucial step in obtaining medical licensure in the United States. In most cases, completing the USMLE is a requirement to practice medicine in the US. However, specific exemptions or alternative pathways may exist for certain individuals based on their qualifications and circumstances. It is advisable to research and consult with relevant authorities for more information.
9. Can I transfer my USMLE scores to another country?
USMLE scores are primarily used for medical licensure in the United States. While some countries may accept USMLE scores as part of their licensure or certification process, it ultimately depends on the regulations and requirements of each specific country. If you are considering practicing medicine in another country, it is recommended to research and contact the appropriate authorities for guidance.
10. How does the USMLE application process work for IMGs?
The USMLE application process for IMGs involves several steps. It typically includes verifying your medical education credentials through the ECFMG, registering for each USMLE step separately, and scheduling your exams at designated test centers. The exact process and requirements may vary, so it’s essential to carefully follow the instructions provided by the ECFMG and USMLE program.
11. Do IMGs need to complete any additional assessments apart from the USMLE exams?
IMGs may need to complete additional assessments, such as the Clinical Skills Assessment (CSA) or the Clinical Skills Examination (CSE), depending on their specific circumstances. These assessments evaluate clinical skills and are required for certain visa categories and some state medical boards.
12. How do residency programs view IMGs who have completed the USMLE exams?
Residency programs in the United States consider IMGs who have completed the USMLE exams as eligible candidates. However, competition for residency positions can be intense, and IMGs may face additional challenges due to differences in medical education systems and cultural contexts. Strong performance in the USMLE exams, letters of recommendation, clinical experience, and research involvement can enhance an IMG’s residency application.
13. Are there specific resources available to help IMGs prepare for the USMLE exams?
Yes, there are resources available specifically tailored to help IMGs prepare for the USMLE exams. These include study materials, review courses, question banks, and online forums that provide guidance and support for IMGs navigating the exam process. It’s important to utilize these resources and create a study plan that addresses your individual needs and challenges.
14. Can IMGs apply for a US medical residency program without completing the USMLE exams?
Completing the USMLE exams is generally a requirement for IMGs to apply for a US medical residency program. Most residency programs require USMLE scores as part of their application process to evaluate an IMG’s knowledge and readiness for postgraduate medical training in the United States.
Remember, it is crucial for IMGs to consult the official resources provided by the ECFMG and the USMLE program for the most accurate and up-to-date information regarding the requirements and process specific to IMGs.
