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USMLE; Essential details

Author: rxpg, Posted on Tuesday, February 04 @ 00:00:00 IST by rxpg  

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USMLE Step 1

Basic Information

Overseas doctors referred as International Medical graduates ( IMG) should get the ECFMG certificate before they can enter in to the residency programs. This involves

  • Passing USMLE step1 & 2
  • Passing the clinical skills assessment (CSA)
  • Passing a TOEFL English examination

Once you have fulfilled the above, the ECFMG will issue you with a certificate saying that you have fulfilled the requirements for entry into training in the USA.

The United States Medical Licensing Examinations (USMLE)

The USMLE are a set of medical exams designed to evaluate your ability to practice safely in the American medical system.

The organisation that monitors the application of foreign nationals to the American Medical system is the Educational Commission for Foreign Medical Graduates (ECFMG ).

USMLE are multiple choice exams that are held now only on computer.

There are three parts, or steps, to completing the USMLE exams.

The computers that you can take them are available in a large number of cities across the world on every working day of the year - you register with the ECFMG who administer the test internationally, and reserve a
place at your local center for a time when you feel ready to take the examination.

To Find Your nearest examination center click here.

The three steps are:

USMLE Step 1

This is a multiple choice exam consisting of four blocks of about 300 questions. You're given about three hours for each block of questions, and take two blocks on each day. 

The step 1 covers all of the basic sciences - Anatomy, Biochemistry, Physiology, statistics, Behavioral science, microbiology, pharmacology, pathology, ethics - and it is typically taken in the first half of the medical school curriculum at a time when these subjects have been covered.

USMLE Step 2 

This consists of a similar two-day, four x 3-hour question sessions, and covers all of the clinical sciences including medicine, surgery, paediatrics, obstetrics and gynaecology, psychiatry, forensics, emergency care, ENT, ophthalmology, tropical health, ethics. It is usually taken in the final year of medical school.

Clinical Skills Assessment (CSA)

CSA is an essential part of the requirements needed to obtain ECFMG certification.

CSA is administered throughout the year at the ECFMG Clinical Skills Assessment Center in Philadelphia, Pennsylvania, USA.

It is a one-day examination that requires demonstration of both clinical proficiency and spoken English language proficiency.

Applicants must pass the medical science examination in the basic medical and clinical sciences and the English language proficiency test as prerequisites to taking CSA.

There is no limit on the amount of time which may elapse between these prerequisite examinations and CSA.

Passing performance on CSA is valid for three years from the date passed for the purpose of entry into graduate medical education.

Click here for further information.

USMLE Step 3.

This examination is taken by American students during their residency program within a year or so of graduation. 

International students only need to take the USMLE part 3 if they plan to immigrate on a H-1B visa (recommended over a J-1). 

This exam is only given in the United States, requiring you to travel there to take it. Also, only a few states - most notable Connecticut and New York allow you to take the part 3 in their jurisdiction without being in an American residency program.

It is largely similar in scope to the USMLE step 2 with more emphasis on practical management.

The ECFMG Certificate

The ECFMG (Educational Commission for Foreign Medical Graduates) certificate is a document proving that you have fulfilled the education requirements needed to practice medicine in the USA.

The essential components are:

  • Your medical degree verification by ECFMG
  • Passing USMLE Steps 1 & 2
  • Passing the clinical skills assessment (CSA)
  • Passing a TOEFL English examination
  • Payment of ECFMG fees

Once you have fulfilled the above, the ECFMG will issue you with a certificate saying that you have fulfilled the requirements for entry into training in the USA.

Click here for more information about TOEFL.


The electronic residency application system (ERAS) is a method of centralised, computerised application for residency programs.

After writing to and paying ERAS, you will get sent a disk containing a computer program that allows you to:

  • enter your personal details in a standarised curriculum vitae
  • enter a personal statement
  • register a photograph*
  • dispatch your examination transcript*
  • enter your references*
  • designate the residency programs you wish to have your application sent to

Foreign medical graduates send their disk and the paper items marked * above to the ECFMG who act as your "dean's office".

They scan your paper documents and photo, match it to your disk items and e-mail the lot to the residency programs you selected.

You can follow this process on the Automated Document Tracking System (ADTS) which allows you to see when your application documents are downloaded by the residency programs.

ERAS, the Automated Document Tracking System (ADTS) and the National Residency Matching Program (NRMP) are all run by the AAMC (American Association of Medical Colleges).

You should complete all of the ERAS application procedures as soon as possible, but by November 1st of each year at the latest for the next years program.

The Match

The Match is a centralised computer program that matches a physician's highest ranked residency program with a hospital that ranks them highly.

It is organised by the National Residency Matching Program(NRMP).

Not all of the available spots are listed in the Match, and some of the more competitive specialities participate only in the "Early Match".

Check the National Residency Matching Program(NRMP) site for more information.

As an international applicant, you must register as an 'independent applicant' usually before November third week at the latest .

  • You apply to the programmes in the hospitals that interest you.
  • Those programmes that are interested in you will invite you for an interview
  • After the interview, the hospital ranks you among all those they have interviewed
  • After all your interviews, you rank the programmes that you want and
  • on a certain date in March, all of these preferences are chewed on by a computer and the hospitals are matched with the applicants.

Those that do not 'Match' are notified two days before the official results and can participate in the 'Scramble' where unmatched physicians telephone unmatched residency programs in an attempt to find jobs.

Your chances of matching may be improved by 

  • Having good grades, USMLE scores and references
  • Being organised
  • talking to residents and friends in that hospital and speciality
  • performing well at interview
  • having done an elective at the hospital you're applying to
  • knowing about your visa plans

State Medical Licences

  • After you have successfully matched you need to secure your medical license and your visa.
  • The medical license is specific to the state of your employing hospital.
  • Information on contacting the state medical boards is included in the USMLE/ECFMG Bulletin of Information.
  • Information can also be found at Federation of State Medical Boards Web Page

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Related Links
· Official Site
· Kaplan India
· Step 1 Books at Amazon.com
· USMLE Step 1 forum
· USMLE 2 CK forum
· USMLE 2 CS forum
· USMLE Step 3 forum
· US Visa forum
· USMLE Match forum
· USA IMG forum
· TOEFL forum


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