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.
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
place at your local center for a time when you feel ready to take the
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
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 is an essential part of the requirements needed to obtain ECFMG
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
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
(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
- 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.
for more information about TOEFL.
The electronic residency application system (ERAS)
is a method of centralised, computerised application for residency
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
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
The Match is a centralised computer program that matches a
physician's highest ranked residency program with a hospital that ranks
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
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
- After the interview, the hospital ranks you among all those they
- After all your interviews, you rank the programmes that you want
- 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
- 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