USMLE Exam & ECFMG Certification for International Medical Graduate

We discuss the requirements for International Medical Graduates (IMGs) to be able to sit for the United States Medical Licensing Examination USMLE exam. We’ll also discuss requirements for Educational Commission for Foreign Medical Graduates (ECFMG) certification and we’ll talk about citizenship and visa requirements for IMGs who wished to complete a US Residency program.

Eligibility to take the USMLE

If you’re an IMG and you wish to take USMLE exam you have to meet these requirements. First, you need to be a current medical student who wishes to take STEP 1, STEP 2 CK or STEP 2 CS and you need to meet these requirements.

  • The student needs to be officially enrolled in a medical school located outside of the United States or Canada but that medical school needs to be listed in what’s known as the World Directory of Medical Schools, also shortly called World Directory.
  • You need to have an authorized official from your school, that actually certified your enrollment status as having being in that school.
  • You must have completed at least 2 years of Medical School to be able to take these exams.
  • There are IMGs who’ve actually graduated, who wished to take USMLE STEP 1, STEP 2 CK or STEP 2 CS, you can still take them but your requirements are a little different. You must have a diploma from your medical school. As well as an authorized individual from your school must be able to certify that you have graduated from your school.
  • If you meet these requirements, then you can apply through the ECFMG to obtain a USMLE ID to be able to sign up for the USMLE exam.

Now, you can take USMLE STEP 1 and STEP 2 CK almost anywhere in the world, from the United States to Europe to Asia to Africa. All you have to do is find the nearest country to take the USMLE exam. Unfortunately, there is an extra fee to take these USMLE exam outside of the United States. USMLE’s exams: STEP 1 and STEP 2 CK are performed at Prometric Testing Centers and these are global now. To take USMLE STEP 2 CS, you have to fly to the United States.

ECFMG Certification

IMGs who wished to apply the US residency programs must obtain what’s known as ECFMG certification. ECFMG stands for Education Commission for Foreign Medical Graduates. Now, you must obtain the certification prior to entering and starting a US residency program. 

You must pass STEP 1, USMLE STEP 2 CS and CK as a pre-requisite to be granted ECFMG certification. You must register with the ECFMG in order to be able to sign up and take the USMLE exams. ECFMG registration is your first step in obtaining ECFMG certification. So first you register so, in the end, you can be certified and hopefully start a residency program.

  • In order to register for the ECFMG, you gotta do the following: you gotta create an ECFMG online services account, it’s just like making a basic account, nothing fancy there.
  • Then you need to obtain a USMLE/ECFMG identification number and you do this through this thing they have called the interactive web application, again just an online application, nothing fancy.
  • After you do that, the ECFMG will send you an email with your USMLE ID and also your ECFMG ID and they’ll also give you a password, this takes about like up to 10 days to get so don’t be in too much of a rush. Keep these IDs safe, you will need them.
  • What you will need to do then is obtain a scheduling permit for each USMLE exam you wish to take. So if you wanna take USMLE STEP 1, you gotta get a scheduling permit just for that exam. STEP 2 CK, STEP 2 CS, they all have their own individual scheduling permits that you need to obtain. Also on exam day, I’ll just throw it in here so you don’t forget, you need to bring that scheduling permit with you to be able to sit for the exam. So the scheduling permit and an ID is required to be able to take any USMLE exam. The ECFMG will issue your scheduling permit via email, just comes right through them.
  • If you apply to more than one USMLE exam at the same time, they’ll actually give you separate scheduling permits for each individual exam. Once again emphasizing, each scheduling permit is for each separate exam and once you have the permit, you can go on to the website and schedule the day in which you want to take it.

After you complete and receive your scores for USMLE STEP 1, STEP 2 and STEP 2 CS and CK and you have a Medical School Diploma, you will then receive what’s called an ECFMG certificate in roughly a month. So, if you were a graduate of a school for a Medical School and you have already graduated, your certificate is only waiting on your scores but that’s the key, you have to actually finish those three exams before you get the certification.

Note, you cannot get obtain an ECFMG certificate until you have graduated from your International Medical School. So if you’re obtaining your actual application certification while actually as a student, until the day you graduate, your certificate won’t come through. But don’t worry, this is not gonna hold you up at all.

You can apply to the residency match without an ECFMG certificate, it’s designed to make it just as fair for everyone. But your residency program will need your certificate and for you to receive your final acceptance and actually start your US residency program.  

You should preferably complete all of your step exams in August prior to the year you wanna start residency. Then you will hopefully have your ECFMG certificate in September and then when you apply to the match in September, you will be fully prepared for your acceptance.

Postgraduate Training Authorization Letter (PTAL)

  • As a special side note, for students who will be trying to match into residency programs within the state of California, you have to obtain something called a PTAL or California letter. The PTAL is the Postgraduate Training Authorization Letter. This PTAL is just for California and it’s the same information as ECFMG, it’s just another application they make you fill out.
  • If you think, you’re going to be matching into a California residency make sure you submit for the PTAL as soon as you can, because it takes up to 6 months to receive it. You can apply for the PTAL at the same time as you apply for ECFMG. If you think you’re gonna be going into a California Residency.
  • Do note, ECFMG certifications require to start residency programs and in California, you need both the ECFMG certification and the PTAL to start. So if you’re going for California or shooting for one of those residency programs, apply to ECFMG and PTAL simultaneously.

VISA Requirements

  • If you’re not a US citizen or a permanent resident, you must obtain a visa in order to participate in a United States residency program.
  • The 2 most common visas are the H1-B called the Temporary Worker or The J-1 visa, called the exchange visitor. Some US residency program, once you sponsor a visa for residence in the residency program and some programs just don’t.
  • You do need to look and inquire for each individual residency program that you’re applying to if getting a visa applicable to you and see if this sponsor visa or not.

Final Thoughts

  • In order for IMGs to take the USMLE exams, they must at least have completed the first 2 years in an International Medical School outside of the United States and Canada that’s recognized by the World Directory of Medical Schools.
  • In order to join a US Residency program, students must obtain an ECFMG certificate, you will start this process early in order to obtain your USMLE ID so you can actually take the USMLE exams and you will have to be a graduate from your medical school to have the certification of ECFMG granted to you and then you can start your residency program.
  • Students must be US citizen or permanent residence to participate in the US residency program or if you’re not one of those, you can obtain an H1-B or a J-1 visa to participate in a residency program. Check very carefully when applying for the residency programs if they host these visas or not. Best of luck in the application. Thank you.

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