In order to practice clinical medicine in an unsupervised setting (i.e. outside postgraduate training programs), all physicians (international graduates and domestic graduates in USA) must be licensed by the medical licensing board of the state where they plan to practice.

Passing all four tests of the United States Medical Licensing Exam® (USMLE) sequence is required for any doctor to obtain a license to practice medicine in the United States.
  • Students and physicians trained outside the US take the same test, and are scored by the same standard as US medical school students.
  • USMLE is designed to test problem solving, not simple memorization.

Licensing Exams

The United States Medical Licensing Examination (USMLE) consists of three steps designed to assess a physician’s ability to apply a broad spectrum of knowledge, concepts, and principles to evaluate the physician’s basic patient-centered skills.


Step 1 (multiple-choice exam)

This exam is designed to test how well the examinee applies basic, integral science concepts to clinical scenarios.

Step 2 (two separate exams)

The Step 2 Clinical Knowledge (CK) is a multiple-choice exam designed to determine whether the examinee possesses the medical knowledge and understanding of clinical science considered essential for the provision of patient care under supervision. The Step 2 Clinical Skills (CS) is a separate “hands-on” exam that tests the examinee’s clinical and communication skills through his/her ability to gather information from standardized patients, perform a physical examination, communicate the findings to the patient, and write a patient note.

Step 3 (multiple-choice exam)

This exam assess the examinee’s ability to apply medical knowledge and the understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings.

Pathway to Licensure

International Medical Graduates (IMG) must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). To become certified by ECFMG, an IMG must pass USMLE Step 1, Step 2 CK and Step 2 CS. Doctors can take these exams in any order, but we strongly recommend the order listed. Once a doctor receives ECFMG certification, he/she may apply for a hospital residency.

Step 3 is always taken LAST in the series of medical licensing exams because International Medical Graduates must be ECFMG Certified to be eligible to take Step 3. Some states allow doctors to take Step 3 prior to obtaining a residency. Many doctors perceive that having passed Step 3 enhances their chance of obtaining a residency. This may be true in some cases, but high scores on the Steps 1 and 2 and a strong application are the most important factors in attaining residency. Step 3 must be passed if a student wishes to qualify for an “H” visa.

International Medical Graduates seeking licensure in the United States will have to go through the following sequence to obtain a Post Graduate Medical Residency Training position.


ECFMG Certification

  1. Medical Degree
  2. Medical Transcripts
  3. Step 1 Passing Score
  4. Step 2 CK Passing Score
  5. Step 2 CS Passing Grade

Residency-Match Application

(Electronic Residency Application Service – ERAS / National Residency Matching Program – NRMP)

  1. (Electronic Residency Application Service – ERAS / National Residency Matching Program – NRMP)
    • CV
    • Reference Letters
    • Photograph
    • Personal Statement
  2. Interviews with Program Directors and/or selection committee for new residents
  3. Ranking of programs (both the student and the residency programs will rank each other after the interview process and the computer will put the two rankings together through a query.)
Learn more about Residency

Residency at a US Hospital

3-8 years depending on the speciality that the International Medical Graduate is seeking. This is paid post graduate training where all participating residents receive a salary for their training at the US hospital. Typical 1st year resident salaries are approximately $45,000 USD.

Medical Education