International Medical Graduates (IMGs) seeking to practice medicine in the United States must obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG) and pass the United States Medical Licensing Examination (USMLE) sequence. This pathway governs eligibility for entry into the National Resident Matching Program (NRMP) for accredited residency training, which is mandatory for state medical board licensing.
Success Rate
18–36 Months
$5,000 – $8,500 USD
Total Duration
Estimated Cost
Success Rate
Difficulty Level
Follow these steps to achieve your global medical career
Establish an online account via the ECFMG Interactive Web Applications (IWA) system to secure a unique USMLE Identification Number and submit Form 186 for notary verification.
Sit for the 8-hour computer-based testing (CBT) assessing foundational biomedical sciences. Scored strictly on a Pass/Fail metric to evaluate foundational principles.
Pass the 9-hour multiple-choice clinical science evaluation focusing on patient management, diagnostic reasoning, and health promotion principles.
Satisfy the clinical skills and communication verification by applying to one of the six ECFMG pathways, utilizing home country licensure, OSCEs, or university credentials.
Upon verification of all medical transcripts, Step 1 and Step 2 CK results, and Pathway approval, receive the official ECFMG certificate validating international qualification equivalence.
Register with the National Resident Matching Program and apply to ACGME-accredited residency programs via the Electronic Residency Application Service (ERAS).
Complete the final 2-day computer-based assessment focusing on independent patient management, ambulatory care, and clinical decision-making protocols.
Essential prerequisites for this pathway
Downloadable guides and references
Explore other career pathways