Miscellaneous Blog
Requirements for Medical Residency in the US for IMGs
I hope you enjoy reading this blog post.
If you want my team to help you with your Residency Application, click here.
Requirements for Medical Residency in the US for IMGs
In this post, we will summarize all the requirements to start medical residency in the USA for international medical graduates from the STEP 1 to Matching into residency.
We will provide you with a step-by-step explanation of the stepping stones and hurdles that you face while applying for a US residency program.
Before we start, have a look at the number of active applicants in the 2020 application cycle.
Source: NRMP®
USMLE STEP 1
The STEP 1 exam tests the applicant’s knowledge of the basic sciences.
STEP 1 is a one-day examination with a total duration of 8 hours. The exam is a multiple-choice based exam, with questions being divided into 7 blocks. Each block has up to 40 questions, and the total number of questions do not exceed 280.
A more detailed description is available at the following link:
United States Medical Licensing Examination | About
United States Medical Licensing Examination | Step 1
What is the scope of the exam?
A broad generalization of subjects from where questions are asked in this exam are as follows:
- Behavioral Sciences
- Biochemistry & Nutrition
- Genetics
- Gross Anatomy & Embryology
- Histology & Cell Biology
- Immunology
- Microbiology
- Pathology
- Pharmacology
- Physiology
What do I need to study for STEP 1?
Check our detailed blog post about the study resources for STEP 1.
What do I need to do to apply?
You would need to apply for USMLE/ECFMG identification number that can be used for all USMLE-related exams. Check our detailed blog post on how to apply for your first STEP exam.
After applying for certification, you need to verify your student or graduate status by your medical school, and upload any additional required documents. Afterwards, you get scheduling permits (a paper that has numbers that allow you to both schedule your exam and start your exam on your exam day). For more details, check our post about registering and scheduling your first STEP exam.
How much does STEP 1 cost?
The fee for STEP 1 is $975, along with an International Test delivery surcharge of $180 if you’re taking the exam outside of the US/Canada. Rescheduling, extension of eligibility period, changing of test centers all will incur extra charges.
How much should I score on STEP 1?
In STEP 1, a score of 250 and above is considered a good score for IMGs. Residency programs are less likely to score filter applicants with over 250. You must also know the average score for the specialty you are applying for, as they differ for different specialties. Competitive specialties have higher mean score for those who match, while have lower mean scores.
This graph shows the USMLE Step 1 Scores of International Medical Graduates who matched and did not match by specialty. As you noticed, there is a big difference between the different specialties.
Source: NRMP
STEP 1 will become pass/fail on January 26, 2022. Therefore, the value of STEP 1 score will transition to other aspects of your application.
USMLE STEP 2 CK
What is the STEP 2 CK?
Step 2 CK tests the application of medical knowledge, skills, and understanding of clinical science.
Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks and administered in one 9-hour testing session. The number of questions per block on a given examination may differ but does not exceed 40. The total number of items on the overall examination are around 318.
Check more details about the STEP 2 CK.
What is the scope of the exam?
The STEP 2 CK exam asks questions related to body systems just like STEP 1, with more focus on investigations and management spanning internal medicine, pediatrics, obstetrics gynecology, surgery, psychiatry, behavioral sciences, and statistics.
How to apply for STEP 2 CK?
If you’re applying to STEP 2 CK as your first exam, check our detailed blog post on how to apply for your first STEP exam.
If you already applied for STEP 1, the application is similar to the STEP 1 application.
How much does STEP 2 CK cost?
The fee for STEP 2 CK is $975, along with an International Test delivery surcharge of $200 if you’re taking the exam outside of the US/Canada.
Rescheduling, extension of eligibility period, changing of test centers all will incur extra charges.
What do I need to study for STEP 2CK?
Check our detailed blog post about the study resources for STEP 2CK.
What are the average scores of different specialties for STEP 2 CK?
This graph shows the USMLE Step 2CK Scores of International Medical Graduates who matched and did not match by specialty. Similar to STEP 1, there is a big difference between the different specialties.
Are there any limits on the number of STEP attempts that could be taken?
From July 1, 2021, examinees will be limited to four attempts per Step exam instead of the six allowed currently.
OET Exam
Occupational English Test (OET) is a medical English language test that was added after the cancellation of the STEP 2 CS exam.
The OET Medicine exam has 4 components:
- Listening (45 mins, 42 marks)
- Reading (60 mins, 42 marks)
- Writing (45 mins) (has 6 criteria; “Purpose” has a maximum score of 3, the rest have a maximum score of 7)
- Speaking (20 mins) (maximum of 6 marks on each of the four linguistic criteria, and a maximum of 3 marks on each of the 5 Clinical Communication Criteria)
Each component requires a score of 350 (grade B) to pass. A score of 350 equates to at least 30 marks in each component.
Get 1 on 1 Residency Advising
Clear up any doubts you have about the residency application process and maximize your chances of Matching at your Dream Specialty!
Graduating from Eligible Medical School
For an international medical student to be eligible to apply to ECFMG Certification, their medical school should meet certain ECFMG requirements. The eligible schools are listed in the World Directory of Medical Schools .
“The ECFMG® has announced that, effective in 2024 (previously 2023), physicians applying for ECFMG Certification will be required to graduate from a medical school that has been appropriately accredited. To satisfy this requirement, the physician’s medical school must be accredited by an accrediting agency recognized by WFME.”
Research
To increase the chances of matching, many applicants perform between 6 months to 2-3 years of research, especially for competitive specialties.
Research opportunities are usually unpaid positions if you don’t have much research experience. Hence, it is important to have an adequate source of personal finances for living in the US.
Check this video on how to apply for research positions
And this video on the value of research when applying to residency
Research Course
The research course will teach you how to take a research project from idea to publication and in which I will share my 3-year experience of clinical research in which I had over 100 publications and 80 presentations.
USCE (US Clinical Experience)
USCEs are a necessary part of the US residency application. USCE can help you get Letters of Recommendation (LoRs), which will help you when you apply to residency.
Here are the types of USCE
Electives/Clerkships/ Sub-internships
The best USCE for an application is an Elective/Clerkship. Available only to those who have not yet graduated from medical school. More often than not, it provides a more personalized LoR. The cost of electives can vary between $100 – $5000 per 4-week elective.
Externships
Provides some type of hands-on experience for medical graduates. Usually not done in big university hospitals.
USMLE Tutoring
Get personalized study plan and schedule, study resources, and subject-specific tutoring to ace your USMLE exam!
Externships
Provides some type of hands-on experience for medical graduates. Usually not done in big university hospitals.
Observerships
Observerships are a good choice for medical graduates in which you observe medical care. Observerships do not allow you to interact with patients, however, they give you an opportunity to become acquainted with the US healthcare system and develop networking opportunities.
Telerotations
Telerotations became popular with the COVID-19 pandemic. Although telerotations are not as helpful as in-person USCE, they are better than nothing when you are trying to build your CV. Telerotations cost vary from free to $2000 a month.
To learn how to find USCE, check out this video:
ECFMG certification
Although you can apply to the MATCH® without ECFMG certification, it is highly recommended that IMGs apply with ECFMG certification. In order to match, IMGs must be ECFMG certified. Recently, there has been a change in the certification requirement after the cancelation of the STEP 2 CS exam. To check the six pathways for ECFMG certification, check this video
I hope this information helps you in your preparation for the long, but rewarding US residency journey.
By Susmita Sengupta and Malke Asaad
Latest Articles
2026 Residency Personal Statement The Ultimate Guide to Crafting Your Residency Personal Statement
Malke Asaad
July 8, 2024
Best Resources for USMLE STEP 1! How to Study and Prepare for STEP1?
Malke Asaad
August 12, 2022
ERAS Application 2026 Guide! How to Fill Out ERAS Residency Application?
Malke Asaad
July 13, 2023
Need Help?
Get 1 on 1 Residency Advising
Clear up any doubts you have about the residency application process and maximize your chances of Matching at your Dream Specialty!
CV Editing
Our editing goes beyond language and grammar corrections to structural editing and content advising based on your personal story and achievement.
Interview Preparation
The best way to learn something is to do it. That’s why we divide our one-hour interview preparation sessions into two parts. The first half of the session would be a mock interview as if you are interviewing with a program while the second half would provide you with feedback on your performance.
Research Course
The research course will teach you how to take a research project from idea to publication and in which I will share my 3-year experience of clinical research in which I had over 100 publications and 80 presentations.
USMLE Tutoring
Get personalized study plan and schedule, study resources, and subject-specific tutoring to ace your USMLE exam!
Do you want our experienced team to edit your Personal Statement?
Personal Statement Editing
Our editing includes not only language but also context, structure, and content advising.
ERAS & Supplemental CV
The editing goes beyond language and grammar corrections to structure, design, and content advising based on your personal story and achievement.
Interview Preparation
The best way to learn something is to do it. That’s why we divide our interview preparation sessions into two parts:
Mock Interview + Feedback
Residency
Advising
We are able to provide you with the guidance you need at any step of your journey to make it to your final goal!
