If you’re seeking licensure in the United States (US) or applying for a Post Graduate Medical Residency Training programme, you’ll need to undertake the United States Medical Licensing Examination (USMLE); this guide will provide you with all the information you require in relation to the USMLE for foreign medical graduates.
For general information about the USMLE, including eligibility criteria, registration and fees, visit our USMLE complete guide.
The USMLE aims to assess essential skills needed for safe and effective patient care. It focuses on your ability to apply knowledge, concepts and principles, and evaluates your patient-centered skills.
The exam is formed of three multiple-choice tests – Step 1, Step 2 Clinical Knowledge and Step 3 – which are covered in more detail in the format section below.
The purpose of the USMLE is to provide a common standard of assessment for medical licensure within the US. It is a requirement for both graduates who qualified within the US and internationally. Those who trained outside of the US are assessed against the same standards as US medical school students and graduates; this ensures that all physicians have met the same standards, regardless of their previous training.
As an international medical graduate, you must be certified by the Educational Commision for Foreign Medical Graduates (ECFMG). To become certified you must pass Step 1 and Step 2 of the USMLE, meet the ECFMG’s eligibility criteria and ensure that the teaching institute from which you graduated is listed in the World Directory of Medical Schools.
Following this you can apply for a Post Graduate Medical Residency Training position (residency). This can be done either prior to or following completion of the USMLE Step 3. Gaining residency is competitive, so some applicants choose to complete Step 3 first to enhance their chances of being accepted, while others choose to wait if their Step 1 and Step 2 scores are high. Step 3 would usually then be completed following the first year of your graduate residency programme.
Either way, you cannot complete Step 3 of the USMLE until you are certified by the ECFMG, so you must obtain this first. Following completion of your residency, and successfully passing Step 3, you can apply for a license to practice medicine in the state of your choice.
If you’re applying for a medical license, to enable you to practice clinical medicine in an unsupervised setting (i.e. outside of postgraduate training programs), you also need to gain ECFMG certification – following completion of Step 1 and Step 2 of the USMLE – and successfully complete Step 3 of the USMLE.
As mentioned above, the USMLE consists of three multiple-choice exams: Step 1, Step 2 Clinical Knowledge and Step 3. Previously, Step 2 also included a Clinical Skills section, however, this has now been discontinued.
The USMLE website provides details of the exam format for each section, which are as follows:
Step 3 is divided into two parts – Foundations of Independent Practice (FIP) and Advanced Clinical Medicine (ACM) – taken over two days. It assesses your ability to apply medical knowledge and understanding of biomedical and clinical science, with a focus on patient management in ambulatory settings.
With three different exams to prepare for (although of course not at the same time) and the difficulty of each element, successfully completing the USMLE can be a long and challenging process.
The competitiveness of post graduate residency programmes means that it’s essential that you score highly on the USMLE. When you consider the importance of the exam, and the challenging nature of it, it’s clear why you need to prepare effectively. Our USMLE complete guide provides advice on materials to use to help you prepare.
USMLE practice questions will be invaluable in helping you to prepare for the exam. Incorporating these in your preparation will support you to become familiar with the types of questions you’ll be asked during each step of the exam and provide you with opportunities to practice applying your knowledge and skills.
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Every year the USMLE website provides data on performance in each of the USMLE exams.
The following shows the number of candidates from non-US or Canadian Schools, and the percentage that passed, for each step of the USMLE in the last two examination years:
Although designed as an assessment for medical licensure in the US, the USMLE is accepted by a limited number of countries outside of the US. If you’re considering applying to work in a different country to the US, it’s advisable to check what exams and qualifications are needed, as the USMLE may not be the most appropriate route even if it is accepted. However, if you complete the USMLE and find you are unable to gain a post graduate residency or no longer wish to work within the US, there may be alternatives available for you using the USMLE.
Without completing the USMLE (Step 1 and Step 2), you cannot apply for residency within the US as a foreign medical graduate. Likewise, without completing all elements of the USMLE (including Step 3), you’ll be unable to apply for medical licensure within the US. Licensure is required for all practicing physicians in an unsupervised setting (i.e. outside of postgraduate training) and is therefore essential if you wish to work in this capacity.
You can, however, work within non-clinical roles if you choose not to complete the USMLE. However, your options will undoubtedly be limited and you may find that some roles still request medical licensure as a requirement. Therefore, even if your goal is a non-clinical role, successful completion of the USMLE can help you to secure a job, and ensure that you have more opportunities available to you.
As mentioned above, without successful completion of the USMLE you would be limited to non-clinical based roles. There are a range of options available for non-clinical roles, however, they are often competitive, require experience and / or further training or certification.
Some potential areas which you may want to research further are: research roles, pharmaceutical roles for unlicensed physicians and roles within a business capacity. This will allow you to compare potential roles without the USMLE to those available if you complete the exam and are able to apply for residency and / or licensure.
If you choose not to complete the USMLE, the salary you’re able to achieve will depend on the type of role you manage to secure, and the level at which you’ll be working. If you’re considering this route, it will be worthwhile researching the particular area you wish to work in, to gain an understanding of the salary you can expect to achieve.
As a way of comparison, post graduate training (residency) at a US hospital is a paid post, with first year residents typically earning approximately $45,000 USD.
For more information about the USMLE, including eligibility criteria, registration, fees, exam format and materials to prepare, check out our USMLE complete guide.
