USMLE: From Start to End !

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Hello USMLE aspirants! This blog is your one-stop destination for all things USMLE. Learn about the steps required from start to Finish to pursue residency in the US.

What is USMLE?

USMLE stands for United States Medical Licensing Exam. It is a three-step exam that allows you to obtain practicing licensure in the US. While Step 1 and Step 2 CK are required to start residency, Step 3 USMLE can be completed during residency. In addition, USMLE Step 1 and Step 2 CK can be taken from both in and outside the United States, unlike Step 3, which is administered only in the US. Step 3 USMLE also requires you to be ECFMG certified before applying for the exam.

How to register for the USMLE exam?

As an International medical graduate (IMG), you must register for the USMLE through the ECFMG (Educational Commission for Foreign Medical Graduates). It begins with the application for ECFMG certification- Form 186, also known as the Certification of Identification form, which should be filled and notarized via NotaryCam. This includes a payment of 160 USD. Make sure to dress formally as a photograph is taken during the notarization process.

For more details, you can check out our blog on how to register for STEP 1.

How to apply for the USMLE exam?

Following the notary confirmation, you will receive a unique ECFMG number/ USMLE ID used throughout the USMLE process. Then, you can log in to the IWA (Interactive Web Applications) portal to begin a new application for your exam. You must choose an eligibility period (3-month window) and complete your exam within this timeframe. Next, the ECFMG will request documents from your medical school (for students) to issue a scheduling permit. This is completed using an online portal if your school is registered with the Medical School Web Portal (MSWP) or by mail. After receiving a scheduling permit with a unique code, you can choose the testing center and test date on the Prometric website.

USMLE Step 1

USMLE Step 1 is the first installation of the three-step exam. It tests the foundational sciences (such as biochemistry, physiology, pathology) over seven blocks lasting 60 minutes each, each block containing a maximum of 40 single-item multiple-choice questions. You are entitled to a flexible break time of 45 minutes, which can be scheduled between the blocks. The break time can be increased by skipping the introductory 15-minute tutorial or finishing the blocks early.

The result, which will arrive around three weeks after test day, will only display a Pass or Fail report, a change made since 2023 to reduce the pressure on test takers. Primary resources for the exam include UWorld question bank, First Aid for Step 1, Boards and Beyond, and Amboss question bank.

For more detailed information about STEP 1 resources, check out our blog here.


This exam tests the application of medical knowledge (including internal medicine, pediatrics, OB/GYN, surgery), emphasizing health promotion and disease prevention. With up to 318 questions divided over eight 60-minute blocks, each block contains a maximum of 40 questions. The number of questions can be reduced to 38 or 39 if drug ads or research abstracts are included in the block. Since the Step 1 USMLE has turned Pass/Fail, the importance of the Step 2 CK score has risen. Primary resources for the test include UWorld and Amboss question banks.

For more detailed information about STEP 2CK resources, check out our blog here.

Also don’t forget to check out our USMLE exam series on my YouTube channel here.

USMLE Step 3

Step 3 is a two-day exam that assesses your application of concepts for independent practice in the US. This exam can only be taken by medical graduates, and ECFMG certification is a requirement for International Medical Graduates (IMGs) to apply for it.

Day 1, or Foundations of Independent Practice, lasts 7 hours with up to 233 multiple choice questions divided over six one-hour blocks, 38 – 40 questions per block. This day emphasizes medical ethics and biostatistics, apart from basic medical and scientific principles.

Day 2 is Advanced Clinical Medicine which tests the application of comprehensive medical knowledge in patient management. It contains six 45-minute blocks with a maximum of 30 questions per block. This is followed by 13 computer-based case simulations, or CCS, which test patient management skills in real-time.

Step 3 USMLE is not a requirement to apply for the Match and can be completed during residency. However, IMGs must have their Step 3 scores ready around Match Day (mid of March) if seeking an H1B visa. Primary resources include UWorld, our CCS Course, and ccscases.com.

For more detailed information about STEP 3 resources, check out our blog here.

Master the CCS part of the USMLE exam along with the complicated biostatistics abstracts with our CCS and biostatistics bundle

What is USCE?

USCE stands for United States clinical experience and includes electives, observerships, and externships. While electives are meant solely for medical students, observerships and externships are open for graduates. USCE is an integral part of the USMLE process, and many residency programs use it as a mandatory criterion to consider for the screening process. It also helps to build connections in the branch of your choice which might prove beneficial during the Match process.

Are you an IMG trying to find USCE with no luck? Check the list of our experienced doctors offering USCE to IMGs!

Do you wanna read more details on USCEs for IMGs? Check out our blog here

What is ECFMG Certification?

ECFMG Certification is the standard for evaluating the qualifications of IMGs who wish to enter the United States healthcare system.

What are the requirements for ECFMG certification?

  1. An application for ECFMG certification (Form 186)
  2. The medical school listed by the World Directory of Medical Schools (World Directory) from 2024
  3. USMLE Step 1 and Step 2 CK scores via the USMLE Transcript
  4. One of the six ECFMG Pathways OR Step 2 CS passing performance
  5. Occupational English test (OET)
  6. Medical school documents

What are the medical school documents required for ECFMG certification?

  1. Medical school diploma/degree
  2. Medical school transcript
  3. Medical school performance evaluation (MSPE)/ Dean’s letter

What are the 6 pathways for ECFMG certification?

  • Pathway 1: Already Licensed to Practice Medicine in Another Country
  • Pathway 2: Already Passed an Objective Structured Clinical Examination (OSCE) for Medical Licensure Administered by an Acceptable Medical School
  • Pathway 3: Medical School Accredited by Agency Recognized by World Federation for Medical Education (WFME)
  • Pathway 4: Medical School Accredited by Agency that Has Received a Determination of Comparability by National Committee on Foreign Medical Education and Accreditation (NCFMEA)
  • Pathway 5: Medical School Issues Degree Jointly with a U.S. Medical School Accredited by Liaison Committee on Medical Education (LCME)
  • Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians

    Source: ECFMG website

How to get ECFMG certified?

After the timely production of the documents and application for the appropriate pathway (925 USD), the ECFMG will process your application for the pathway. However, you will not be ECFMG certified unless you pass both STEP 1 and STEP 2CK. In other words, you can start the process for the pathway without STEP 2CK or STEP 1 but you need to pass the exam before you become ECFMG certified.

Also, remember that the ECFMG certification is temporary until you Match into a residency in the US and finish a year of residency if you are applying through one of the pathways. This is not the issue if you have a passing score report on the USMLE Step 2 CS, in which case, the ECFMG certificate is permanent.

It is advisable to be ECFMG certified for IMGs by the time ERAS applications go online (end of September). This is because many programs have ECFMG certification as a criterion to be considered for an interview.

How to register for the Match?

The process starts with creating an account with the AAMC (Association of American Medical Colleges) and completing an Electronic Residency Application Service (ERAS) application. 

What is the role of the NRMP in the Match?

The NRMP (National Resident Matching Program) is software used towards the end of the Match season to create a Rank Order List (ROL). To participate in the Main Residency Match and Supplemental Offer and Acceptance Program (SOAP), you need to create an account with the NRMP by January 31 of the Match cycle by paying a standard fee of 70 USD. In addition, a 50 USD late fee applies for those who register beyond this date till March 1, which is also the last day to register for the Match. Note that some residency programs do not participate in the NRMP Match but offer Pre-Match positions after interviewing candidates.

What is an ERAS CV?

An ERAS CV is a significant part of the ERAS application and a golden opportunity to portray your skills and accomplishments to residency programs.
You must fill in personal information, medical school details, awards, and certifications.

The experiences section is crucial to your CV and entails volunteer, work, and research experiences. New changes in the 2024 ERAS CV limits the number of each of the work experiences to ten but help describe them more effectively.

In addition, the ERAS CV also contains a section on research publications, in-press articles, submitted articles, and poster and oral presentations.

Finally, it ends with a section on hobbies, languages spoken, and awards.

Once you certify and submit your ERAS CV, you cannot change it except for personal information. Once certified and submitted, the ERAS CV is usually available to residency programs by the end of September of the Match cycle. However, you can certify and submit even after this date.

Submit your ERAS CV before residency programs start reviewing applicants’ ERAS CVs (generally happens at the end of September) to ensure your CV doesn’t go unnoticed. 
If your application arrives after program directors have finished reviewing submissions, they won’t have the opportunity to evaluate your CV and extend an interview invitation.

Check our blog on how to fill the ERAS application here.

Don't risk your residency match chances with an average CV. Allow our experts to enhance your accomplishments using our comprehensive ERAS CV editing services.

Personal Statement

Your personal statement can make or break your application. Therefore, you must draft a personal statement that will describe you perfectly. Make sure to express your love towards the specialty you are applying to and how you would stand out to the residency program. The personal statement should answer the burning question, Why you?

Check out our two blogs on how to write a personal statement and personal statement examples.

Transform your residency application with our top-notch personal statement editing services. Let our experts help you craft a compelling, standout statement that captures program directors' attention.

What is a Supplemental ERAS application?

It is a short application containing questions to incorporate personal preferences into the ERAS application. The deadline for submission for Supplemental ERAS is around two weeks before the ERAS Application. Sections include five meaningful experiences, three geographical preferences, and urban or rural preferences. Program Signalling is arguably the most important part of the Supplemental ERAS application, with the number of signals varying with the specialty you apply to. The signals are a way to convey your interest in the program and to be recognized in a sea of applicants.

Check our blog on the supplemental ERAS application here.

Need our experts to edit your supplemental ERAS? Don’t waste time and sign up now!

Letters of Recommendation (LOR)

LOR is a document obtained from your attending/ superior/ mentor after working with them during an elective/ clinical rotation/ research rotation. It is meant to describe your qualities and skills professionally and is a crucial part of your application. You can upload many LORs into your ERAS application but can assign a maximum of three or four to residency programs. In addition, waiving your right to see the LOR increases its credibility. We recommend you use LORs from the US from people who know you well and can speak up regarding your strengths and why should programs choose you.

Check out our video about letters of recommendation here.

Interviews season

When a residency program finds your application attractive, they will offer you an interview. Interview season spans from the beginning of October to early February. Since the COVID-19 pandemic, most of these interviews have occurred on a virtual platform. This provides the advantage of saving thousands of dollars on traveling and allows accepting more interviews. However, the disadvantage of virtual interviews is that you cannot get a natural feel of the program as you would if you were to visit in person.

Ace your residency interview with our personalized one-on-one interview preparation services! Build confidence and impress program directors with expert guidance, practice, and tailored feedback.

Rank Order List (ROL)

The ROL is certified on the R3 system on the NRMP website during the one-month ROL window. You can rank some or all of the programs you interviewed at. It is important to remember that the ROL can be changed after certifying but must be re-certified once a change is made. Also, by certifying the ROL, you agree to the binding contract of the NRMP Match and accept the residency position you Match into. You will automatically participate in SOAP if you have not received any interview invites or certified a ROL.

Match Week

Around mid-March, you will get to know if you have Matched or not on the Monday of Match Week. The Match could be a full or a partial Match (for residencies with a prelim or transitional year). For those who do not Match, the next three days will be spent in SOAP, attending interviews and accepting offers. Then, on the Friday of Match Week, all applicants will know where they have Matched.

This concludes your tenacious journey to Match Day! I hope this blog helps you succeed through this arduous journey and achieve the Match of your dreams!

By Dr.Vikyath Satish and Malke Asaad

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