USMLE Blog
Complete USMLE Guide: From Start to Finish
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Updated October 2026
Hello USMLE aspirants! This blog is your one-stop destination for all things USMLE. Learn about the steps required from start to end to pursue residency in the US.
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Table of Contents
- What is USMLE?
- How to register for the USMLE exam?
- How to apply for the USMLE exam?
- What is USCE?
- What is ECFMG Certification?
- How to register for the Match?
- What is the role of the NRMP in the Match?
- What is an ERAS CV?
- Personal Statement
- What is a Supplemental ERAS application?
- Letters of Recommendation (LOR)
- Interviews season
- Rank Order List (ROL)
- Match Week
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.
USMLE Exam Registration: Requirements, Fees, and Timeline
As an International medical graduate (IMG), you must first create an account on ECFMG’s new MyIntealth Application Portal to verify your identity. Fill out your Intealth Identification Form (IIF) to establish your account. This form should be filled and notarized via a live video call on NotaryCam, which includes an Account Establishment fee of 110 USD. Make sure to dress formally as a photograph is taken during the notarization process.
Once NotaryCam confirms your identity, the actual exam registration path moves outside of ECFMG. As of January 12, 2026, all IMG exam registration and scheduling is officially handled through the Federation of State Medical Boards portal (FSMB).
For a step-by-step guide to this new process , check out our Step 1 registration guide and our Step 3 registration guide.
How to Apply for the USMLE Exams
Following the notary confirmation, you will receive a unique MyIntealth ID linked to your USMLE ID used throughout the USMLE process. Once your ECFMG application is approved, you are ready to apply for the actual exam. Log in to the Federation of State Medical Boards (FSMB) portal to begin your exam application.
You must choose an eligibility period (3-month window) and complete your exam within this timeframe. Next, the FSMB will request eligibility confirmation from ECFMG, which coordinates with your medical school to issue a scheduling permit. This is completed using an online portal if your school is registered with the Electronic Credentials Verification (EMSWP) program or by mail. After receiving a scheduling permit from the FSMB with a unique code, you can choose the testing center and test date on the Prometric website.
USMLE Step 1 Application Guide
USMLE Step 1 is the first installation of the three-step exam. It tests the foundational sciences (such as biochemistry, physiology, pathology) over 14 blocks lasting 30 minutes each, each block containing a maximum of 20 single-item multiple-choice questions. You are entitled to a flexible break time of 55 minutes, which can be scheduled between the blocks. The break time can be increased by skipping the introductory 5-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 in January 2022 to reduce the pressure on test takers. Primary resources for the exam include our 7-Day High-Yield Course and Synapse question bank. We recommend that First Aid be used as a reference rather than a primary resource. UWorld will be your escalation tool if your NBME self-assessments show clear content gaps.
For more detailed information about STEP 1 resources, check out our blog here.
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USMLE Step 2 CK Application Guide
This exam tests the application of medical knowledge (including internal medicine, pediatrics, OB/GYN, surgery), emphasizing health promotion and disease prevention. With up to 316 questions divided over 16 blocks lasting 30 minutes each, each block contains a maximum of 20 questions.
The number of questions can be reduced to 18 or 19if drug ads or research abstracts are included in the block. You are entitled to a flexible break time of 55 minutes, which can be scheduled between the blocks. The break time can be increased by skipping the introductory 5-minute tutorial or finishing the blocks early.
Since USMLE Step 1 became pass/fail, Step 2 CK scores have become more important. We recommend the Step 2 High-Yield Course and Synapse Step 2 QBank, alongside NBME self-assessments to track your progress and exam readiness. UWorld or AMBOSS can also be useful as a supplemental resource or if you need additional practice in areas where your NBME results reveal gaps.
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.
Don’t forget to check out our new High-yield Nutrition Notes for focused revision of commonly tested nutrition topics.
USMLE Step 3 Application Guide
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 approximately 7 hours in the test session, including 55 minutes of break time and a 5-minute optional tutorial. The day includes 232 multiple choice questions divided into 12 blocks of 18-20 items, with 30 minutes allotted for completion of each 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. There are approximately 9 hours in this test session, which includes a 5-minute optional tutorial followed by 180 multiple-choice items divided into 9 blocks of 20 items, with 30 minutes allotted per block. This is followed by a 6-minute CCS tutorial and 13 to 14 computer-based case simulations, or CCS, which test patient management skills in real-time with a minimum of 45 minutes available for break 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.
Our recommended resources for Step 3 are the Step 3 High-Yield Course, the Synapse Step 3 question bank, and our CCS and biostatistics courses. UWorld or AMBOSS can also be useful as a supplemental resource or if you need additional practice in areas where your NBME results reveal gaps.
For more detailed information about STEP 3 resources, check out our blog here.
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What Is U.S. Clinical Experience (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!
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Do you wanna read more details on USCEs for IMGs? Check out our blog here.
What Is ECFMG Certification and Why Is It Important?
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?
- An Application for ECFMG Certification along with digital Identity Verification completed via the MyIntealth portal
- The medical school listed by the World Directory of Medical Schools (World Directory) from 2024, with an active ECFMG sponsor note
- USMLE Step 1 and Step 2 CK scores via the USMLE Transcript
- One of the six ECFMG Pathways OR Step 2 CS passing performance
- Occupational English test (OET)
- Medical school documents
What are the medical school documents required for ECFMG certification?
- Medical school diploma/degree uploaded via MyIntealth
- Medical school transcript
- 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 (945 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. For applicants who passed Step 2 CS before its discontinuation in January 2021, the ECFMG certificate is permanent. All other applicants obtain certification through the Pathways, which carry expiration dates.
It is advisable for IMGs to be ECFMG certified by September 2, 2026, when ERAS submissions open for the 2027 cycle.
How to Register for the Residency Match
The process requires two separate registrations:
- For your Application Service: You must purchase your ERAS Token ($185 fee) via the MyIntealth portal, then use that token to create an account with the AAMC to complete and submit your MyERAS application to programs. However, some specialties, such as Emergency Medicine and Obstetrics and Gynecology, now use ResidencyCAS instead of ERAS. Applicants should check the application service required by their specialty and programs.
- For the Match : You must register on the NRMP (National Resident Matching Program) website and pay the current Main Residency Match registration fee, which is $85, to enter the official matching algorithm.
What Is the Role of NRMP in the Residency Match?
The NRMP (National Resident Matching Program) is the organization that administers the Match. Applicants use the NRMP R3 system to register for the Match, create and certify their Rank Order List (ROL), and view Match results. To participate in the Main Residency Match and Supplemental Offer and Acceptance Program (SOAP), you need to create an account with the NRMP by the standard registration deadline of the Match cycle and pay the standard fee (85 $).
A $50 late fee applies if you register after the standard deadline. Registration closes strictly before the Rank Order List certification deadline. Applicants should always check the official NRMP calendar for the exact dates of their Match cycle. 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 for Residency Applications?
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. You can also select up to three of these experiences as most meaningful. Beginning with the 2027 ERAS application season, the publications/research section is updated as Scholarly Work, where applicants can report publications, presentations, posters, submitted work, and other scholarly contributions. Applicants can also select up to three Most Meaningful Scholarly Works.
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 video 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.
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What Is a Personal Statement for Residency?
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?
You are not limited to one personal statement. You can create multiple versions in your Documents section of MyERAS, and you must manually assign a specific personal statement to each program you apply to. However, you can assign only one personal statement to each program. This allows you to tailor your message to different programs if you choose.
Check out our two blogs on how to write a personal statement and personal statement examples.
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What Is the Supplemental ERAS Application?
The Supplemental ERAS application is not currently a separate application, its now incorporated into the main MyERAS application. It contains questions to incorporate personal preferences into the ERAS application. There is no separate Supplemental ERAS submission deadline, so applicants should follow the official ERAS/MyERAS timeline for each application season.
Sections include up to 10 selected experiences, up to three most meaningful experiences, three geographical preferences, and urban, suburban, or rural preferences. Program Signalling is an important part of the ERAS application, with the number and type 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 for Residency Applications (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 four LORs to each residency program. Beginning with the 2027 ERAS application cycle, LORs are uploaded through the AAMC Letter Writer Portal, usually by the letter writer or their designee. 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 each program’s requirements before assigning letters, because assigned letters cannot be changed after applying.
Check out our video about letters of recommendation here.
Residency Interview Season: What to Expect
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. The AAMC continues to recommend virtual interviews for residency and fellowship programs; however, some programs or specialties may still use in-person interviews. 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.
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Rank Order List: How to Rank Residency Programs (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. If you have not received any interview invites or did not certify a ROL, you can still participate in SOAP if you are eligible.
What Is Match Week in the Residency Match?
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!
If you need help with USMLE Step 1, Step 2 CK, and Step 3 tutoring or having an expert guide you through high-yield concepts and test strategies, don’t hesitate to reach out to us HERE!
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By Dr.Vikyath Satish and Malke Asaad
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