Help for IMGs

Who is an International Medical Graduate?

Medical schools outside of the United States and Canada vary in educational standards, curricula, and evaluation methods. The information that follows is intended to provide international medical school students and graduates with basic information on the process for becoming certified to participate in the U.S. residency application process.

Definition of an International Medical Graduate (IMG): A physician who received a basic medical degree from a medical school located outside the United States and Canada. The location of the medical school, not the citizenship of the physician, determines whether the graduate is an IMG. This means that U.S. citizens who graduated from medical schools outside the United States and Canada are considered IMGs. Non-U.S. citizens who graduated from medical schools in the United States and Canada are not considered IMGs.

The Educational Commission for Foreign Medical Graduates

What is the ECFMG?

The Educational Commission for Foreign Medical Graduates (ECFMG). It was founded in 1956 to assess whether IMGs are ready to enter ACGME accredited residency programs in the United States. You must be certified by the ECFMG before you can start a graduate medical education program. Visit for more information.

Requirements for ECFMG Certification

International medical graduates must complete all of the requirements to be certified. The ECFMG will then issue a Standard ECFMG Certificate.

1. Application for ECFMG Certification

Submit an application for ECFMG certification before applying to the ECFMG for examination.

Application includes: confirmation of identity, contact information, graduation from medical school listed in the International Medical Education Directory (IMED) list from the Foundation for the Advancement of Medical Education and Research (, and release of legal claims.

2. Examination Requirements

IMGs must pass Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE), which are the same examinations taken by U.S. and Canadian graduates. Time limits may apply. Detailed information on the USMLE is available at

  • Medical Science Examination
  • Pass Step 1 of the USMLE
  • Pass Step 2, clinical knowledge, of the USMLE
  • Clinical Skills Examination
  • Pass Step 2, clinical skills, of the USMLE

3. Medical Education Credential Requirements

  • Physician’s medical school and graduation year is listed in International Medical Education Directory (IMED)
  • IMGs are awarded credit for at least four credit years of medical school
  • Documentation for completion of all credits and receipt of a final medical diploma
  • Final medical school transcripts

The Certification Process

The first part of the certification process starts when you apply to ECFMG for a USMLE/ ECFMG identification number. Once you obtain this number, you can use it to complete the Application for ECFMG Certification. Once you submit your Application for Certification, you may apply for examination.
Medical students and graduates can begin the certification process. Because one of the requirements of certification is the verification of your medical school diploma, you cannot complete the process until you have graduated. You can apply for the required examinations as soon as you meet the examination eligibility requirements. All of the required examinations are offered throughout the year.
The Federation of State Medical Boards publishes state-specific requirements for initial medical licensure, including minimum postgraduate training required, number of attempts at licensing examination allowed, and time limits for completion of licensing examination sequence needed for license eligibility. This is available at

Applying to U.S. Graduate Medical Education Programs

FREIDA® Online is the online directory of graduate medical education programs sponsored by the American Medical Association (AMA). The Accreditation Council on Graduate Medical Education (ACGME) also offers a residency directory at The AAFP offers an online family medicine residency directory that has search functionality beyond those of the AMAs or ACGMEs.

For each medical specialty, there is specific information on individual programs and any general or special requirements for application. Application deadlines may vary among the programs, and you should contact programs directly about their deadlines.

Most programs require applicants to submit their applications using the Electronic Residency Application Service (ERAS®). The ECFMG coordinates the ERAS application process for IMGs. Visit for more information.
The National Resident Matching Program (NRMP®) is the mechanism for connecting programs and applicants. The NRMP also coordinates the Match® for U.S., Canadian, and IMG students and graduates. If you wish to participate, you must register with the NRMP and submit the needed materials. See Section 6, “the Match,” in this book for more detailed information about how the process works.

Residency Program Requirements

Many residencies list their program requirements for applicants on their websites, such as medical school graduation year, types of visas accepted, or number of attempts on the USMLE. Research residency requirements before applying, and direct the submission of your applications appropriately.
Because offers made and accepted during Match Week will be binding under the Match Participation Agreement, only applicants eligible to begin training on July 1 in the year of the Match will be allowed to participate. The NRMP will exchange data with the ECFMG to recertify the status of IMGs.

Obtaining a Visa

To participate in U.S. graduate medical education programs, IMGs who are not citizens or lawful permanent residents must obtain the appropriate visa. The two most common visas are the H1-B (Temporary Worker) or the J-1 (Exchange Visitor). Some institutions will sponsor the visa for residents in the residency program. The ECFMG is also authorized by the U.S. Department of State to sponsor foreign national physicians for the J-1 visa. Questions about obtaining a visa should be directed to your residency program staff, the U.S. embassy or consulate in your country of residence, or the U.S. Citizenship and Immigration Services.


The complete guide to the process for application for certification, important dates, application materials, and publications including:

  • ECFMG Information Booklet
  • The ECFMG Reporter – free newsletter
  • International Medical Education Directory Reference Guide for Medical Education Credentials

Visa Information

U.S. Citizen and Immigration Services

U.S. Department of Homeland Security

Graduate Medical Education Resources

AAFP Directory of Family Medicine Residency Programs

Association of American Medical Colleges ERAS Website

Educational Commission for Foreign Medical Graduates

Graduate Medical Education Directory

National Resident Matching Program