• Residency Application Requirements for International Medical Graduates

    Who is an International Medical Graduate?

    The definition of an international medical graduate is a physician who received a basic medical degree from a medical school located outside the United States and Canada that is not accredited by a U.S. accrediting body, the Liaison Committee on Medical Education, or the American Osteopathic Association. The location/accreditation 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) was founded in 1956 to assess whether IMGs are ready to enter ACGME-accredited residency programs in the United States. Visit www.ecfmg.org for more information.

    ECFMG Certification Requirements and Process

    The Commission issues a Standard ECFMG Certificate to IMGs who apply for certification and meet all of ECFMG's requirements. There are three steps for receiving ECFMG certification.

    1. Meet medical education credential requirements

    IMGs must be certified by the ECFMG before taking the U.S. Medical Licensing Examination® (USMLE®) or start a graduate medical education program. To certify an IMG, the ECFMG must be able to verify the following credentials:

    • Physician's medical school and graduation year listed in the World Directory of Medical Schools
    • Credit awarded for at least four credit years of medical school
    • Documentation for completion of all credits and receipt of a final medical diploma

    2. Application for ECFMG Certification

    To apply for certification, IMGs must:

    2. Examination Requirements

    The Federation of State Medical Boards (FSMB) publishes state-specific requirements for initial medical licensure, including:

    • Minimum postgraduate training required
    • Number of attempts at licensing examination allowed
    • Time limits for completion of licensing examination sequence needed for license eligibility

    IMGs must verify their eligibility within each U.S. state and to each program before applying for the USMLE. Failure to do so could result in wasted time and money applying in states that limit training permits and licensure to fewer international medical schools than the full World Directory of Medical Schools list.

    Once IMGs meet the examination eligibility requirements, they can apply for the required examinations. IMGs are required to take and pass the same examination taken by U.S. and Canadian medical students. The examinations are offered throughout the year.

    • USMLE Step 1: Assessment of medical knowledge and foundational science
    • USMLE Step 2: Clinical knowledge - assessment of knowledge of clinical science (USMLE Step 2 CK)

    Detailed information on the USMLE is available at www.usmle.org.

    Eligibility for ECFMG Pathways

    International students and graduates must also meet eligibility requirements for ECFMG Pathways, a program that assesses clinical and communication skills required for ECFMG certification. The sequencing and timing of these requirements has been a challenge. It's important to review these requirements and start the process by your third year of medical school.

    To be eligible for ECFMG Pathways, applicants must:

    • Not have taken and passed the previous USMLE Step 2 CS exam
    • Not be barred by the ECFMG from pursuing certification
    • Have previously been registered for a USMLE Step or Step Component (Register for a USMLE exam before submitting Pathways application)
    • Have completed an application for ECFMG certification

    There are several pathways for an international student or graduate to meet requirements to apply for residency in the U.S. Visit ecfmg.org for detailed information about Pathways.

    Applying to U.S. Residency Programs

    The Fellowship and Residency Electronic Interactive Database Access 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. The AAFP offers an online family medicine residency directory that has search functionality beyond those of the other two.

    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.

    Get an ERAS Token

    Most programs require applicants to submit their applications using the Electronic Residency Application Service (ERAS®). This requires an ERAS token, which is a one-time access code used to register for MyERAS. The ECFMG coordinates the ERAS application process for IMGs. ERAS tokens for IMGs become available beginning in June.

    Register with the NRMP

    The National Resident Matching Program® (NRMP®) is the mechanism for connecting programs and applicants. It coordinates the Match for U.S., Canadian, and international medical students and graduates. You must register with the NRMP and submit the needed materials to participate in the Match. The NRMP website outlines applicant registration steps in detail.

    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.

    Residency Program Requirements

    Know Application Deadlines and 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 allowed attempts on the USMLE. Research residency requirements before applying and direct the submission of your applications appropriately.

    Understand Eligibility Requirements

    Before expending effort and financial resources applying, it is important to understand the eligibility requirements for each residency program of interest. It can be challenging for IMGs to obtain residency interviews in the U.S. The number of U.S. allopathic and osteopathic medical schools has grown considerably, resulting in increasing competition for a relatively fixed number of residency positions in the U.S. As a result, many residency programs have tightened their eligibility requirements. Many residencies list their requirements for applicants on their websites.

    Get State-Specific Information

    Before applying to residency programs, research the license requirements for that specific state. The Federation of State medical Boards (FSMB) publishes state-specific requirements for initial medical licensure. In addition, some states have a list of recognized international medical schools that are eligible for licensure in the state.

    Will You Need a Visa?

    Types of Visas

    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:

    • H-1B (Temporary Worker)
    • J-1 (Exchange Visitor)

    Obtaining a Visa

    Some institutions will sponsor the visa for IMGs 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 the residency program staff, the U.S. embassy or consulate in your country of residence, or the U.S. Citizenship and Immigration Services.