IMG residency application and Match resources

Navigate certification, examinations, applications and the residency Match.

Applying to family medicine residency in the United States involves several important steps, from confirming your eligibility and completing required examinations to researching programs, preparing applications and participating in the Match.

As an international medical graduate (IMG), you may have additional requirements related to certification, medical education credentials and visa sponsorship.

Use this guide to understand the process, plan your next steps and find resources to help you prepare.

Step 1: Confirm your eligibility for U.S. residency

Before beginning the application process, make sure you understand the requirements for international medical graduates.

Understand ECFMG certification

The Educational Commission for Foreign Medical Graduates (ECFMG), a division of Intealth, evaluates whether international medical graduates meet the requirements for entering accredited U.S. graduate medical education programs.

ECFMG certification involves several requirements, including:

  • Verifying that your medical school meets ECFMG eligibility requirements

  • Completing medical education credential verification

  • Passing USMLE Step 1 and Step 2 Clinical Knowledge (CK)

  • Meeting applicable clinical skills and communication skills requirements through an ECFMG certification Pathway

For applicants using the current certification Pathways​ process, the communication skills requirement includes the Occupational English Test (OET) Medicine. Requirements may differ for physicians who previously satisfied these requirements through another accepted route.

Review the ECFMG certification requirements​ and current certification Pathways​ before planning your examinations and application timeline.

Verify your medical school's eligibility

Your medical school must meet ECFMG's eligibility requirements.

Start by checking the World Directory of Medical Schools​. Confirm that your school has the appropriate ECFMG Sponsor Note and that your graduation year meets the applicable requirements.

A school's inclusion in the directory alone does not establish eligibility for ECFMG certification.

Review state and program requirements

Residency eligibility and medical licensure requirements can vary by state and institution.

Some states have additional requirements related to international medical education, examination attempts or postgraduate training.

Before applying, review requirements for the states and programs you're considering. The Federation of State Medical Boards (FSMB)​ provides information about state medical licensing authorities.

Step 2: Understand the USMLE Step exams

The United States Medical Licensing Examination (USMLE) is a three-step examination program that assesses the medical knowledge and clinical decision-making skills needed for medical licensure in the United States.

For IMGs, Step 1 and Step 2 CK are required for ECFMG certification. Step 3 is the final examination in the USMLE sequence and may also be important for applicants considering certain visa sponsorship options.

Step 1 assesses your understanding of basic medical sciences and their application to the practice of medicine.

The examination covers concepts related to health, disease, treatment and the scientific foundations of clinical care.

What IMGs should know:

  • Step 1 is required for ECFMG certification.

  • Results are reported as pass/fail.

  • You must meet USMLE and ECFMG eligibility requirements before registering.

  • You may take Step 1 and Step 2 CK in either order.

Review the official USMLE Step 1 information​ for eligibility, exam content and preparation resources.

Step 2 Clinical Knowledge (CK) evaluates your ability to apply medical knowledge and clinical science to patient care under supervision.

The examination emphasizes diagnosis, patient management, disease prevention and health promotion.

What IMGs should know:

  • Step 2 CK is required for ECFMG certification.

  • Results include a three-digit score.

  • Residency programs may consider your Step 2 CK performance when evaluating applications.

  • Plan your examination date to allow time for scores to become available during the application process.

Review the official USMLE Step 2 CK information​ for exam content, scheduling and preparation resources.

Step 3 is the final examination in the USMLE sequence. It assesses your ability to apply medical knowledge and make clinical decisions in the unsupervised practice of medicine, with particular emphasis on patient management.

Unlike Step 1 and Step 2 CK, Step 3 is not required for ECFMG certification.

What IMGs should know:

  • You must pass Step 1 and Step 2 CK before becoming eligible for Step 3.

  • IMGs must have graduated from medical school and obtained valid, unexpired ECFMG certification.

  • Step 3 is administered over two days at testing locations in the United States and its territories.

  • Many physicians take Step 3 during postgraduate training, but eligible IMGs may take it before beginning residency.

  • Some residency institutions require applicants seeking H-1B visa sponsorship to pass Step 3 before residency begins.

What does Step 3 cover?

Step 3 includes two testing days:

Day 1: Foundations of Independent Practice (FIP)

Assesses foundational medical and scientific knowledge, including biostatistics, epidemiology, patient safety, clinical decision-making and application of basic science principles.

Day 2: Advanced Clinical Medicine (ACM)

Focuses on diagnosis, treatment, patient management and clinical decision-making. This day includes multiple-choice questions and computer-based case simulations that assess how you manage patient care over time.

Visit the official USMLE Step 3 page​ for current eligibility requirements, exam details and preparation resources.

Do IMGs need Step 3 before applying to residency?

Not generally. Step 3 is not required for ECFMG certification or as a universal condition of participating in the NRMP Match.

However, Step 3 may be important if you are considering programs that sponsor H-1B visas.

Some institutions require applicants seeking H-1B sponsorship to have passed Step 3 before training begins. Policies and deadlines vary by program.

Before deciding when to take Step 3, consider:

  • Whether your target programs sponsor H-1B visas

  • Whether they require Step 3 for H-1B applicants

  • Your eligibility and ECFMG certification status

  • Examination preparation time and score reporting

  • How Step 3 fits into your residency application timeline

Confirm requirements directly with individual programs.

For more information about J-1 and H-1B sponsorship, visit Visa requirements for international medical graduates.

How do IMGs register for USMLE exams?

Beginning January 12, 2026, students and graduates of medical schools outside the United States register for all three USMLE Step exams through the FSMB.

ECFMG continues to manage certification requirements and medical education credential verification.

To prepare for registration:

  1. Confirm your medical school's ECFMG eligibility.

  2. Begin the applicable ECFMG certification process.

  3. Review eligibility requirements for your intended Step exam.

  4. Apply through the FSMB's USMLE portal.

  5. Follow the scheduling instructions provided after your application is approved.

Visit the FSMB USMLE information page​ and the USMLE exam resources​ for current instructions and preparation materials.

Step 3: Research family medicine residency programs

Choosing where to apply is about more than meeting minimum eligibility requirements. Look for programs that align with your clinical interests, professional goals and personal priorities.

Find programs that match your goals

Consider factors such as:

  • Geographic location and community setting

  • Patient populations and clinical training opportunities

  • Program mission, culture and values

  • Faculty mentorship and resident support

  • Opportunities in pregnancy care, procedures or other clinical interests

  • Experience supporting international medical graduates

  • Visa sponsorship policies, if applicable

The AAFP Family Medicine Residency Directory​ allows you to explore programs by location, clinical strengths, community setting and other characteristics.

Find programs that sponsor visas

The AAFP Residency Directory also provides program-level information indicating which programs sponsor visas for non-U.S. citizen, non-permanent resident IMGs.

Use the directory to identify potential programs, then contact them to confirm current sponsorship policies, supported visa categories and eligibility requirements.

If you're considering H-1B sponsorship, ask whether the institution requires a passing Step 3 result and when that result must be available.

Search residency programs

Questions to ask residency programs

  • Does your program accept international medical graduates?

  • Are there medical school graduation-date or examination requirements?

  • Does your institution sponsor J-1 or H-1B visas?

  • Is Step 3 required for applicants seeking H-1B sponsorship?

  • What orientation, mentorship or transition support is available to IMGs?

  • How does your program's clinical training align with my career goals?

Step 4: Prepare your residency application

Most U.S. residency programs use the Electronic Residency Application Service (ERAS) to receive applications.

For IMGs, ECFMG serves as the designated dean's office for ERAS and provides instructions for obtaining an ERAS token and submitting supporting documents.

Visit ECFMG's ERAS resources​ for IMG-specific application instructions.

Your application should help residency programs understand your clinical experiences, professional strengths and interest in family medicine.

Key components may include:

Curriculum vitae (CV)

Present your education, clinical experience, research, volunteer activities, leadership and other accomplishments clearly and accurately.

Use the AAFP's residency application guidance for tips on preparing application materials.

Personal statement

Explain why you're pursuing family medicine and how your experiences have shaped your professional goals.

Your international medical education and clinical background may provide meaningful examples of adaptability, patient-centered care and commitment to the specialty.

Explore the AAFP's residency personal statement guide.

Letters of recommendation

Seek recommendations from physicians or supervisors who can speak meaningfully about your clinical abilities, professionalism and readiness for residency.

Review individual program requirements, including whether U.S. clinical references are preferred.

Medical education records

Follow ECFMG and ERAS instructions for submitting your medical school transcript, Medical Student Performance Evaluation (MSPE) and other required documents.

Programs want to understand why you've chosen family medicine and how your goals align with their mission.

Use specific examples to demonstrate your interest in comprehensive care, continuity of care, working with diverse patient populations and serving communities.

If you have prior clinical experience in another specialty or health care system, explain how it has informed your interest in family medicine.

Application dates and requirements may change from year to year.

Before each application cycle:

The AAFP's applying to residency guide provides additional application planning resources.

Step 5: Prepare for residency interviews

Residency interviews allow programs to learn about your experiences and goals while giving you an opportunity to evaluate whether a program meets your needs.

Share your experiences and strengths

Be prepared to discuss:

  • Why you chose family medicine

  • Your medical education and clinical experiences

  • How you've adapted to different environments

  • Your approach to teamwork and communication

  • Challenges you've encountered and what you've learned

  • Your professional goals and interest in the program

Focus on specific examples that demonstrate your skills, values and readiness for training.

Learn about the residency program

Interviews are also an opportunity to ask about the training environment.

Consider questions about supervision, feedback, resident support, clinical experiences and professional development.

If you have questions about visa sponsorship or IMG-specific onboarding, ask the appropriate program representative.

The AAFP's residency interview preparation guide offers practical advice for preparing, interviewing and following up.

Prepare for interviews

Step 6: Understand the Match process

The National Resident Matching Program (NRMP) uses a computerized matching process to pair applicants with residency programs based on their rank order lists.

ERAS and NRMP serve different purposes: ERAS supports the application process, while NRMP administers the Match.

Register for the Match

Review the NRMP website​ for registration instructions, eligibility requirements and current deadlines.

IMGs must satisfy applicable ECFMG examination requirements by the NRMP rank order list certification deadline to be eligible to participate in the Main Residency Match. Additional certification requirements must also be met according to the applicable ECFMG and NRMP timelines.

Create your rank order list

Rank programs in your genuine order of preference, considering factors such as:

  • Clinical training and curriculum

  • Program culture and mentorship

  • Geographic and family considerations

  • Career goals

  • Visa sponsorship and eligibility, if applicable

Use your interview experiences and program research to make informed decisions.

Prepare for Match Week

During Match Week, applicants learn whether they've matched and, later, where they've matched.

Eligible unmatched or partially matched applicants may have opportunities to participate in the Supplemental Offer and Acceptance Program (SOAP).

Review the AAFP's SOAP residency Match guide to understand the process and available resources.

After the Match: Prepare for residency

Once you've matched, your residency program will provide instructions for onboarding, credentialing, licensing and orientation.

If you need visa sponsorship, coordinate with your program and sponsoring organization to complete immigration-related requirements before training begins.

The AAFP's residency preparation checklist can help you organize your next steps.

For guidance on relocating, understanding U.S. clinical workflows, orientation and adjusting to a new community, explore Preparing for U.S. residency as an IMG.

Prepare for residency