Requirements for medical residency in the USA for IMG

The most frequently asked questions by medical students are: How much does medical residency cost? What are the requirements for medical residency in the USA? How long does the medical residency application take? How do I get a medical residency in the USA as IMG? If to answer in short: You must be graduated from ECFMG eligible medical school. You must pass USMLE Step 1,2 exams. Exams should be passed with the first attempt and high scores. You should be a recent graduate, if possible. You should have hands-on clinical experience in the USA. You should have strong letters of recommendation from U.S. physicians. You should not have gaps in your medical career. You must have great language skills. You must be ready to pay travel expenses and around $4000 for fees. The whole process will take 2-3 years. Let us consider the match process for medical residency in detail now. Steps 2,3,4,5,10 are specific for foreign medical graduates while other steps are common for all applicants.

Medical residency application step by step

  1. Work on academic performance

    Work hard on your academic performance during studying at medical school. You will need MSPE (Medical Student Performance Evaluation) letter and medical school transcript to be submitted during an application process. MSPE is an important and one of the most frequently used factors during selecting for an interview.

  2. Start the ECFMG certification process.

    One of the most important medical residency requirements is to be ECFMG certified. All IMGs must be in process of certification or already certified to be eligible to apply for medical residency in the United States. Students often start ECFMG certification process during the third year at medical school. Start the process by verifying if your school and your year of graduation meet ECFMG requirements here, your school must have a special note from ECFMG. Search your school and check presence of ECFMG note under "Sponsor notes" tab. If your school is eligible, visit ECFMG website and follow instructions to get your USMLE/ECFMG Identification Number. Then establish your ECFMG account here. (After receiving your medical diploma it must be submitted to ECFMG. The exact degree and title of the diploma that you must submit can be found with ECFMG reference guide for medical education credentials. Fees for certification are around 2500$. Exact information about fees can be found here. )

  3. USMLE Step 1 application

    As a part of the ECFMG certification process, you will need to pass USMLE Step 1 and Step 2 exams. Most residency programs require USMLE STEP 1 for interview consideration. Also, passing Step 1 with good score can help with searching for clinical electives in the United States. Therefore, there is a reason to start from USMLE Step 1 unless you are prepared to pass Step 2 with a high score at that moment. Two years at medical school must be completed before the start of the application process. For USMLE Step 1 registration, read USMLE application overview to understand how to register for USMLE Step 1 and USMLE exam eligibility. USMLE Step 1 score is the most frequently used factor for selecting candidates for interview. So, it is extremely important for IMGs to pass USMLE Step 1 with scores above the average. In addition, the first-time passage is a very important criterion used by many programs. Study really hard to pass USMLE Step 1 with one attempt and a high score. (The overuse of the Step 1 score as one of the main criteria for interview consideration has resulted in a decision to make Step 1 Pass/Fail in 2022. And this is why the first time passage may become more important in 2022.)

  4. Do clinical elective in the USA (for students only)

    Do not miss your chance to gain hands-on clinical experience in the USA during your final year at medical school. Many hospitals in the USA provide an opportunity for IMGs to have their optional away rotation in the USA during the final year. It is very important to have hands-on (direct patient care) supervised experience in the United States. A clinical elective is the best way to do it. It will be very hard to gain the same level of USCE (US clinical experience) after graduation because of legal reasons. Other important aspects are LORs (letters of recommendation) from US physicians and personal prior knowledge of the applicant factor. LORs are the second most frequently used factor for interviews. LORs from U.S. physicians are the most valuable. Also, no doubt that the weight of personal prior knowledge of the applicant factor is very high.

  5. Secure an official observership in the USA (for graduates without any U.S. clinical experience at the time of application)

    Observership can't satisfy program requirements for hands-on USCE but easy to find. Observership is better than nothing and an obvious benefit especially if to target a specific residency program.

  6. Register with ERAS

    Most programs use special electronic service (ERAS) to receive applications. First request your ERAS token at ECFMG app (OASIS web app or MyECFMG mobile app). Go to ERAS Support Services -> Request a Residency Token. Usually, tokens for the next ERAS season are available starting from some date in June. You will need to pay a fee for generating a token. Then create AAMC account and go to AAMC MyERAS, and sign-in with AAMC Account. Enter your ECFMG token and accept Terms and Conditions.

  7. Prepare all required documentation

    You will need to apply to residency programs via ERAS with required documentation included. Ensure that your personal statement(s), common application form, cv have high quality and no mistakes. Ensure that your LORs on place and other documents are transmitted by ECFMG. You can apply without all required documentation included, but you must submit documents before deadline. Each program has own system of deadlines for interview consideration, inclusion into the rank order list, H1 visa sponsorship, etc.

  8. Select the right programs to apply to

    ERAS takes fees for each extra program you choose to apply. You should choose the right programs from thousands available to have the best chances for residency. Each program has requirements like minimum USMLE scores, years from graduation, USMLE first time passage, type and duration of US clinical experience, accepted or sponsored visas. Residency Programs List helps with selecting programs by minimal requirements and other important characteristics. The most commonly used visa for medical residency in USA is J1 visa sponsored by ECFMG. Many programs can accept this visa while others can't. More information about J1 visa can be found here. Less frequently used visa is H1B visa that sponsored by program itself. More information about H1B visa can be found here.

  9. Pass USMLE STEP 2 exam

    It is highly recommended but not mandatory to pass USMLE Step 2 before applying to programs but a high Step 2 score is much more important. Do not hurry with it. Since Step 1 is expected to be Pass/Fail, USMLE Step 2 will be even more important in 2022. Many programs wish to see Step 2 before granting interviews but they also wish to see really high USMLE Step 2 scores for IMGs. There is a time limit for passing exams, but it is important to be a recent graduate at the time of application if possible.

  10. Find externsip (for graduates without U.S. clinical experience)

    Very often graduates passed USMLE exams but still have no hands-on clinical experience in the U.S. and corresponding LORs. To fill this gap applicants search for such opportunities. It is not easy to find an externship after graduation because clinical electives are not accessible for graduates. Externships are rare. In most cases, clinics provide externship as a source of cheap labor. There are companies that search for eligible candidates, connect graduates and clinics and take money from both sides. Such externships are not so valuable as clinical electives but together with corresponding LORs may satisfy minimum requirements for many residency programs.

  11. Apply to selected programs

    You should apply to programs via ERAS before the date when data will be released to programs, if possible. 2021 year, it is September 29. Some very limited amount of programs may not use ERAS for application and you may need to apply manually.

  12. Prepare for your interviews

    The only way to residency is to be selected for an interview first. And this is why it is so important to select the right programs to apply to. Once selected you may need to practice answering common interview questions. Your interpersonal skills, interaction with faculty and staff during interviews and visit, and feedback from current residents are the most important factors for ranking.

  13. Register with NRMP

    To be matched for residency applicants must participate in the National residency matching program (NRMP). Applicants must register at The Match, R3 system. It is possible to find registration opening day and upcoming deadlines here. On registration, you must enter your AAMC id, ECFMG id, and other information as well as pay registration fees. Then go back to your ERAS profile and add your NRMP ID. (Plastic surgery and Urology do not participate in the Match®)

  14. Fill the rank order list

    In case you have interviews you can fill a rank order list of your preferred programs via the NRMP R3 system. Programs also fill the list of preferred applicants among interviewed. When all referred programs are entered you must certify your rank order list as final to be used in the Match. It must be done by the submission deadline.

  15. Match and SOAP

    Based on rank order lists NRMP releases the list of matched candidates. Usually, it happens on the 15 of March. It is a happy day for many matched candidates. But it is, also, not a finish for many IMGs. NRMP also releases the list of unfilled positions and the Supplemental Offer and Acceptance Program begins. SOAP consists of several fast match rounds. One week duration usually. Most SOAP positions are in preliminary and categorical internal medicine, preliminary surgery, transitional year, and family medicine.