United States Medical Licensing Examination (USMLE)



The United States Medical Licensing Examination (USMLE) has become a common evaluation system for those wanting to get an initial license to practice medicine in USA.

USMLE is sponsored by the Federation of State Medical Board (FSMB) of the United states and the National Boards (FSMB) of the United states and the National Board of Medical Examiners ( NBME) . The USMLE results are reported to the licensing authorities for use in granting the initial license to practice medicine to a doctor. Examination Eligibility for USMLE:

Case 1:
Students or graduates of, a US or Canadian medical school program which is accredited by the Liaison committee on Medical education (LCME ) or the American Osteopathic Association (AOA ).

Case 2:
Medical students or graduates of a medical school outside the United states and Canada and eligible for examination by the ECFMG ( Education Commission for Foreign Medical Graduates )

Case 3:
All Medical students who have passed Case 1 & Case 2. Certification by ECFMG for graduates or medical students outside the United States and Canada.

Educational Commission for Foreign Medical Graduates

Through its program of certification, the Educational Commission for Foreign Medical Graduates (ECFMG) assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).

ECFMG acts as the registration and score-reporting agency for the USMLE for foreign medical students/ graduates, or in short, it acts as the designated Dean's office for International Medical Graduates (IMGs) in contrast to the American Medical Graduates (AMGs).

It conducts four examinations: Step 1, Step 2CK, Step 2CS and Step 3. The ECFMG certificate is issued to a physician if he or she passes the above the four exams within a time period of seven years.

Medical schools in Canada that award the M.D. are not assessed by ECFMG, because the Liaison Committee on Medical Education historically accredited M.D.-granting institutions in both the U.S. and Canada (today, Canada has its own accrediting body that generally follows U.S. standards). M.D. graduates of American and Canadian institutions are not considered IMGs in either country.


The main pathway for international medical graduates who wish to be licensed as a physician in the United States is to complete a U.S. residency hospital program. An international medical graduate (IMG), earlier known as a foreign medical graduate (FMG), is a physician who has graduated from a medical school outside of the country where he or she intends to practice. Generally, the medical school of graduation is one must be listed in the International Medical Education Directory (IMED) as accredited by the Foundation for Advancement of International Medical Education and Research or the World Health Organization. 

IMED is a public database of worldwide medical schools. The IMED is published as a joint collaboration of the ECFMG and the Foundation for Advancement of International Medical Education and Research (FAIMER). The IMED along with the AVICENNA Directory for medicine are the primary medical school databases used by medical regulators.

As of April 2014, IMED and AVICENNA have merged to create the new World Directory of Medical Schools. The World Directory will take over as the definitive list of medical schools in the world, as IMED and Avicenna will be discontinued in 2015. As of to date, there are 188 Chinese medical schools listed on the World Directory of Medical Schools and medical graduates from these schools are eligible to take USMLE. You may click the above links to find out whether your medical school is listed and medical students are eligible to take USMLE and practise medicine in U.S.

Objective of ECFMG

The purpose of ECFMG Certification is to assess the readiness of international medical graduates to enter clinical specialty training programs as resident physicians and fellowship programs in the United States.

The general method to apply for residency programs is through the National Resident Matching Program (abbreviated NRMP, but also called "the Match"). To participate in the NRMP, an IMG is required to have an ECFMG certification by the "rank order list certification deadline" time (usually in February of the year of the match).

To acquire an ECFMG certification, the main requirements are:

In comparison, regular graduates from medical schools in the United States need to complete USMLE Steps 1 and 2 as well, but can participate in the NRMP while still doing their final year of medical school before acquiring their medical diplomas. In effect, taking regular administrative delays into account, and with residency programs starting around July, there is a gap of at least half a year for IMGs between graduation from medical school and beginning of a residency program.

A pilot project has started for an electronic verification system of medical credentials from international medical schools, with participation from approximately 20 international medical schools. After completion of this pilot project, ECFMG will invite additional medical schools to participate.

Related article about USMLE:

1. Putting Chinese Doctors to The US Medical Test

2. United States Medical Licensing Examination (USMLE)

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