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ECFMG certification and the USMLE for international graduates.

How ECFMG certification connects to the USMLE, a sensible order of work, and where to confirm current requirements.

ECFMG certification is the credential international medical graduates (IMGs) need before they can start U.S. residency training. It is closely tied to the USMLE, but the two are separate: you apply for the Step exams through one organization and obtain ECFMG certification through another. Requirements and procedures change, so use this page as an orientation and confirm every detail with the official sites.

How ECFMG fits with the USMLE

  • Applying for the Steps: usmle.org says students and graduates of medical schools outside the U.S. apply for Step 1, Step 2 CK and Step 3 through FSMB, while students and graduates of LCME- or COCA-accredited U.S. programs apply through NBME (MyUSMLE). See FSMB and the USMLE and the USMLE Step 1 guide.
  • Step 1 and Step 2 CK eligibility: the Bulletin requires that your school is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements and meets other ECFMG eligibility criteria.
  • Step 3: usmle.org states that all international medical graduates need ECFMG certification, with a valid and unexpired certificate, to be eligible for Step 3.
  • ECFMG also supports IMGs applying through ERAS, which connects to the NRMP Match.

A sensible order of work

  1. Confirm that your medical school and graduation year meet ECFMG's current requirements.
  2. Check that your school is listed in the World Directory of Medical Schools, then apply for Step 1 and Step 2 CK through FSMB, planning around the current block format.
  3. Watch the time limits that apply to your target state.
  4. Plan visas early. See our international graduates and visa guide.

Why details matter

ECFMG's rules on which schools and graduation years qualify, and on any additional requirements, can change. We link ECFMG's own pages below rather than repeat details that may be out of date.

See also attempt limits, FSMB and state licensure and interviews and travel.

Frequently asked questions

What is ECFMG certification?

It is the credential international medical graduates need before starting U.S. residency training, and it depends on USMLE results and medical education requirements.

How do IMGs apply for the USMLE?

usmle.org says students and graduates of medical schools outside the U.S. apply for Step 1, Step 2 CK and Step 3 through FSMB.

Do IMGs need ECFMG certification for the USMLE?

usmle.org says all international medical graduates need ECFMG certification to be eligible for Step 3. For Step 1 and Step 2 CK, the Bulletin requires a school listed in the World Directory as meeting ECFMG eligibility requirements.

Where do I confirm current requirements?

On the ECFMG and FSMB websites and the USMLE Bulletin, because requirements and procedures change.