How IMGs can Navigate Upcoming Changes to the USMLE®
Published on Oct 25, 2021. Updated on Feb 24, 2023.
The United States Medical Licensing Examination (USMLE) is changing! How will this affect residency applications and timelines? International medical graduates (IMGs) already have extra application steps and changes may add some new challenges. But, the USMLE changes for IMG don’t have to be scary - we’re here to walk you through everything!
What is the USMLE®?
The USMLE is a three step exam required to practice medicine within the US. After passing the first two exams, STEP 1 and 2, you can practice medicine with supervision and apply to residency. STEP 3 may be completed before or during residency, and after passing you are officially allowed to practice medicine in the US without supervision!
STEP 1 and 2 may be taken in any order, but it is helpful to take STEP 1 first. Prior to testing, IMGs must meet USMLE STEP 1 requirements for international students by getting the Educational Commission for Foreign Medical Graduates (ECFMG) certification.
STEP 1 is an 8-hour, multiple choice exam covering basic medical sciences. The current passing score is 194/300.
STEP 2 CK (clinical knowledge) is a 9-hour, multiple choice exam focused on clinical knowledge. It emphasizes underlying disease mechanisms and how to diagnose and treat a patient. The current passing score is 209/300.
Passing these two exams makes IMGs eligible for a J1 visa.
STEP 3 is a 2-day, multiple choice and computer-based case simulation exam covering application of both basic sciences and clinical knowledge. The current passing score is 198/300. STEP 3 is not required before residency, but it makes you more competitive and eligible for the H1B visa. But, taking this exam before residency may delay your application.
What has changed?
July 1, 2021: USMLE reduced the lifetime attempt limit policy from 6 to 4 attempts per STEP exam.
STEP 1
October 2020: Increased the number of questions assessing communication skills like patient empathy, privacy, consent, and reporting.
January 26, 2022: STEP 1 will change to pass/fail outcomes, so you won’t get a score.
STEP 2
November 2020: Increased the number of questions assessing systems-based practice, patient safety, legal/ethical issues, and professionalism.
January 2021: STEP 2 CS (clinical skills) was permanently canceled and replaced by the OET for international students.
- During the pandemic STEP 2 CS stopped for safety purposes since it required in-person student and patient actor interactions. Everyone did really well on it, so it didn’t help differentiate between students. Also, it was only available in 5 cities.
- Instead, OET is a computer-based, international, English-proficiency exam that assesses healthcare professionals’ language and communication skills.
The 6 ECFMG pathways for IMGs applying to residency in the US
When selecting your pathway, always go to the first pathway that applies to you (i.e. if pathway 1 and 3 apply to you, go with pathway 1).
Pathway 1: For people currently licensed in another country to practice medicine.
Pathway 2: For people who passed a standardized clinical skills exam for medical licensure.
Pathways 3-5 are similar and are for people whose medical school is accredited by one of these organizations or committees.
Pathway 3: accredited by an agency recognized by the World Federation for Medical Education (WFME)
Pathway 4: accredited by an agency received determination of comparability by the National Committee on Foreign Medical Education and Accreditation (NCFMEA)
Pathway 5: medical school issued the degree jointly with a US medical school accredited by the Liaison Committee on Medical Education (LCME)
Pathway 6: For people who don’t meet requirements for pathway 1-5 or failed STEP 2 CS before it was canceled.
Upcoming changes
Starting in 2024 only medical schools accredited by agencies recognized by WFME will be accepted. So applicants from some medical schools may no longer be eligible for ECFMG certification!
This map shows all countries currently recognized by the WFME in dark blue. The grey countries are not accepted and the blue are in the process of being accepted.
But, don’t panic! This is only the current status and more countries will be added. Next year you will be able to go on their website and search your school to check if it will be accepted.
If you start the ECFMG process (i.e. form 186) prior to 2024 these changes won’t apply.
How you can plan ahead for success
ECFMG certification
- Apply for the USMLE/ECFMG identification number on the ECFMG website. They will email you a number to create an account.
- Apply for the certification by downloading and filling out form 186, paying the fee, and scheduling the notary with NotaryCam.
- Takes about 2 weeks.
USMLE
- Apply for USMLE STEP 1 or 2 online and pay the fee
- Wait for ECFMG to verify your status by contacting your medical school online or complete form 183.
- Schedule the test on the Prometric website.
- Takes more than 1 month.
Restrictions
Check for the closest USMLE test center, there might not be one in your country. If you have to travel, try arriving at least one day in advance to make sure you know where you are taking the test and you are rested. Be sure to know what COVID-19 and travel visa restrictions might apply before traveling. Last year students were able to reschedule their test if borders closed.
Budget
BONUS: Tips on how to study as an IMG
Tips for studying:
- Avoid using too many resources, just stick to a few that work well for you.
- Study according to your schedule and take breaks to avoid burnout.
- Use assessment tools (e.g. NBME, UWorld) to assess and measure your progress.
- After each assessment, study every question (BOTH right and wrong ones)
- Familiarize yourself with radiographic images (e.g., chest x-ray, abdominal CT scan).
FAQ for IMGs
What happens if you fail a STEP exam?
Failing remains on your record and counts against your test limit. If you aren’t ready, don’t go!
Do your scores expire?
Yes, in 7 years. So take your time, but not more than 7 years!
Do you need the OET or STEP 3 to apply to residency?
Yes, you need the OET.
No, you don’t need STEP 3. However, taking it before will help your application, let you apply for your H1b visa, and you don’t have to study for it during residency.
What are the residency visas?
J1 is essentially an academic exchange visa for international students to be in the US for school. It is sponsored by ECFMG for residency, and requires you to return to your home country afterwards for at least two years. There’s a J1 waiver for doctors where you work one year in an area of the US lacking doctors - anywhere from New York to Alabama - instead of returning to your home country for two years.
H1b visa is a dual intent visa meaning that after school you might return to your home country or stay in the US. It is better for IMGs, but is trickier to get. As it requires passing all 3 STEP exams and is sponsored by the residency hospital.
Speak to your university about the proper forms for your situation.
Should you take STEP 1 before it turns to pass/fail?
If you are ready to have a great score, it would be an extra score to make you stand out on residency applications.
BUT, don’t take it if you aren’t ready! If you take it pass/fail you still have STEP 2 CK to show off your clinical knowledge. Also, there are other important application sections to help you stand out like letters of recommendations, especially one’s from a US doctor.
How do you stand out in electives or interviews?
Get a great score on STEP 2 CK.
Electives: Keep learning, stay engaged, and be interested.
Interviews: Be prepared, but don’t forget to be yourself. If you are interested in a certain area it will show.
Are residency interviews going to stay virtual or return to in-person?
We don’t know yet. It is good that they have been virtual because anyone can apply anywhere in the world without traveling. However, there was a record number of applications last year with the increased flexibility.
Osmosis is here to support your journey with easy to understand and fun review videos, quizzes, flashcards, and a customized study schedule so you can successfully conquer the USMLE!
To learn more details about planning for the USMLE check out our IMG USMLE STEP 1 and STEP 2 CK exam guide!
