In this post, we will describe the major steps required for getting a medical residency position in the United States. Every step can be complex and extensive. This information applies mainly to International Medical Graduates (IMGs). The order used to describe the topics below follows a chronological order that applicants usually pursue as they prepare for their applications. Even though this information may seem overwhelming, taking a step-by-step approach is best to avoid frustrations as the process can be challenging and long. Don’t get discouraged by all the information and focus on one step at a time. Remember, thousands of IMGs are successful in getting a residency position every year and you can be one of them!
“Hope is important because it can make the present moment less difficult to bear. If we believe that tomorrow will be better, we can bear a hardship today.” – Thich Nhat Hanh
Most Important Steps to Getting a US Medical Residency
- Check medical school eligibility.
- Start applying for the ECFMG (Educational Commission for Foreign Medical Graduates) certification.
- Pass the USMLE Step 1 (now pass or fail) and Step 2 CK (scored).
- Obtain the ECFMG Pathways (alternative to the discontinued Step 2 CS exam).
- Apply for residency using the Electronic Residency Application System (ERAS).
- Attend the residency interviews.
- Apply for the NRMP MATCH.
- Get your MATCH results. Usually, they are released in March every year.
One would need to work on more than one of this requirements at a time and it is helpful to create a timeline to achieve these goals. It is important to get clinical experience in the United States and get letters of recommendation, preferably from practicing physicians in the United States.
General Description of the Most Important Steps
1. Medical School Eligibility
The first important step is ensuring your medical school meets the requirements established by ECFMG. A school that meets all requirements for ECFMG is listed in the World Directory of Medical Schools and has an ECFMG note on the “Sponsor Notes” tab of the school’s listing stating that the school meets eligibility requirements. The ECFMG note also mentions the graduation years for which the school meets ECFMG requirements (your graduation year must be included here to participate).
2. ECFMG Certification
ECFMG is the organization in charge of certifying IMGs to apply for a medical residency program. The goal for ECFMG is to assess whether an IMG is ready to train in U.S. Graduate Medical Education (GME) programs where they provide supervised patient care. There are 2 major requirements for the certification: examinations (USMLE and pathways) and medical education verification. The ECFMG certificate is not a medical degree, and it does not allow an IMG to practice medicine in the United States independently. Instead, the certificate provides proof that an IMG has met the required examinations (USMLE) and documentation (medical degree, credentials, etc.) to apply for a medical residency program and train under supervision.
In summary, there are 3 fundamental requirements for getting the ECFMG Certification:
- Passing the USMLE Step 1 and Step 2 CK.
- Meet the Clinical Skills Requirement and Communication Skills Requirement:
- Complete an ECFMG Pathway, which includes a satisfactory score on the Occupational English Test (OET) Medicine, OR
- Have a passing performance on the former Step 2 Clinical Skills (CS) exam (discontinued in March 2020).
- Medical education credentials verification.
We will describe in detail how to obtain the ECFMG certification in the next post. The application for the USMLE certification is done before the application for the USMLE exams.
3. USMLE Exams:
The United States Medical Licensing Examinations (USMLE) consist of three exams, of which two are mandatory for the residency application (Step 1 and Step 2 CK). The third exam (USMLE Step 3) is not required to obtain the ECFMG certificate. However, it is mandatory when applying for an H1B visa instead of a J1 visa for residency and to apply for a medical license. More information about J1 and H1B visas for medical residency can be found here: J1 Vs H1B Visa for Medical Residency.
– Step 1: Computer-based exam. It is an 8-hour-long exam that covers the medical basic sciences such as anatomy, biochemistry, pharmacology, pathology, physiology, etc. This exam may be the most challenging of all, particularly for International Medical Graduates (IMGs), mostly if you have graduated or studied basic sciences more than 2 years before taking the exam. The preparation for the Step 1 exam used to take longer time than the other exams. However, the USMLE Step 1 exam changed to pass or fail on January 26, 2022. In the past, the USMLE Step 1 score was the most important aspect used by programs to select candidates. Since the modification was done, the Step 2 CK exam has taken that role. Nonetheless, it is crucial to pass the USMLE Step 1 exam on a first attempt and avoid failures as this can significantly impact the chances of an applicant during the MATCH.
– Step 2 CK (Clinical Knowledge): Computer-based exam. It is a more clinical-based exam in which specialties such as internal medicine, pediatrics, gynecology, cardiology, and others are tested in a multiple-choice test format. As previously mentioned, the score obtained on the exam has become one of the most important factors used by programs to compare candidates.
– Step 3: Computer-based exam. Not mandatory for the residency application unless pursuing an H1B visa. Some IMGs take this exam before starting residency, although most we usually take it and IMG applicants during the first year of residency training.
Once an applicant has completed the ECFMG application (consists of Verification of Medical Credentials and Certification of Identification), ECFMG pathways, and the USMLE Step 1 and 2 CK exams, a certificate will be issued by ECFMG.
4. Apply to residency using the Electronic Residency Application System – ERAS:
The Electronic Residency Application System (ERAS) is an electronic system that allows candidates to apply to the different residencies (internal medicine, pediatrics, family medicine, emergency medicine, etc.) provided by the American Medical Association (AMA). The best recommendation is to obtain the ECFMG certification before the ERAS application date, although it is not mandatory. However, programs will require an ECFMG certificate before the rank order list deadline. Some programs may filter out applicants who do not have an ECFMG certificate at the time of application. Since the competition is so high, it is recommended to get the certificate before the application is submitted. The ERAS application portal usually opens in September each year. More information will be provided in the following posts.
5. Attend residency interviews:
After applying, the next step is waiting for interview invitations from the programs we have applied. The more invitations one gets, the better. It is not possible to MATCH in a program without attending an interview. Acing your interviews is crucial. The interview is probably the most important factor used by programs to rank you high in their rank order list. After the COVID-19 pandemic, interviews have continued to be conducted virtually although some programs could consider invitations for in-person interviews.
6. Apply for the NRMP MATCH
Once the interview session ends, you must write your Rank Order List (ROL) using the NRMP website. The rank order list allows you to set your preferences for the programs you interviewed with from the most to the least preferable option you have. Programs also send their Rank Order Lists from the applicants. This explains why we cannot match in a residency program that did not invite us to an interview.
7. Get your MATCH results:
Finally, during the MATCH day (generally in March), applicants are informed if they have “matched” with a program. One of the happiest emails you will get will include the words: “Congratulations. You have matched.”
We have described an overview with brief details of the most important steps to follow to obtain the residency program of your dreams. Our future posts will describe each one of these steps in detail.
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