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USMLE, Medical Residency & Fellowship

  • USMLE, Residency and Fellowship applicants are often faced with conflicting information in their efforts at understanding the residency process and finding their ideal medical residency program. We have compiled several relevant medical articles on these vital topics and plan to keep you informed of events in the field of Medical education.
  • Our ultimate goal is to make available all essential information on USMLE, Residency, Fellowship, Physician job search and setting up your private practice in one place - our website. We proudly dedicate this website to all Physicians-in-training.
  • Medical Residency Forum is a discussion community for USMLE, Residency and Fellowship applicants to share information on ERAS, NRMP match, the residency application process, Step 1, Step 2, Step 3 exams, medical licensure issues, board exams and specific problems faced by International Medical graduates (IMG).


  • By issuing this certificate, ECFMG certifies that you have completed all requirements to begin your internship, residency or fellowship.
  • The USMLE exam consists of three components: Step 1, Step 2, and Step 3

UPDATE: New fees for changing appointments at Prometric test centers effective January 1, 2011

Effective January 1, 2011, Prometric will charge a fee if USMLE examinees change testing appointments (e.g., reschedule, cancel, change test center location) at Prometric Test Centers thirty or fewer days before their scheduled test date. No fee is charged for changing testing appointments 31 or more days prior to the first day of the scheduled test.

The date that you change your appointment, using local time at the Regional Registration Center for the Prometric Testing Region, will determine whether you pay a fee and the amount of this fee:

- If you change your appointment 31 or more days before (but not including) the first day of your scheduled test date, there is no fee.

- If you change your appointment fewer than 31 days but more than 5 days before (but not including) the first day of your scheduled test date, there is a $50 fee.

- If you change your appointment 5 or fewer days before (but not including) the first day of your scheduled test date, there is a higher fee. This fee varies by Prometric Testing Region and by exam.

For complete information and a schedule of fees, visit the USMLE website at www.usmle.org.

This policy applies only to appointments for USMLE Step 1, Step 2 Clinical Knowledge (CK), and Step 3. For information on the fees associated with changing testing appointments for Step 2 Clinical Skills (CS), refer to Rescheduling in the ECFMG Information Booklet available on the ECFMG website at www.ecfmg.org.

ECFMG Newsletters

  • Signup for three free email Newsletters from ECFMG
  1. The ECFMG Reporter is a free email newsletter for IMGs (International Medical Graduates) sitting for the USMLE Step 1, 2 & 3 exams about ECFMG certification. To subscribe, click the above link.
  2. The ECFMG Correspondent is a free email newsletter for ECFMG certified physicians. This newsletter focuses on the J-1 Exchange Visitor Sponsorship Program, performance of IMGs in the USMLE exams, CSA, NRMP Match etc.
  3. ECFMG-ERAS News is a free email newsletter for residency applicants who are in the ERAS / NRMP match. It gives important updates and changes to the ERAS application process.

ECFMG Certification

  • When you have completed USMLE Step 1, Step 2 CK & Step 2 CS, you will be eligible for ECFMG certification.
  • You will initially be given a standard ECFMG certificate with an expiry date.
  • If you don’t join a medical residency or fellowship program before the date printed, your ECFMG certificate will expire.
  • Do this ASAP after starting your residency. You will require your residency program director’s signature on the form.

Minimum Passing Scores on USMLE Step Examinations

  • The requirements for passing the USMLE Step examinations are updated often.
  • There are two scales on which USMLE results are reported, a three-digit scale and a two-digit scale. On the three-digit scale, the current minimum passing scores are as follows:
Examination Minimum Passing Score 
Step 1  188 
Step 2 CK  189 
Step 3  187 
  • On the two-digit scale, the minimum passing score is always a 75.
  • Performance on Step 2 Clinical Skills (CS) is reported as a pass or fail only, without a numerical value.

Number of Attempts and Time Limits

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  • There is no limit on the total number of times you can retake a USMLE Step or Step Component you have not passed.
  • However, USMLE recommends to state medical licensing boards
  1. that the state medical boards have a time limit of 7 years within which you should have passed Step 1, Step 2, and Step 3 examinations.
  2. that the state medical boards allow no more than six attempts to pass each Step or Step Component
  • The ultimate decision on accepting these above USMLE recommendations rests on the state medical licensing boards. This is the reason that there are so many confusing requirements from each state medical licensing authority.

Time limit for completion of all three Steps

  • The time period may start from the date the first USMLE Step Component is passed (or in some states from the date of the first attempt even if you didn't pass that attempt)

Retaking a USMLE Step

  • There is no limit on the number of attempts to pass each USMLE Step.
  • There is a minimum wait period of 60 days between consecutive attempts and a limit of three attempts in a 12-month period.
  • For USMLE Step 1 and Step 2 CK: You can retake the exam no earlier than the first day of the month that begins at least 60 days after your previous test date.
  • For Step 2 CS and Step 3: Your eligibility period for the retake will begin no earlier than 60 days after the date of your prior attempt.
  • For Step 3: You may not reapply sooner than 60 days after your last attempt.

USMLE & ECFMG Rules in General

  • If you pass a Step or Step Component, you are not allowed to retake it.
  • To be eligible to register for USMLE Step 3, you must have passed Step 1, Step 2 CK and Step 2 CS.
  • You can take the Step 1, Step 2 CS or Step 2 CK in any order or sequence that you wish (provided you fulfill all eligibility requirements)
  • Individuals who have passed Step 2 prior to the implementation of Step 2 CS are not permitted to take Step 2 CK.

USMLE Step 3 eligibility

  • To be eligible to apply and register for USMLE Step 3, you must have

Graduated from medical school and obtained a MD / DO degree (or its equivalent)

  • Passed Step 1, Step 2 CK, and Step 2 CS
  • Should be ECFMG Certified.
  • Fulfill other requirements as determined by the state medical licensing board to which you are applying (residency requirements etc).

Differences between MD and DO

  • DO : Doctors of osteopathic medicine. They are referred to as osteopathic physicians
  • MD : Doctors of medicine. They are also referred to as allopathic physicians

For all practical purposes, DO trainees undergo an almost identical training as MD trainees do; with additional emphasis on osteopathic joint manipulations. They can merge into the mainstream and complete conventional residencies in hospitals and training programs; and are eligible to get licensed in all states. Detailed article on Comparison of MD and DO in the United States


COMLEX-USA or Comprehensive Osteopathic Medical Licensing Examination is a series of three osteopathic medical licensing examinations administered by the National Board of Osteopathic Medical Examiners (NBOME) similar to the United States Medical Licensing Examination (USMLE). COMLEX-USA is the most common pathway by which osteopathic physicians (D.O. apply for licensure, and is accepted in all 50 states. The 3-digit standard scores of COMLEX-USA Level 1, Level 2-CE, and Level 3 have a mean of 500. Detailed article on COMLEX

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