The USMLE guide for international medical graduates
From checking your school to Match day: every requirement in one place, with official numbers and links. Use it to plan before you pay for anything.
Six steps from school to residency
- Check your medical schoolECFMG requires your school and graduation year to be in the World Directory of Medical Schools and to meet its eligibility rules.
- Open your accountsUSMLE services for IMGs run through FSMB. ECFMG certification and the Pathways run through MyIntealth.
- Pass Step 1 and Step 2 CKYou get up to four attempts per Step, and the required Steps must be passed within seven years of the first one you pass.
- Complete a Pathway with OET MedicineECFMG offers six Pathways. All of them need a satisfactory OET Medicine score.
- Apply through ERAS and the MatchWith ECFMG certification you can apply to residency programmes and enter the NRMP Match.
- Plan Step 3Step 3 is held only in the US. It is not needed for certification but is needed for a full licence.
The numbers that matter
How candidates fare
Step 1: 75% passed on the first attempt in 2025, against 93% of first-time US MD candidates. Step 2 CK: 90% of first-time candidates from non-US schools passed in 2024–25. Step 3: 88% passed in 2025.
The 2026 Match
6,733 non-US IMGs matched in 2026. The match rate for non-US citizen IMGs was 56.4%, down 1.6 percentage points from 2025.
Visa effect
Non-US IMGs needing sponsorship matched at 54.4%, compared with 67.9% for those who did not.
Source: usmle.org performance data. From 2025 these figures group Canadian schools with non-US schools.
Match sources: NRMP 2026 results and ECFMG.
What the exams cost
| Exam | Exam fee | Test-delivery surcharge | Total |
|---|---|---|---|
| Step 1 | US$ 695 | US$ 210 | US$ 905 |
| Step 2 CK | US$ 695 | US$ 235 | US$ 930 |
| Step 3 | US$ 955 | None (US test centres only) | US$ 955 |
Sources: fsmb.org and the ECFMG fees page, checked October 2026. Fees can change, so confirm when you register.
Where you can test
| Region | Countries with Prometric centres |
|---|---|
| United States and Canada | All US states, Guam, Puerto Rico, the Virgin Islands and eight Canadian provinces (no surcharge) |
| Africa | Ghana, Kenya, South Africa, Uganda |
| Asia | Bangladesh, Malaysia, Nepal, Pakistan, the Philippines, Singapore, Hong Kong |
| Australia | Australia, New Zealand |
| China | People’s Republic of China |
| Europe | Armenia, Croatia, Denmark, France, Germany, Greece, Ireland, Israel, Italy, Latvia, Netherlands, Portugal, Spain, Switzerland, Turkey, United Kingdom |
| India | India (an extra 18% tax is collected) |
| Indonesia | Indonesia |
| Japan | Japan |
| Korea | Korea |
| Latin America | Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Mexico, Peru, Trinidad and Tobago, Venezuela |
| Middle East | Egypt, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, United Arab Emirates |
| Taiwan | Taiwan |
| Thailand | Thailand |
Source: ECFMG, updated 22 December 2025. Step 3 is given only in the United States.
Guides for your region
Past papers and syllabus
USMLE publishes no past papers, and recalled questions are unlawful to share. Your syllabus is the official content outline for each Step, and the Qbank is built to follow it.