USA
The USMLE is the written multiple choice exam required to be accepted into a Residency program in the USA. It consists of three “Steps” that assess different knowledge as you progress through your medical school and residency journey. This set of exams forms one of the main components of every residency application, and will be a major determinant of where and what a candidate will match to.
Exams
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Step One
+Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. It ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. Step 1 is constructed according to an integrated content outline that organizes basic science material along two dimensions: system and process.
Step 1 is a one-day examination. It is divided into seven 60-minute blocks and administered in one 8-hour testing session. The number of questions per block on a given examination form may vary, but will not exceed 40. The total number of items on the overall examination form will not exceed 280.
The examination also includes a minimum allotment of 45 minutes of break time and a 15-minute optional tutorial. The amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires. -
Step 2CK
+Step 2 CK assesses an examinee’s ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 CK ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine under supervision.
Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks and administered in one 9-hour testing session. The number of questions per block on a given examination will vary but will not exceed 40. The total number of items on the overall examination will not exceed 318. -
Step Three
+Step 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. It is the final examination in the USMLE sequence leading to a license to practice medicine without supervision.
The examination material is prepared by examination committees broadly representing the medical profession. The committees comprise recognized experts in their fields, including both academic and non-academic practitioners, as well as members of state medical licensing boards. Step 3 content reflects a data-based model of generalist medical practice in the United States. The test items and cases reflect the clinical situations that a general, as-yet undifferentiated, physician might encounter within the context of a specific setting.
Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.
Register
ECFMG
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Step One
+Obtain a USMLE/ECFMG identification number: Click here
Read the instructions and click next
Click “no, I have never submitted an application to ECFMG for any examination”
Use your FULL NAME to register as it appears on the piece of ID that you will take to write the exam (similar to writing the MCAT) -
Step Two
+Wait for ECFMG to email you your USMLE/ECFMG identification number (usually takes between 1 day - 3 weeks) and one-time password
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Step Three
+Once you have received your number and one-time password, follow the link (will send you back to ECFMG Interactive Web Application site) in the email provided.
Follow the steps to create a new password.
From the home page, click the button in the middle of the page to begin the application for certification, fill out the information regarding name etc and check all the agreement boxes. Click Submit.
You will have to pay $135.00 US at this stage -
Step Four
+Wait to receive an email that Form 186 (Certification of Identification) form is ready. Login to ECFMG and download this as a pdf.
Follow the link at the top of this PDF in order to make a NotaryCam appointment by uploading the BLANK Form 186 PDF and scanned JPEG of your passport (or form of ID you used in STEP 1 above) in the corresponding sections. Submit -
Step Five
+Wait to receive an email from NotaryCam.
You can either select to do the video chat at that moment or schedule it for another time.
All you will need is your passport and a computer or smart phone with video and microphone capabilities.
You can do a diagnostic test of your device using their link in the email. Google Chrome is suggested. -
Step Six
+For your NotaryCam appointment, follow the safe link they provide you with.
You will be asked to create a password and then it will bring you to a live chat with the Notary.
They may send a quick chat message to you to turn on your camera.
They will walk you through all the steps, asking you to show them your passport and click a few buttons. -
Step Seven
+Wait for ECFMG email for the next step, it may take up to 10 days. Follow the link in the email to the ECFMG website, sign in, and under “Being a New Application” click on “USMLE Step1, Step 2 CK and/or Step 2 CS”
https://secure2.ecfmg.org/emain.asp?app=iwa
This is the step where you will pay for the exam, but you will not be able to schedule the exam until later on
You do have to pick a three month period that you wish to write the exam in:
Most students will pick the period of July - Sept (some choose August - October) of the following summer
Note: use your Canadian SIN # in the section where it asks for National ID, leave the US SIN # blank, unless you are American of course -
Step Eight
+Wait for ECFMG to send you an email notifying you that you have a permit to schedule the examination. This will occur either once they have processed your application or no more than six months before the first date of your scheduling block.
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Step Nine
+Access your scheduling permit and print/save it for later. **You will need a hard copy of this permit form to bring to your exam.**
https://secure2.ecfmg.org/emain.asp?app=iwa" -
Step Ten
+Visit the prometric website to schedule your test date.
https://www.prometric.com/en-us/Pages/home.aspx
You will need to enter your scheduling number and last name
Interview Preparation
Prep
You decide which and how many interviews you attend – if you purchase an account with “Match a Resident”, they have a built-in interview manager to keep you organized!
Always have about 2-3 questions prepared to ask the program, examples include:
- What is the most unique aspect of the program in your opinion?
- How are residents given feedback (informal and/or formal)?
- What is something you want applicants to know about the program that may not be experienced since it is a virtual interview?
- How much (or little) research is expected of residents?
- What do the program didactics look like (are they resident led, or faculty led)?
- Are there elective rotation or global health opportunities there?
- What fellowships does the institution have?
- Where do your graduates go after residency? Private practice, fellowship, academics…?
Getting Matched
Visas
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J1 Visa
+-easier to acquire (sponsored by ECFMG)
- exchange visa so you are required to return to home country
-there is a waiver but the process can be gruelling
-a physician can work in a US designated underserved area to waive the requirement depending on specialty
-not a visa meant for a long-term stay in the US
-no pathway to permanent residency (green card) -
H1B Visa
+-requires visa sponsorship and is difficult to acquire (usually large university programs sponsor this)
-lottery-based system, but healthcare workers usually do not have problems
-legal fees are handled by the home department or GMR, so it is a rare visa for residency and fellowship programs
-requires USMLE Step 3 so usually cannot b e obtained during PGY-1 year, but then can be on it for 3 years
-does not have the return to country requirement
-Opportunity to stay in the US and apply for permanent residency
Post Match
If you didn’t match you have a second chance at the SOAP for unfilled positions
FAQ'S
Frequently Asked Questions
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What are the exams and timeline to match in the US? and Canada?
+The two main exams are the USMLE Step 1 and Step 2 CK. Students typically take the Step 1 the summer before the penultimate year (before starting their clerkship). Students take Step 2 CK the summer before the final year. A comprehensive timeline of the US examinations can be found on the AAMC website. You may also view the timeline on the US Pathway to Residencypage of our website.
Canadian Exams The two main exams are the MCCQE1 and NAC OSCE. Students are expected to write both exams the summer before their final year. The NAC OSCE only has two sittings per year. Typically, IMGs take it in the second sitting during early September. Most sit the MCCQE1 during the Medical Council of Canada's third annual sitting which is between August and September. A comprehensive timeline of the Canadian examinations can also be found on the CaRMS website. You may also view the timeline on the Canadian Pathway to Residency page of our website. -
When should I start studying for the USMLE?
+You should aim to start studying for Step 1 at the beginning of your 2nd year of the GEM program or 3rd year of the UEM program, near the end of your pre-clinical years. For Step 2 (and MCCQE1) during your clerkship.
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How do I approach studying for residency exams?
+A comprehensive guide can be found on the Exam Preparation. This page also includes resources and a detailed description of how to use them (including the ANKI deck)
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Can I participate in the Erasmus program in Europe?
+Not all Universities participate in the Erasmus program but check with your school and they will provide you with further information. They may also offer a small stipend to help cover the cost.
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Is it possible to do Electives in the US and Canada?
+Yes, you can do electives in either the US or Canada.
In Canada, official electives are done through the AFMC Portal. Each University has their own criteria so please read them carefully. There are standard checklist items to complete for all, including vaccine forms, N95 mask fittings, and Criminal Record Checks. It's important to prepare these documents (particularly the Criminal Record Check) months in advance to ensure a stress-free process.
In the US, official electives are done through the VSLO website. It is also commonly acceptable to utilize personal connections to find electives. There are also third party websites available to assist students with this process. -
What is the difference between an elective, clerkship, and observership?
+Electives: Clinical experience in the specialty of your choice (likely ont that will complement the residency program you are applying to). You apply through portals or companies.
Clerkship: Core clinical experiences that are mandatory for all medical students training. These include medicine, surgery, acute critical care, pediatrics, psychiatry, OBGYN and family medicine.
Observorship: Shadowing experience/opportunities students usually engage in during their pre-clinical year summers. Most are personal connections organized due to the nature of the opportunity. It's a nice way to get an overview or preview of the specialty you're interested in pursuing. -
Can I do core clinical rotations abroad?
+Yes, depending on which university you are attending. University of Galway and University College Cork offer these opportunities so it is best to speak with your international medical school office/managers to receive further information.
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What is the match rate for different specialties?
+For American rates see here "ERAS 2023 Matches by Specialty"
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What are the options to stay in Europe after residency?
+Students have the option to stay in Ireland by applying to the Irish Internship or applying to the the UK Foundation Year. More information about the Irish Internship Year and the UK Foundation Year can be found on this website.
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What is a preliminary year?
+Regarding residency, there are 2 different positions: categorical and preliminary.
Categorical is when you are offered the full residency training for that specific specialty (i.e. in the US, categorical general surgery positions mean you will train all 5 of your general surgery residency years within the same program and be board certified by the end.)
Preliminary is 1-2 years of training prior to the rest of residency. For example, you would apply to a preliminary position through one program. On completion, you will still need 4 more years of residency completed for general surgery in another program (called & position). -
Why do US and Canada match date order matter?
+They matter as ranking programs after interviewing are legally binding contracts. At this time, the US release their matches before Canada. If you match in the US, your Canadian application is automatically withdrawn (and vice versa).