The USMLE for international medical graduates

Who does what

Your name in your FSMB account has to match your name with Intealth exactly. If it doesn’t, email usmle@fsmb.org. Allow at least two weeks for FSMB to approve your application and send your permit.

• ECFMG, through MyIntealth: your Application for ECFMG Certification, checking your medical school credentials, and the certificate itself.
• FSMB: Step applications, scheduling permits, eligibility extensions, testing region changes, score reports, rechecks and transcripts.
• Prometric: booking your test date.

Who can register

You must be enrolled in, or have graduated from, a medical school outside the U.S. that’s listed in the World Directory of Medical Schools as meeting ECFMG’s rules, and meet ECFMG’s other criteria. That has to be true when you apply and on test day.

Graduates of Canadian medical schools from July 1, 2025, onward are counted as international medical graduates too.

Fees as of October 2026

In India, an 18% tax is added to Step 1 and Step 2 CK. ECFMG charges its own certification fees on top.

ECFMG Certification and Step 3

ECFMG still needs you to pass Step 1 and Step 2 CK for its exam requirement, and it sets a separate clinical and communication skills requirement. You need ECFMG Certification to start an ACGME-accredited residency or fellowship, and a valid, unexpired certificate to apply for Step 3.

Step 1 and Step 2 CK are offered at Prometric centers around the world. Step 3 is only offered in the U.S. and its territories, so plan travel if you’ll take it from abroad.