In order to practice clinical medicine in an unsupervised setting (i.e., outside
postgraduate training programs), all physicians (domestic and international grads alike)
must pass the USMLE Step 1, STEP 2 and Step 3. Unlike Steps 1 and 2 which are
administered to IMGs by the ECFMG, Step 3 administration issues (registration deadlines,
cost, repeat policy) are regulated by the individual medical boards and can vary from
state to state. You should contact your state medical board for the most current
information. Further, USMLE Step 1 and Step 2 are requirements for obtaining ECFMG
certification. Candidates who have not completed ECFMG certification requirements by
June 30, 1998 are required to take the Clinical Skills Assessment test also as a part
of the ECFMG requirement. The USMLE Step 3 can be completed after joining the
residency program also.
The purpose of the USMLE is to provide the various state licensing boards with a national
"yardstick" by which they can measure and assess an applicant's knowledge of medicine.
The average United States medical student will usually take Step 1 after their
second year of medical school, Step 2 in their third to fourth year of medical school,
and Step 3 after one year of residency. Today many international medical students follow
the same schedule as United States students, but most international medical graduates
take the tests after they have graduated from medical school. This puts this latter
group at a slight disadvantage, since the material they studied in medical school
is now years old and probably out of date.
The USMLE steps are now computerized and offered throughout the year.
More description on the USMLE steps in the following pages:
- USMLE Step 1
- USMLE Step 2
- USMLE Step 3
On October 1, 1996, the ECFMG announced details of a change in the certification requirements for international medical school graduates that will take effect on July 1, 1998. The ECFMG will be providing more definitive information on the changed examination requirements closer to the 1998 implementation date.
Candidates for ECFMG certification will be required to pass the ECFMG Clinical Skills Assessment (CSA) if they have not met all the requirements for ECFMG certification on or before June 30, 1998. Eligibility for the CSA will be restricted to 1) students officially enrolled in a medical school listed in the current edition of the World Directory of Medical Schools (published by the WHO) and who are within 12 months of completion of the full didactic curriculum or 2) graduates of a medical school listed in the WHO directory. All applicants must also have passed the required basic and clinical science examinations and the ECFMG English test (or TOEFL). Those who have already obtained the ECFMG certificate or who meet all of the certification requirements as of 6/30/1998 will not be required to take the CSA, but are eligible to do so.
The CSA will utilize clinical encounters with standardized patients that typify what residents will deal with. The examinee will be asked to obtain histories, peform relevant physical examinations and arrive at initial diagnoses and management plans. Candidates will be required to summarize their findings and management plan in the form of patient progress notes. It is anticipated that the CSA will require a full day of testing and that candidates will examine 10 patients. The standardized patients (often actors) are trained to simulate clinical problems and to document and rate the clinical skills of the examinee as well as his/her interpersonal communication skills.
The CSA is administrered year round at a single test site in Philadelphia, Pennsylvania, USA.
More description on the CSA in the following page:
- Clinical Skills Assessment (CSA)
After successfully completing the USMLE Steps 1 and 2, and the CSA, ECFMG awards the certificate that makes you eligible to apply for residency in the US.
