Pathway guide · Verified August 2026
The USMLE pathway for international medical graduates.
Thousands of doctors trained outside the United States enter US residency every year through the same three steps American students take — plus one extra gate: ECFMG certification. Here is the entire pathway, in order.
The pathway, step by step
1. Create your MyIntealth account
MyIntealth is the online platform through which ECFMG services run — certification applications, document upload, and exam registration for IMGs. Your identity and medical-education credentials are verified here first; everything downstream depends on it.
2. Apply for ECFMG certification
Certification requires verified medical-education credentials, the English-proficiency requirement (OET Medicine), and passing Step 1 and Step 2 CK. You can begin steps before certification is complete, but the Match requires finished certification.
3. Pass USMLE Step 1
The basic-science step, reported pass/fail. Strong question-bank volume with systematic wrong-answer review is the core preparation method — see our Step 1 guide for structure and timelines.
4. Pass USMLE Step 2 CK
The scored clinical-knowledge step that carries the most weight in modern residency applications. Management reasoning, next-best-step decisions, and full-length timed practice define preparation.
5. ERAS applications and the Match
Through ERAS you apply to residency programs; interviews follow; the NRMP Match assigns positions. US clinical experience (electives or observerships) strengthens applications materially for IMGs.
6. Step 3 during residency
Most states require a passing Step 3 for full licensure; many residents take it in the first years of training. Certification plus Step 3 completes the licensure chain.
USMLE around the world
The pathway is identical for every nationality — what differs is local context: testing centers, verification timelines, and community. The countries below are where ClinIQ students are most active.
- Jordan →
One of the largest IMG communities; Jordanian graduates have a long US-residency track record.
Saudi Arabia
Large cohort pursues USMLE alongside residency programs; Prometric centers available in-country.
Egypt
One of the biggest medical graduate pools in the region; strong private USMLE-prep scene.
United Arab Emirates
Mix of local and expatriate medical students; Prometric centers in Dubai and Abu Dhabi.
Kuwait
Growing IMG interest, with candidates commonly testing at regional Prometric centers.
Qatar
Candidates typically combine local training with USMLE steps; Prometric available in Doha.
Iraq
Rising USMLE interest among graduates pursuing US training pathways.
Palestine
Established IMG pipeline; candidates usually test in neighboring centers.
Lebanon
Long-standing US-residency tradition among graduates of Lebanese medical schools.
Syria
Significant IMG community; ECFMG verification of medical education runs through standard channels.
Yemen
Candidates commonly complete steps at regional Prometric centers.
Oman
Small but active cohort; Prometric centers available in-country.
Bahrain
Candidates typically test regionally; growing USMLE interest.
Libya
IMG candidates follow the standard ECFMG certification pathway.
Algeria
French-curriculum graduates add USMLE steps for US training; medical-document verification applies.
Morocco
Established IMG pipeline with candidates testing at regional centers.
Tunisia
Growing USMLE interest among graduates of Tunisian medical schools.
Sudan
Active IMG community pursuing ECFMG certification.
Official sources for processes, fees, and testing: ECFMG · MyIntealth · Prometric. Regulations change — always confirm against the official sites before acting.
IMG questions, answered
What is an IMG in the USMLE context?
An international medical graduate (IMG) is anyone who graduated from a medical school outside the United States and Canada. IMGs take the same three USMLE steps as US students, plus an extra certification layer: ECFMG certification, which verifies the medical degree and English proficiency before testing can begin.
What is ECFMG certification and why does it matter?
ECFMG certification is the gateway for IMGs: it verifies your credentials and English proficiency, and it is required both to enter Step 3 and to participate in the Match. Certification runs through MyIntealth, the platform that replaced the classic ECFMG portal.
What is the IMG pathway in order?
Create a MyIntealth account and apply for ECFMG certification; pass OET Medicine for the English requirement; pass Step 1 and Step 2 CK; register through ERAS and enter the NRMP Match; complete Step 3 during residency where required for licensure.
Preparing from anywhere in the world.
ClinIQ was built for international medical graduates: full QBank, Step eBooks, flashcards, and AI analytics — on web, iOS, and Android.