• Introduction
• United States Medical Licensure Examination (USMLE) - an Overview
• Licensure for Foreign Medical Graduates: Step-by-Step Guide
• Links

There is no national medical licensing authority in the US. The license to practice medicine in the US is granted by the individual medical licensing authorities in each of the 50 states, commonly known as the "state medical boards."

Each board sets its own rules and regulations and individuals wishing to practice medicine in the US are advised to contact the state in which they plan to work for complete information.

Contact details for state medical boards are available from the Federation of State Medical Boards (FSMB).

If you are a doctor wishing to go to the US for research that does not involve patient care, you are not required to pass the USMLE.

The United States Medical Licensure Examination (USMLE) is a common method of evaluation for medical licensure established by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME).

It is a single exam comprised of three steps that assess a doctor’s ability to apply knowledge that is important in medicine and that constitutes the basis of safe and effective patient care.

Step 1 assesses biomedical knowledge,

Step 2 assesses clinical science knowledge and

Step 3 assesses the ability to apply medical knowledge and understanding of biomedical and clinical science considered necessary for the unsupervised practice of medicine.

Steps 1 and 2 are administered only on computer, year round, in various regions around the world. Step 1 and 2 Exam scores are valid for seven years for the purposes of US residency application.

On-line information about the USMLE, including a current list of test centers and the USMLE registration bulletin, can be obtained at www.ecfmg.org

To be eligible to take Step 3 you should have obtained an MD degree, have successfully passed both the Step 1 and Step 2 Exam, and have met the requirements set by the individual state medical board that is administering Step 3 (for example, the completion of any postgraduate requirements).

As a foreign medical graduate, you will also need to pass the Clinical Skills Assessment (CSA) and obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG) to be eligible for Step 3 of the USMLE.

The CSA is administered by ECFMG only in the US, in either Philadelphia, Pennsylvania or Atlanta, Georgia

The CSA can be taken either before or after passing the USMLE Step 2, but candidates must pass the USMLE Step 1 and the TOEFL with a passing score of at least 213 (for computer-based test) or 550 (for the paper-based test) before taking the CSA.

CSA scores are valid for three years and TOEFL scores are valid for two years.

Information on Step 3 can be obtained from the individual state medical boards or the Federation of State Medical Boards.

Step I: Contact the State Medical Board

Your first step is to contact the state board of medicine for the state in which you plan to practice.

Most states require ECFMG certification of foreign medical graduates as a pre-requisite to obtaining a license to conduct supervised medical practice in that state.

To conduct unsupervised medical practice, you must also complete Step 3 of the USMLE.

The ECFMG assesses the readiness of foreign medical graduates to enter a residency or fellowship program in the US. They currently administer Step 1 and Step 2 of the USMLE to foreign medical graduates.

You must obtain ECFMG certification in order to take Step 3 of the USMLE.

On-line information about the USMLE, including a current list of test centers and the USMLE registration bulletin, can be obtained at www.ecfmg.org.

Step II: Passing Step 1 and Step 2 of USMLE

Currently, USMLE Steps 1 and 2 are the only approved medical science examinations administered by ECFMG, and offered at Pro-metric testing centers worldwide throughout the year.

Exam scores for Step 1 and Step 2 are valid for seven years for the purposes of US residency application.

Step III: Passing the CSA

All foreign medical school graduates also need to pass the CSA - a one-day examination that examines clinical proficiency and spoken English language proficiency using "standardized patients."

The CSA can be taken either before or after passing Step 2, but candidates must pass Step 1 and the TOEFL before taking the CSA. The CSA is administered in the US by ECFMG in Philadelphia, PA and Atlanta, GA. Scores are valid for three years.

Step IV: Passing an English Language Proficiency Test (TOFEL)

if you passed the ECFMG English Test on or before 3 March 1999, you have satisfied this requirement. However, the ECFMG no longer administers this test, and foreign medical graduates will now need to take the Test of English as a Foreign Language (TOEFL) administered by the Educational Testing Service (ETS).

Step V: Documenting the completion of Medical Education abroad

Successful completion must be from a medical school listed in the International Medical Directory (IMED). The Foundation for Advancement of Foreign Medical Education and Research (FAIMER), a non-profit branch of ECFMG, maintains IMED.

The standard ECFMG certificate remains valid as long as your English language exam is valid (TOEFL results expire after two years). After admission to a residency program, you can apply for permanent ECFMG certification, which means that you do not need to prove English proficiency every two years.

• Educational Commission for Foreign Medical Graduates: http://www.ecfmg.org/
• Federation of State Medical Boards: http://www.fsmb.org/
• International Medical Directory: http://imed.ecfmg.org/
• National Board of Medical Examiners: http://www.nbme.org/
• Pro-metric Test Centers: http://www.prometric.com/USMLE/default.htm
• Test of English as a Foreign Language (TOEFL): www.ets.org
• USMLE: http://www.usmle.org/default.asp