The USMLE (United States Medical Licensing Examination) is a key exam that you must pass to become a doctor in the USA. It tests your medical knowledge and skills through several steps. 

For international students and graduates, understanding the USMLE’s rules is crucial for success. This includes knowing how many times you can take the exam, waiting periods between attempts, and the need for ECFMG (Educational Commission for Foreign Medical Graduates) certification. 

Performing well on the USMLE is a big step towards practicing medicine in the U.S., making it important to get familiar with these requirements early on to plan your study and exam schedule effectively. So, read on to learn more about the USMLE requirements for international students!

What Is the United States Medical Licensing Examination (USMLE)?

The USMLE is crucial in becoming a licensed doctor in the United States. Each aspiring student must pass this exam after medical school to practice medicine legally. That said, excelling in the USMLE is quite demanding and requires a lot of preparation.

The exam consists of three phases, each tackling a specific area of skill in medicine. The first step tests your understanding of science related to health and diseases. The second checks your clinical knowledge and skills, showing how well you can care for patients. The third step assesses whether you can manage patient care unsupervised. This is to ensure doctors have the necessary knowledge and skills to practice medicine safely and effectively.

What Are the USMLE Requirements for International Medical Graduates (IMGs)?

The USMLE requirements for U.S. and Canadian students differ from those applied to internationals. This includes specific rules on the type of medical school, language proficiency, and traveling. 

USMLE Requirements for International Medical School Students

You don’t need to have graduated from medical school to take the USMLE. Internationals can take the exam even if they’re still students at the time of taking it. There is one specific requirement, though: these students must have completed at least two years of their medical studies. In addition, the school they’re enrolled in must be listed in the World Directory of Medical Schools, with an official note that proves the said school meets the requirements set by the Educational Commission for Foreign Medical Graduates (ECFMG). The candidate must also be in good standing at their school. These rules apply to Step 1 and Step 2 CK of the USMLE. 

USMLE Requirements for International Medical School Graduates

International medical graduates who finish their studies outside the U.S. or Canada must follow certain steps to take the USMLE. Again, it’s crucial to ensure their medical school is recognized in the World Directory of Medical Schools. They also need to obtain an Educational Commission for Foreign Medical Graduates (ECFMG) certification. This involves passing exams that assess their understanding of basic medical sciences and their clinical skills. Additionally, they must verify their medical education credentials by proving they have graduated from an approved medical school. Completing these steps allows them to take the USMLE, a key step towards practicing medicine in the U.S.

Additional Requirements

In addition to securing an ECFMG certification and verifying their medical education credentials, international medical graduates aiming to take the USMLE must also navigate a few more hurdles. 

One key requirement is ensuring they have the appropriate visa status. For those planning to enter the U.S. for any portion of the exam or for their residency training, obtaining a visa that permits educational pursuits is crucial. 

Demonstrating proficiency in English is another significant requirement. This typically means passing a recognized English language proficiency test and verifying that the candidate can effectively communicate in an English-speaking medical environment. 

These additional steps are essential for ensuring that international graduates are fully prepared to engage with the U.S. medical system, from understanding patient needs to collaborating with healthcare teams.

What Is the USMLE Format and Length?

The USMLE has three steps, each with its format and content focus. 

Step 1 is a one-day test with around 280 multiple-choice questions, taking about 8 hours. This timeframe is divided into seven 60-minute blocks. This first step tests your knowledge of basic sciences like anatomy, biochemistry, and physiology, focusing on understanding these concepts in medical practice.

Step 2 CK (Clinical Knowledge) is also a one-day test but includes about 318 multiple-choice questions over 9 hours. These are divided into eight 60-minute blocks. This step assesses your ability to apply medical knowledge and understanding of clinical science in providing patient care.

Step 3 is spread over two days. The first day has around 232 multiple-choice questions over 7 hours, while the second day has about 180 multiple-choice questions plus 13 computer-based case simulations over 9 hours. Step 3 evaluates your ability to apply medical knowledge and understanding in unsupervised practice settings, emphasizing patient management.

USMLE Attempt Limits and Time Restrictions

There’s a limit to how many times you can attempt to pass each step of the USMLE. Essentially, you’re allowed up to four attempts for each step. If you’re unable to pass within those four tries, you become ineligible and can’t take that step again. Students were allowed up to six attempts up until July 2021; however, the committee decided to shorten the amount after.

Additionally, if you take a step and don’t pass, you’re required to wait a specific period before your next attempt. For Steps 1 and 2 CK, this waiting period is 6 months, while for Step 3, it’s 4 months. Remember that you can’t take the same step more than three times within a 12-month period. This rule ensures that if you don’t pass, you have to spend some time preparing before you’re allowed to retake the exam. Make sure to prepare ahead, by following a USMLE Step 1 and Step 2 CK study plan.

What Is the USMLE Pass Rate for International Students?

On paper, international students and graduates generally have lower pass rates on the USMLE compared to U.S. medical graduates. However, the percentage of those who passed is heavily affected by the number of exam takers from each category. 

For example, referring to USMLE performance data from 2023:

  • U.S. and Canadian graduates have a pass rate of 92% on their first attempt for Step 1, while for international students, it is 72%.  
  • For Step 2 CK, the percentage of U.S./Canadian students passing on their first attempt is 98%, whereas for international students, it is 88%. 
  • As per Step 3, the pass rate for U.S. and Canadian graduates as first takers is 97%, while for international graduates, it is 92%.

This difference can be due to several other factors. Firstly, the exam content is heavily based on the U.S. healthcare system, which might be unfamiliar to international students. Language barriers can also play a significant role, as the exam is in English and might present challenges in understanding questions quickly and accurately. 

Additionally, differences in educational backgrounds and access to USMLE preparation resources can influence performance. International students often need to adapt to these challenges to improve their chances of passing the exams.


Understanding and meeting the USMLE requirements is crucial for international students and graduates aiming to practice medicine in the U.S. It’s important to remember that you have a limit of four attempts per step and required waiting periods between tries. While pass rates for international test-takers are generally lower compared to U.S. graduates, focusing on overcoming language barriers, familiarizing yourself with the U.S. healthcare system, and accessing quality prep resources can boost your chances of success. 

Start preparing early and make sure you understand all the requirements to reach your goal of practicing medicine in the U.S. Ready to get started? Dive into your USMLE prep today!

Frequently Asked Questions (FAQs):

Which countries’ students are eligible to take the USMLE exam?

Students from any country are eligible to take the USMLE, provided their medical school is listed in the World Directory of Medical Schools.

Can a second year MBBS student in India apply for USMLE?

Yes, a 2nd-year MBBS student in India can apply for the USMLE, as long as they meet the eligibility requirements set by the ECFMG. They can then explore many career options for international MBBS students.

How long are USMLE scores valid for international students?

USMLE scores are typically valid for seven years, but it’s important to check specific residency program requirements as they can vary.

What are the fees associated with taking the USMLE as an international student?

The fees for taking the USMLE as an international student include an exam fee (which ranges from approximately $975 to $1,300 for Steps 1 and 2 CK) and an ECFMG certification fee, with additional costs for test center locations outside the U.S.