USMLE Eligibility for IMGs: Who Can Apply and When

If you are an IMG, you can register for USMLE Step 1 or Step 2 CK when you are officially enrolled in, or a graduate of, a non-US medical school that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, and you meet the other criteria in the Bulletin. You must meet those criteria both when you apply and on the day of your exam.

Eligibility by Step #

USMLE recommends, but does not require, that Step 3 candidates have completed or be near completion of at least one postgraduate training year in an accredited US program.

Two organizations, two jobs #

Two separate bodies are involved, and mixing them up is a common source of confusion.

• ECFMG / Intealth decides whether you meet the requirements for ECFMG certification, including medical school eligibility. See ECFMG certification overview and World Directory and school eligibility.
• FSMB manages USMLE exam services for IMGs, including registration, since January 12, 2026. Before that, ECFMG handled Step 1 and Step 2 CK services for IMGs.

The Bulletin states that IMGs should apply for Step 1, Step 2 CK and Step 3 through the FSMB website. ECFMG still determines IMG eligibility for ECFMG certification, and Step 1 and Step 2 CK remain required for the medical science requirement.

Medical school and graduation requirements #

Your school must be listed in the World Directory with the right eligibility information, and there is also an accreditation requirement for graduates of non-US schools. Read the accreditation requirement because it affects which graduation years and schools qualify. Do not assume your school is eligible because graduates have registered in the past.

Rules that can make you ineligible #

1. Dismissal or withdrawal from medical school. This makes you ineligible even if you are appealing.
2. Leave of absence. Check with your registering organization before applying or testing.
3. Four or more attempts at a Step without passing. If you have made four or more attempts at any Step (including incomplete attempts) without passing, you cannot apply for any Step. Attempts at the former Step 2 Clinical Skills count. See attempt limits and retakes.
4. Prior US license. If you already hold a US physician license based on other exams, you may not be eligible.
5. Passed Steps. You cannot retake a Step you passed, with narrow exceptions.

Time limits and state boards #

The Bulletin does not impose a fixed years-since-graduation limit for registering, but many state medical boards require all Steps to be completed within a set period for licensure. Check the board in the state where you hope to train and practice. Programs may also have their own preferences about graduation year, covered in how programs screen applications.

Step-by-step: confirming eligibility #

1. Search for your school in the World Directory and read the eligibility details.
2. Create or log in to your MyIntealth account and confirm your ECFMG requirements. See setting up MyIntealth.
3. Read the current Bulletin.
4. Register through the route the Bulletin gives for IMGs.
5. Record your eligibility period and plan your seat. See scheduling with Prometric.

IMG-specific considerations #

• Check the Bulletin's name and identification requirements before you register, and fix any mismatch between your records and your ID early.
• You need a valid ECFMG Certificate to be eligible for Step 3 as a non-US graduate.
• Your timeline for ECFMG certification and your timeline for the exams interact; see when to take each Step.