The IMG Roadmap: From Medical School to US Residency, Year by Year

To train in the US as an international medical graduate (IMG), you must pass the required USMLE exams, earn ECFMG certification, submit a residency application through ERAS, interview, and match through the NRMP. This page shows those steps in the order most applicants meet them and points to the detailed guide for each one.

The years below are labelled relative to the year you apply (Year 0 is the application year), because your calendar will differ from anyone else's.

The big picture #

Year -3 to -2: Foundations #

This is the stage to check eligibility and decide whether the path is realistic for you.

1. Verify your school and graduation year. Start with the World Directory and school eligibility and the accreditation requirement.
2. Create your MyIntealth account and begin credential verification. See setting up MyIntealth and EPIC credential verification. Verification can be slow because it depends on your school and licensing body.
3. Understand the full path with the ECFMG certification overview.
4. Build a rough budget using the total cost guide.
5. Start thinking about specialty. Read choosing a specialty before you commit years to one direction.

Year -2 to -1: Exams #

The two exams every IMG needs for ECFMG certification are Step 1 and Step 2 CK.

• Read the Step 1 guide and the Step 2 CK guide.
• Decide the order and spacing with when to take each Step.
• Check USMLE eligibility for IMGs and how scheduling works.
• Use NBME self-assessments to decide when you are ready, and know the attempt limits before you register.

Step 1 is reported pass/fail, so Step 2 CK is where a three-digit score can still help you. See Step 2 CK scores and what programs look for.

Year -1 to 0: Experience, research and the application #

Programs do not only read scores. They look for evidence that you can function in a US clinical team.

• US clinical experience: USCE explained, how to get it and how much programs want.
• Letters: turning USCE into a strong letter and letters of recommendation.
• Research: why research matters for IMGs, and when it does not.
• Application materials: ERAS timeline, MyERAS walkthrough, experiences section and personal statement.
• ERAS token: IMGs need a token to start their application. See the ERAS token.

Year 0: Application and interview season #

1. Build your program list with building a program list, identifying IMG-friendly programs and how many programs to apply to.
2. Use signals deliberately: program signaling explained.
3. Understand screening: how programs screen applications.
4. Prepare for interviews: interview season overview and common interview questions.
5. Plan travel and visas for interviews if you will attend in person: B-1/B-2 for interviews and exams.

Year 0 to +1: Match and the move #

• Build your rank order list, learn how the algorithm works and what Match week looks like.
• Know the fallback: SOAP and what to do if you do not match.
• Start the visa process right after the Match: your visa timeline after the Match. Compare options in J-1 vs H-1B.
• If you may want an H-1B, read Step 3 and H-1B timing early, because Step 3 is often planned around that decision. The Step 3 guide covers the exam itself.

What can change the plan #

For a realistic time estimate, read how long it takes.

Rules, practice and opinion #

The exams, ECFMG certification and the Match are official requirements. Typical timing, how much experience to gather and how many programs to target are common practice, not rules. Our view (opinion): start earlier than feels necessary, keep a single tracker of documents and deadlines, and revisit your plan after each exam result rather than committing to a fixed calendar.