Medical doctors aspiring professional practice in the US have to pass through a three-step examination for medical licensure. It is the USMLE (The United States Medical Licensing Examination). It is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). The results of USMLE, which offer a common platform to doctors from diverse backgrounds, are used for medical licensing. The ECFMG (Educational Commission for Foreign Medical Graduates) states thus: 'Medical schools outside the United States and Canada vary in their educational standards and curricula. The purpose of ECFMG certification is to assess the readiness of graduates of these schools to enter US residency and fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education. Applicants for ECFMG certification must satisfy both the medical science examination and clinical skills, through the specified steps of the examination'. All of the exams required for ECFMG certification are offered continuously throughout the year. There is neither a minimum nor a maximum age limit for applying for ECFMG certification. There is no limit on the number of times you can take the test. The three steps of the examination evaluate a physician's ability to apply knowledge, concepts, and principles that are important in health and disease. This ability is the basis of safe and effective patient care. 

Step 1: It assesses basic knowledge in science, stressing on principles underlying health, disease, and therapy.  It ensures mastery of the sciences supporting competent practice of medicine. Further, it emphasises the scientific principles for maintaining competence in future through appropriate learning.
Step 2 : It measures the capacity for applying medical of clinical science for providing patient care under supervision. This step Covers health promotion and disease prevention. Step 2 CS is a separately administered health  component of the examination that assesses clinical skills. Step 2 CK is computer-based, multiple-choice test that evaluates clinical knowledge. 
Step 3: It determines the ability for applying medical knowledge and understanding of clinical science essential for the unsupervised practice of medicine. It stresses on patient management in ambulatory settings. This step aims at a final assessment of physicians for independent practice. Clinical problems involve mainstream, high impact diseases. Less common clinical problems are also covered. Test items and cases are patient-centered. Both the multiple-choice items and case simulations involve clinical decisions. 

The first two steps are delivered in India. The third step has to be taken in the US. Those who hold the MBBS degree from India are eligible for examination by the ECFMG. There is a constraint in respect of those who are qualified from Medical Colleges outside the US and Canada. The Medical College and graduation year have to be listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER). You can check and confirm whether your college and graduation year have been listed by visiting the site  
The USMLE is an eligibility based examination. To register for the USMLE, you should obtain an eligibility number directly from ECFMG (3624 Market Street, Philadelphia, PA 19104-2685 USA; Phone: +1 215 386 5900, email:; Website: 
Once you receive the authorisation letter from ECFMG, you may get in touch with the Regional Contact Center of Prometric in India, to schedule your USMLE appointment. (2nd Floor, DLF Infinity Tower-A, Sector-25, Phase-2, DLF City, Gurgaon-122002, Haryana; Ph: 0124-451 7145; Website: Steps 1 & 2 of USMLE are held at Allahabad, Ahmedabad, Bangalore, Chennai, Gurgaon, Hyderabad, Kolkata, Mumbai, and Trivandrum. You can register, reschedule, cancel or reconfirmyour appointment on the Prometric website. 

You can take Step 1 or Step 2 CK in either order. For the registration for Step 3, you have to contact ECFMG. There is an interactive web application facility at Detailed information  is available in the ECFMG 

Information Booklet, which can be downloaded from the website, Details of the USMLE are available on the site, 

Step 3

The Federation of State Medical Boards in the US serves as the registration entity for all Step 3 applicants. To be eligible for Step 3, Indian medical graduates must have passed Step 1 and Step 2, and must be certified by ECFMG. 

Step 3 consists of multiple-choice items and computer-based case simulations. It is a two-day examination. You must complete each day of testing within eight hours. The first day of testing includes 336 multiple-choice items. There will be 144 multiple-choice items on the second day. The test items present detailed clinical situations, usually from the patient's perspective. The presentation may be supplemented by one or more pictorials or audio or video. Assessing the patient's situation in the context of his or her environment or family is an important element of many Step 3 questions. The focus lies on: 
• Applying scientific concepts 
• Formulating a diagnosis 
• Managing the patient 

Test preparation 
Indications that help test preparation are available in the USMLE Bulletin of Information. Details can also be gathered from the sample test material in the USMLE website and the USMLE CD available through Prometric. 
Passing performance on an English language proficiency test, such as the TOEFL is no longer a requirement for ECFMG certification. 

How much should you pay? 
The current rates of fees are indicated below. However, you may confirm the rates from ECFMG at the time of registration. 
Step 1: $740 plus International Test Delivery Surcharge $140 
Step 2: CK $740 plus International Test Delivery Surcharge $155 
Step 3: CS $1295 
There are specific rates of fees for the extension of the eligibility period, rescheduling, transcript etc. Confirm the latest rates of fees at the time of application. 
While applying online, the payment can be made through credit card. 

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