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Residency Process

USMLE Step 3

If you are an Indian MBBS student, you are considered as an International Medical Graduate, IMG. Your application must be submitted to the Educational Commission for Foreign Medical Graduates (ECFMG®) before you take the USMLE..

To apply for USMLE examinations, you must submit an application through the appropriate registration entity to the following link:

ECFMG Online Services
ECFMG Fees Details

In order to be certified for the Residency process, you must submit the application, pass USMLE Step 1, USMLE Step 2 CK and USMLE Step 2 CS within the allowed time limits, and present sufficient medical education credential requirements.

Certification does not guarantee acceptance into a residency program. IMGs must complete all of the standard residency application requirements, plus make sure that their application gives them an extra edge to stand out from the crowd. Here are some tips for residency success:

  • Plan your USMLE studies carefully to allow yourself time to fully prepare for optimal success on the first attempt.
  • Participate in observership rotations in a clinical setting before applying to residency programs to become familiar with U.S. medical practices and with U.S. doctors who can serve as references.
  • Obtain letters of recommendation from licensed U.S. doctors. If possible, get these from your most recent clinical rotations opportunities.
  • Learn about program requirements as part of the research process, including visas accepted, graduation year requirements and limits on USMLE exam attempts.
  • Talk to previous graduates from your school and learn from their experiences and advice.
  • Participate in medical graduate research to learn about the field and demonstrate commitment to your desired specialty.
  • Choose your desired specialty early, so you can focus your observerships, electives and research efforts accordingly.

Once you are accepted into a program, if you are not a U.S. or Canadian citizen, you will need to obtain the appropriate visa. Some institutions will sponsor visas for students in their residency programs. The EFCMG is also authorized to sponsor visas for foreign national physicians.

Residency Programs and Specialties

Choosing a specialty is a critical decision. Not only will your choice impact your chances of making a residency match, but more importantly, it will impact your career in medicine for years to come. Here are some questions to ask yourself when choosing your specialty:

  • What do I want to be doing from day to day? Hands-on patient interactions and counseling? Dealing with medical technology? Research and education?
  • How do my skills line up with my desired specialty?
  • What's the job forecast like for my desired specialty?

Although it's important to pick a specialty that you will like, it's also important to be realistic about your odds of securing a match. The most popular and high-earning specialties frequently have the most competitive residency programs. Your faculty and clinical advisors can help you with an honest assessment of your academic performance, clinical strengths and exam scores. Talking to current residents and practicing physicians can give you insight into the specialties you are considering. Go into the decision process with an open mind—maybe a specialty that you had never considered before will be the one that best meets your career goals and residency match profile.

Once you have decided on a specialty, the next step is to research residency programs for potential application. There are several sources that can help you determine your selections:

  • Your Becker residency advisor can help you identify programs that can match your goals and strong points.
  • Talking to past residents can give you information on the day-to-day aspects of a particular location and assess if the program would be a fit for you.
  • The Graduate Medical Education Directory (or the "Green Book") and the online FREIDA database available through the American Medical Association contain program information by location and specialty, plus provide the ability to compare programs.
  • The Accreditation Council on Graduate Medical Education (ACGME) residency directory provides program information by specialty and location.
  • The AAFP online residency directory provides program information for family medicine residencies.
  • NRMP Match results from the previous year can help you narrow down programs based on past competitiveness, including programs with high acceptance rates and ones that did not fill.

As a general rule, candidates should apply to a variety of programs, including hospital, university and community-based programs. The more competitive the specialty, the more programs you should apply to. Even if you are a strong candidate with top grades and high USMLE scores, it does not hurt to include a few less competitive programs for back up.

The Medical Residency Application

Your residency application, submitted electronically through the Electronic Residency Application Service (ERAS®), provides information about you to programs that helps them decide if you could be a potential fit and whether a personal interview will be granted. Application requirements will vary from program to program, so it is critical that you verify the contents before you submit. The application consists of four parts:

  1. Letters of Reference
  2. (CV) Curriculum Vitae
  3. Personal Statement
  4. Medical School Performance Evaluation

Letters of Reference

Programs can ask for a combination of personal and professional letters of recommendation. These letters can provide valuable details and characteristics that can help you stand out among the many applicants. They can also provide details about your academic and clinical strengths, and personal character. If you are an IMG, it is preferable to secure letters of recommendations from U.S. medical professionals where possible.

(CV) Curriculum Vitae

Your CV should detail your educational and professional accomplishments, including contact information, education, internships and observerships, research, association memberships and other professional experiences. Content should be organized in reverse chronological order, with the most recent activities at the top. You can optionally include information about your hobbies and activities to provide a well-rounded view of you as a person and provide additional examples of leadership and other qualities.

When you draft your CV, think about what the residency program is looking for in a candidate and write your descriptions to try and fit those needs. Make sure your CV is error-free, so proofread carefully.

Personal Statement

The Personal Statement is your chance to tell the residency selection committee why you are a good candidate for their program. It should complement your CV, and not repeat the same information or provide just biographical details. It should be both clearly written and engaging.

Your personal statement should explain why you are unique as a candidate and why you are prepared and committed to pursuing a career in your chosen specialty. It should tell why you selected your specialty and what your career goals are. It should also outline why you think you are a good fit for a particular program, and what you think you could bring to the program if you were accepted.

A good personal statement can give you the extra edge to get the interview. Start early to give yourself plenty of time to craft a well-written and personal overview. Be sure to schedule additional time for review.

Medical School Performance Evaluation

Also called the Dean's Letter, the Medical School Performance Evaluation (MSPE) provides a summary assessment of your academic progress in medical school. MSPEs are released to residency programs on October 1 of each year. Every medical school will have a different format for the letter and evaluating your progress. Some involve a personal meeting with the dean or a staff member, so personal information can be included as well.

Timing and follow-up

Ideally, applications should be submitted when ERAS opens up on September 15, or by October 1, at the latest.

Submitted documents are sent by ERAS electronically to as many programs as the applicant chooses. Programs evaluate applications and determine which applicants they want to interview during November, December and January.

Once you hit submit, the process is not over. Following up appropriately can be the difference that gets you the interview. Stay in touch with the program coordinators, affirming your interest. Even if you're not selected initially for an interview, a phone call or an email might get you a canceled slot. Be thoughtful as you follow up. You want to keep in touch but not be seen as a nuisance.

The Medical Residency Interview

If you receive a request for an interview, congratulations. This means your application made it through the first round of review!

The interview is a chance for the program coordinators to meet you and decide if you're a good fit for their program. This is how the selection committee will get to know you as a person and gain insight about how you might respond to the stresses and rigors of residency. Expect to answer questions about your education, motivations for becoming a doctor, career goals and clinical skills. Your answers, communication skills and self-confidence will be assessed, along with your potential fit among existing residents and staff.

If you are an IMG, the interviewer will also be interested in your fluency in English and your understanding of the U.S. residency training environment.

The interview is also your chance to learn as much about the program as possible to see if the program is a good fit for you. Find out as many details about the program as possible in advance of your interview, so you can ask any specific questions that you have—and compare programs against each other when you are done with the interview process.

It's a good idea to bring some prepared questions so you don't forget to ask them. This will ensure that you look prepared and interested to the interviewer. Having a set of questions in advance also helps give you critical information that you need to rank the program after the interview is complete.

The Match

The final stage in the residency process is the Match. You will need to register for a place in the Match through the National Resident Matching Program (NRMP®) before you start the interview process.

After interviews, you will rate all of the programs that you had interviews with in a rank order list from the most desired to the least desired. At the same time, programs will provide a rank order list of all of the candidates that they interviewed. Applicants are then matched by computer algorithm to the highest-ranking program on their list that offers them a position.

The order that you rank programs in is a critical step in the process. Make sure that you put careful consideration into your list. The Match is binding, so you cannot decline the residency you match into for another position. If you are unsure about any of the programs that you interviewed for, you may want to decide upfront if you would rather be unmatched than match into a residency that you don't want.

If you don't match, don't despair! Not everyone will match into a position, and not every position that is left open is undesirable.

Applicants that do not match, and residency programs that have unfilled spaces can participate in the Match Week Supplemental Offer and Acceptance Program (SOAP). Candidates can try and find open slots in their chosen specialties, or consider changing specialties to a less competitive one with more openings. Candidates can also decide to take a year to gain experience that will make their applications more competitive for the next Match, including finding a transitional year program or focusing on research.

STEP 3 Exams

Step 3 is the final exam in the USMLE series of examinations. It is part of the licensing requirements for Doctors of Medicine (M.D.) and International medical graduates to practice medicine in the United States. The USMLE Step 3 exam is considered the final step in the series of medical licensure examinations. Generally, it is a pre-requisite of the majority of the state licensing boards.

The Step 3 examination devotes attention to the importance of assessing the knowledge and skills of physicians who are assuming independent responsibility for providing general medical care to patients. The first day of the Step 3 examination is referred to as Foundations of Independent Practice (FIP) and the second day is referred to as Advanced Clinical Medicine (ACM).

Step 3 MCQ Test Content Specifications

  • General Principles of Foundational Science
  • Immune System
  • Blood & Lymphoreticular System
  • Behavioral Health
  • Nervous System & Special Senses
  • Skin & Subcutaneous Tissue
  • Musculoskeletal System
  • Cardiovascular System
  • Respiratory System
  • Gastrointestinal System
  • Renal & Urinary System Pregnancy, Childbirth, & the Puerperium Female Reproductive & Breast Male Reproductive Endocrine System Multisystem Processes & Disorders Biostatistics & Epidemiology/Population Health, & Interpretation of the Medical Literature Social Sciences

Step 3 CCS Test Content Specifications Categories:

  • General Principles of Foundational Science
  • Immune System
  • Blood & Lymphoreticular System
  • Behavioral Health
  • Nervous System & Special Senses Skin & Subcutaneous Tissue
  • Musculoskeletal System
  • Cardiovascular System
  • Respiratory System
  • Gastrointestinal System
  • Renal & Urinary System
  • Pregnancy, Childbirth, & the Puerperium
  • Female Reproductive & Breast
  • Male Reproductive
  • Endocrine System
  • Multisystem Processes & Disorders
  • Biostatistics & Epidemiology/Population Health, & Interpretation of the Medical Literature Social Sciences


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