In the last few posts, we have talked about the USMLE Step 1, Step 2 CK, and Step 2 CS. In order to get ECFMG certification, you need to have passed all three of these exams. These three exams are also the prerequisites for the USMLE Step 3 exam, which you need to pass in order to earn a license to practice medicine in the United States. As a foreign medical graduate, you have the option of taking the exam before submitting your application to a U.S. medical residency program or taking it after your residency has started. Depending on your personal situation, there are benefits and drawbacks to both approaches. Here three critical questions you need to ask yourself when making this decision:

Question 1: Do you have enough time to prepare for and take the USMLE Step 3 before applying to a residency program?

Before you take the USMLE Step 3, you already need to have passed the USMLE Step 1, Step 2 CK, and Step 2 CS. As a foreign medical graduate, you also need to have fully completed the ECFMG certification process. Your timeline for meeting these requirements can help you determine whether or not you want to take the USMLE Step 3 before you apply for your residency. You need to remember that preparing a successful residency application takes a great deal of time and effort, and you don’t want to rush through it because you are trying to study for the USMLE Step 3 at the same time — not to mention balancing the residency application process with the other responsibilities in your life.

However, if you have completed the requirements well in advance and feel like you have more than enough time to prepare yourself for success on the USMLE Step 3 before applying for your residency, it can reduce pressure once you start your residency. In most states, you need to pass Step 3 before the third year of your residency program, which can be a challenge as you balance residency program requirements, personal responsibilities, and adjusting to life in the United States. So if it’s easy to fit the USMLE Step 3 into your schedule before you apply for a U.S. medical residency, you may want to consider it.

Question 2: Do you have the medical background you need for success?

Like the USMLE Step 1 and Step 2 CK, the first part of the USMLE Step 3 consists entirely of multiple choice questions. The second part is somewhat similar to Step 2 CS — it tests your clinical skills, but instead of interacting with real-live patients, your performance is evaluated on a series of computer-based case simulations.

But don’t be fooled by these structural similarities. The USMLE program recommends that applicants have completed at least one full year of post-medical school training before taking the Step 3 exam. Therefore, many American and foreign medical school graduates use the first year of residency training as preparation for the USMLE Step 3.

However, some foreign medical graduates who apply for U.S. medical residency programs have already gained additional educational or work experience after medical school. For instance, you may have completed a post-graduate education program in your home country and/or completed a graduate externship in the United States. If that is the case for you — and you did well on the USMLE Step 1, Step 2 CS, and Step 2 CK — you may have the foundation you need for success.

Question 3: Are there logistical issues that you need to consider?

In some cases, whether or not you take the USMLE Step 3 before applying to a U.S. medical residency program can come down to logistics. These three logistical issues commonly come into play:

    • Immigration status. In order to apply for an H1-B Visa sponsorship, you need to have passed the USMLE Step 3. If you plan to apply for this type of visa, you should plan to take the USMLE Step 3 before applying.
    • Cost. The USMLE Step 3 can be cost-prohibitive for some students. If you can’t afford the $875 fee, you should wait until after you can save some money from your first year of residency work.


  • Location. The USMLE Step 3 is only offered at Prometric test centers in the United States and its territories. If traveling to the United States from your location is too expensive or difficult, you should probably just wait until you start your program. Alternatively, if you are already in the United States — whether for a graduate externship, to visit family, or to see the sights — it may be convenient to take the test.

If you need more help making decisions about the residency application process, FMG is here to help. Contact us today for more information!