The IMG Path

For international medical graduates

The road from USMLE to US residency, in plain words

Nobody gave me a map, so I learned this path the hard way. Here is the map I wish I had: every step from your first exam to becoming an attending, explained simply, one step at a time.

See the 12-step map Follow on LinkedIn

The map

The whole path in 12 steps

Three phases: pass your exams and get certified, apply and match, then train and grow. Each step gets its own post in the series.

PHASE 1

Exams and certification

  1. 1

    USMLE Step 1

    Pass/fail since 2022. Programs see your attempts, so aim to pass the first time.

  2. 2

    USMLE Step 2 CK

    The scored exam programs focus on. Think clinically: what is the next best step?

  3. 3

    OET Medicine + ECFMG Pathway

    Meets the clinical and communication skills requirement. Pathways run on a yearly cycle.

  4. 4

    ECFMG certification

    Steps 1 and 2 CK, verified credentials and an accepted Pathway. You need it to enter the Match.

PHASE 2

Applying and the Match

  1. 5

    US clinical experience

    Observerships and hands-on rotations. Ask for letters while your attending remembers your work.

  2. 6

    ERAS application

    Personal statement, letters and program signals. Check visa sponsorship before you apply.

  3. 7

    Interviews

    Programs invite you after reviewing your application. Know your story and bring good questions.

  4. 8

    The Match

    You and the programs submit rank lists through the NRMP. Results arrive on Match Day in March.

PHASE 3

Residency and beyond

  1. 9

    Residency

    Family Medicine, Internal Medicine or any other specialty. Primary care programs take three years; many others take longer.

  2. 10

    USMLE Step 3

    Taken before or during residency. USMLE recommends about one year of training first.

  3. 11

    Board certification

    From your specialty's board after residency, such as ABFM or ABIM.

  4. 12

    Attending or fellowship

    Practice on your own, or train further. J-1 doctors often start in a waiver job, such as through Conrad 30.

New in 2026: IMGs now register for the USMLE through FSMB. ECFMG still confirms you are eligible.

Need a visa? Most IMG residents train on a J-1 sponsored by ECFMG. An H-1B usually requires passing Step 3, and not every program offers it.

The series

One step a week, on LinkedIn

Each part explains one step: how to prepare, register and book, and what I wish I had known.

  • PART 1The IMG path at a glance
  • PART 2Preparing for Step 1
  • PART 3Registering for the USMLE
  • PART 4Booking your exam date
  • PART 5Preparing for Step 2 CK
  • PART 6ECFMG certification, Pathways and OET
  • PART 7Getting US clinical experience
  • PART 8ERAS, signals and letters
  • PART 9Why an MPH helps an IMG
  • PART 10Step 3, when and why
  • PART 11Visas for residency, J-1 and H-1B
  • PART 12From residency to attending
  • PART 13Tips I wish I'd known earlier

About

Started by Sanjay Karki, MBBS

I grew up in a farming village in Nepal and studied medicine in Bangladesh. I worked as a doctor in Nepal and the Maldives, often as the only physician for an island community, before moving to New York.

Along the way I had to figure out the USMLE, ECFMG certification, US clinical experience and the Match mostly on my own. The IMG Path is the guide I wish I had: honest, simple and free.

Research: co-author of a 2025 study in Medicine (Baltimore) on abnormal amniotic fluid and pregnancy outcomes.

Medical degree
MBBS, University of Science and Technology, Chittagong
Certification
ECFMG certified
Studying
Master of Public Health, Monroe University (2027)
Based in
Queens, New York
Languages
English · Nepali · Hindi · Bengali

Follow

Follow the series

New parts post every week. More channels are on the way.

LinkedIn Instagram coming soon TikTok coming soon Facebook coming soon X coming soon Threads coming soon

Official sources

Always check the source

Rules for exams, certification and visas change every year. This site is general guidance from one IMG's experience, not legal or immigration advice. Confirm every step on the official sites.

  • USMLE: exams, eligibility and the Bulletin of Information
  • ECFMG: certification, Pathways and J-1 sponsorship
  • FSMB: USMLE registration and Step 3
  • AAMC: ERAS applications
  • NRMP: the Main Residency Match