May 20, 2008


Renowned American author John A Shedd, once said: "“A ship is safe in harbour, but that is not what ships are for.”

In the journey towards postgraduate medical education, this rings true in more ways than one. Upon completion of the MBBS in India, there are several avenues open to doctors for specialisation. With degrees, diplomas and specialised courses offered in every field imaginable, the options are endless.

When deciding to pursue residency abroad though, the United States of America offers doctors tremendous opportunity in the medical specialties with the benefit of a highly structured application procedure for international medical graduates.

The Education Commission for Foreign Medical Graduates (ECFMG) is the organisation, which certifies international medical graduates for entry to US graduate medical education programmes.


The first, and easily the most important requirement for applying to residency programmes in the US, is completion of the United States Medical Licensing Examinations (USMLE).The USMLE consists of four parts:

Step One and Step Two Clinical Knowledge are both computer-based examinations comprised of multiplechoice questions.

Step Two Clinical Skills is a practical exam that involves examining and diagnosing standardised patients.
Step Three, the final exam in the series, is a computer-based exam with both multiple choice questions and clinical case simulations.

These exams can be taken in any order, except Step Three, which requires the candidate to have passed the prior steps, and which can be taken in advance or during residency training itself.While Step One and Two CK are offered at various centres across India, Step Two CS and Step Three can only be taken at centres in the US and its territories.

It is essential to apply well in advance for these exams, as the demand is tremendous and dates get filled rapidly. Applications for all the exams, except Step Three, are made through the ECFMG website

Rigorous preparation for the USMLE is vital, because even though the exams can be taken repeatedly on failure to pass, a passing score remains valid for seven years and cannot be bettered by repeated attempts at the examination. There are various resources in the form of classes, as well as online question banks, which can be purchased to aid with exam preparation.

It is also imperative to solve questions early on in order to become accustomed to the style of answering, which is quite different from that of the Indian medical exams. More information about the USMLE is available on the website (


Certification awarded by the ECFMG is a measure of the readiness of foreign-trained doctors to enter accredited residency programmes in the United States. Certification is awarded when the following criteria are met: successful completion of Step One and Two (CK and CS) and verification of medical education credentials - a procedure involving correspondence between ECFMG and your medical college in India.

Receiving ECFMG Certification is mandatory for international, medical graduates prior to entering accredited residency programmes in the United States. The USMLE Step Three Examination also, can only be applied for after obtaining ECFMG Certification.


If you are an international medical graduate, it is important and highly advantageous to have gained US clinical or research experience prior to applying. Such experience can be obtained in various forms and should ideally continue for at least two to three months.

An Observership involves shadowing a doctor or a team but has strict regulations, forbidding direct patient contact. An Externship, which is done during medical school or internship, offers more hands-on training, and hence provides a more thorough clinical experience.

Says Dr Rohit Singhania, who has just completed a residency in internal medicine from a hospital in New York City,“With the increasingly competitive process of getting into a residency in the US, apart from good scores (which are a prerequisite), it definitely helps to have clinical experience here in the US, along with the related letters of recommendation.These help to strengthen the application significantly.”


Applications for most residency programmes are routed via the online Electronic Residency Application System (ERAS), to which you can submit your application and apply to programmes as well.

The ERAS system generally starts accepting applications around the beginning of September, and it is important to note that each programme has its own application deadline. No matter what the deadline, it is highly beneficial to apply early.

Letters of recommendation and the personal statement are integral parts of the application. It is vital to obtain strong, sincere letters of recommendation from people who have known you as a student/ doctor for a reasonable period of time. If you have had the chance to observe/ work under doctors in the US, submitting letters of recommendation from them is extremely valuable as well.

A personal statement is the one chance you have to give programme directors an insight into your personality, beliefs and career goals. Make it honest, interesting and powerful. Perfecting your personal statement is time well spent, as it can create an extremely favourable impression about you.


Based on the applications submitted to ERAS, programmes invite suitable candidates for a personal interview. Interviews are generally scheduled between October and January, but this varies between programmes. If you are travelling from India for an interview, it is helpful to schedule the interviews well in advance, as well as anticipate air/ road travel between various cities, hotel reservations, etc.

It is essential to be well prepared for the interview, as programmes meet with hundreds of candidates during each application season. Acquaint yourself with the programme through its website and be ready to talk about yourself and the features you have listed in your CV. Also, since interviews offer a chance to learn more about the programme, feel free to ask questions to the faculty and other residents you meet there.

The final step in the journey to obtain a residency position in the United States is known as ‘The Match’ . Both applicants and residency programmes submit rank order lists based on individual preferences.

The National Residency Matching Programme (NRMP) then compares these lists using a computerised match algorithm. This results in successful applicants being matched into suitable residency programmes.

The process of entering a residency programme in the United States requires a high degree of dedication and fortitude. Matching into a programme in a truly international arena however, offers Indian trained doctors a new perspective to medicine, which can only complement all they have learnt in medical college.

(Dr Risheen Reejhsinghani)

(Courtesy: The Times of India)

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