The FAQs

Here, we’ve answered some questions commonly asked by those considering the US and wanting to the USMLE. We cover “cost”, “step 3”, “how to get experience outside of elective time” and “resits”.

How much does all this cost?

This process is not cheap. The following estimates don’t take into account the cost of exam preparation materials.

1.Step 1 fee: $940 (+ $195 for sitting internationally)

2.Step 2 CK fee: $940 (+ $220 for sitting internationally)

3.Step 2 CS fee: $1580 (+ flight tickets to US)

4.ECFMG certification fee: $135

5.Elective costs include flight tickets + living costs + tuition fees. A few places have free tuition, but they usually require a Step 1 score before you apply. Other places have fees, the upper limit at the moment hovers around $1200 per week. Observerships are usually free, especially if arranged through unofficial channels (e.g. directly contacting the doctor you want to observe).

What’s Step 3 all about?

Step 3 is the final exam you need to sit to be a fully licensed doctor in the US. Most US doctors take Step 3 during their ‘intern’ year (equivalent of FY1, before they start their residency). To take Step 3, you must have both a medical degree and ECFMG certification (i.e. pass Step 1, 2 CK and 2CS). Some states and residency programs need IMGs to have passed Step 3 before they can apply for residency. 

I’ve already done my elective somewhere other than the US, but want to apply for residency… how can I get the experience I need?

It’s more difficult to get the required experience, but not impossible. You might be able to squeeze in a clerkship/subinternship/observership if you have another long holiday before you start work as an FY1. Alternatively, there are a few organizations/companies which can arrange for you to get clinical experience once you have qualified. I’m not familiar with this route, but I’m sure a quick Google search will point you in the right direction. 

Can my fellowship count as my US clinical experience for a residency application?

Yes. Let’s say you’re a specialty registrar and you decide to go for a fellowship to the US. Your fellowship can count towards getting the necessary clinical experience and LoRs you would need to apply for residency. But remember, this essentially means retraining from scratch (albeit in a shorter training programme) in the US.

Can I resit exams if I fail?

The USMLE website says you are allowed 6 attempts to pass any component of the USMLE. The majority of people pass the exams first-time round. Your residency/fellowship application may require you to state the number of times you attempted each exam, and some programs might have a cut-off on the number of tries they accept.

Can I resit an exam to improve my score, even if I passed the first time?

No. If you pass an exam, you cannot retake it to improve your score.