United States Medical Licensing Examination

International candidates seeking residency and fellowship positions, as well as research scholarships, at Tufts University School of Medicine (TUSM) affiliated and training hospitals, must submit evidence to the Office of International Affairs (OIA), along with their application form, that they have passed the United States Medical Licensing Examination (USMLE) with the required scores to be accepted into these programs.

Note: Research scholarship applicants can be considered candidates if they have passed USMLE Step 1 with the required score, and are preparing for Step 2. However, to be accepted for a research scholarship (and, eventually, a residency position), they also must complete Step 2 with the required scores.

The USMLE is a three-part professional examination sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Physicians with an MD degree are required to pass this examination before being permitted to practice medicine in the United States. The same is true for international medical graduates, regardless of the title of their degree.

USMLE Step 1, the first part of the examination, tests the knowledge learned during the basic science years of medical school. This includes anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology and physiology, as well as interdisciplinary areas including genetics, aging, immunology, nutrition and molecular and cell biology. Epidemiology, medical ethics and questions on patient interaction also are emphasized. The minimum test score for international TUSM candidates is 215, and the number of attempts taken to pass this examination should be provided in your application.

USMLE Step 2-CK (Clinical Knowledge) covers internal medicine, obstetrics and gynecology, pediatrics, preventive medicine, psychiatry, surgery and other areas relevant to providing care under supervision. Clinical situations are described, and candidates required to provide one or more of the following: diagnosis, a prognosis, an indication of underlying mechanisms of disease, and the next step in medical care, including preventive measures. The examination frequently requires interpretation of tables and laboratory data, imaging studies, photographs of gross and microscopic pathologic specimens, and results of other diagnostic studies. The minimum test score for international TUSM candidates is 215, and the number of attempts taken to pass this examination should be provided in your application.

USMLE Step 2-CS (Clinical Skills), the third part of the examination, consists of a series of patient encounters in which examinees must see standardized patients, take a history, do a physical examination, determine differential diagnoses, and then write a patient note based on their determinations. The examination covers common outpatient or Emergency Room visits encountered in the fields of internal medicine, surgery, psychiatry, pediatrics, and obstetrics and gynecology. The minimum test score for international TUSM candidates is Pass, and the number of attempts taken to pass this examination should be given.

USMLE Step 3 is the final examination in the USMLE sequence leading to a license to practice medicine without supervision. Completion of Step 3 is NOT required for international residency and research scholarship candidates. However, for candidates who have taken or plan to take this examination, completion may be in progress at the time of application. If you have passed Step 3, the number of attempts taken to do so should be included in your application.

Registering for the exam: Through its certification program, the Educational Commission for Foreign Medical Graduates (ECFMG) assesses the readiness of international medical graduates to enter U.S. residency, fellowship and hospital research programs in the United States. ECFMG acts as the USMLE registration and score-reporting agency for international medical graduates.

International candidates for TUSM-affiliated residency or research programs will not be considered without completion of USMLE requirements. However, the ECFMG certification process can be in progress at the time of application. The USMLE exam is given at testing centers in the United States and abroad.

To begin the testing and certification process, international TUSM candidates should visit the ECFMG Web site.