USMLE guide for Indian MBBS graduates

To train as a doctor in the United States, an Indian MBBS graduate needs ECFMG certification and then a residency place through the Match. Here's the route with 2026 rules and fees.

Step by step

1. Register for the USMLE through FSMB. Since 12 January 2026, international medical graduates book USMLE Steps through FSMB instead of ECFMG (ECFMG; USMLE).
2. Step 1 (pass/fail since January 2022) and Step 2 CK (passing score 218 since 1 July 2025) (USMLE scoring). Both can be taken in India.
3. English: OET Medicine with 350 in Listening, Reading and Speaking and 300 in Writing, in one sitting taken on or after 1 January 2025 (ECFMG).
4. Clinical skills pathway: apply through one of ECFMG's Pathways (ECFMG pathways). For the 2027 Match, OET scores and the Pathways application must reach ECFMG by 31 January 2027.
5. Get ECFMG certified, then apply to residencies through ERAS and rank them in the NRMP Match.
6. Visa: most IMGs train on a J-1 visa, which needs a Statement of Need from India's health ministry and usually carries a two-year home-country requirement afterwards (USCIS).

Main fees (2026)

Sources: USMLE, ECFMG fee notice (from 1 April 2026). USMLE says 18% GST applies to Step exams taken in India. OET, ERAS, travel and visa fees are extra.

Attempt limits

You can't take the same Step more than 3 times in 12 months, and four or more failed attempts at any Step make you ineligible for all Steps (USMLE eligibility).

2027 Match dates

NRMP registration opened 15 September 2026; rank lists are due 3 March 2027 and Match Day is 19 March 2027 (NRMP).

Common questions