United States Medical Licensing Exams (USMLE) has multiple steps.
Step 1 and Step2 CK can be taken in the home country and in any order.
Step 3 however is taken in the United States only after finishing Step 1, Step 2 CK, finishing medical school and having received a medical degree and securing an Educational Commission for Foreign Medical Graduates (ECFMG) certificate.
It is important to recognise that Step 3 is not required to start residency and can be taken during residency however, Step 3 is required to secure an H-1B visa for the residency.
In addition, with Step 1 being only pass/fail, a high Step 3 score will benefit in establishing a strong candidacy for a Foreign Medical Graduate (FMG).
Step 1 tests concepts acquired during the preclinical years of medical school. The test is delivered over eight hours. The cost is ~$1,000
Step 2 Clinical Knowledge (Step 2 CK) is a one-day exam administered over nine hours. Cost: ~$1,000
For non-native English speakers, passing an English proficiency exam like the Occupational English Test (OET) is required for certification. Cost: ~$200-$300
ECFMG certification: Cost ~ $925 for the certification fee, but this process includes verifying your medical degree and credentials, adding to the cost.
Step 3 is a two-day exam. The first day is a seven-hour multiple choice questions test. The second day is a nine-hour test and includes multiple choice questions and 13 case simulations. Cost: ~$900
US clinical experience in the form of electives/observership. These rotations are often costly and competitive to secure. Cost: Starting from ~$2,000 per rotation.
ERAS application: Cost: $11 per programme for the first 10 programmes, $30 per programme after that. Most IMGs apply to 150-200 programsme, which can amount to over $3,000 in application fees alone.
In addition, there are miscellaneous costs that add up fast. These include but are not limited to the cost of living while on rotation, visa application, flights to the United States and then within the United States for rotations at different hospitals. Flights and hotel stay for in person interviews or Step 3 exam.