IMG Path to OrthoStep 2 of 7
Step 2: Exams & ECFMG
Your scores and certification timeline drive everything else. This page keeps it high-level and practical so you can plan backward from your target application cycle.
Step 2 is the differentiatorECFMG timing mattersPlan backward from ERAS
1. USMLE essentials
Think of this as your exam stack. Step 2 usually carries the most weight for IMG applicants.
Step 1 (Pass/Fail)
Baseline requirement. A pass gets you in the game, but it rarely separates applicants.
Step 2 CK (Score)
Often your biggest differentiator. Strong Step 2 can compensate for limited U.S. clinical time early on and helps convince programs you’ll perform well on boards.
Step 3 (Strategic)
Optional. Sometimes useful for visa planning or specific programs, and can strengthen credibility if you’re further out from graduation.
Practical rule of thumb
If you’re deciding what to prioritize: Step 2 first, then build U.S. experiences and letters around that timeline. Don’t let “busy” research months delay Step 2 indefinitely.
2. ECFMG certification (high level)
Programs care because it confirms eligibility for U.S. training and (often) visa processing.
What it is (in plain English)
ECFMG certification is the credentialing process for IMGs. It’s one of the standard boxes programs use to confirm you can start residency training in the U.S. when the time comes.
Why programs care
It reduces uncertainty. For programs, “certification on track” signals fewer last-minute issues around eligibility, onboarding, and (when needed) visa paperwork.
Timing: when you typically need it by
- • By application: Ideal (strongest signal), but not always required everywhere.
- • By ranking: Common expectation for many programs if certification is pending.
- • By start date: Non-negotiable. If you cannot start, you will not match there.
Note: requirements vary by program and can change. Always verify on each program’s website.