One of the more frequent discussions among English-language medical students in Italy, especially given that such programs are so new and yet to set solid precedent outside Europe, includes the possibility of doing post-graduate residency training in North America. In the next few articles I will try to give students a general overview of the initial steps one should take in order to potentially acquire Educational Commission for Foreign Medical Graduates (ECFMG) certification in what seems to be a challenging yet mandatory path for International Medical Graduates (IMGs) who wish to practice medicine in the US.

Please note that I will do my best to be as accurate and factual as I can. Nevertheless, if you do find errors, reach out to me and we can work together towards perfecting this article to the best of our ability; some topics concerning the accreditation of the English-language Italian medical programs within different American states remain ambiguous (you can read more about this here and also here) — yet, theoretically, I could not find potential barriers that will prevent graduates from proceeding through the steps of obtaining such certificate, and thus eventually apply safely to some US residency positions.

At large, to be eligible for certification by ECFMG, an IMG must meet the following requirements: attending a medical school that is listed in the World Directory of Medical Schools, passing two written and one clinical board exam (USMLE), and lastly getting the board’s verification of the applicant’s final medical school transcript and diploma. Once granted, ECFMG-certified IMGs would be able to apply for residency positions. It is important to mention that although mandatory, acquiring an ECFMG certificate does not guarantee residency acceptance; in fact, only about 50% of IMGs who apply for residency positions across US are able to match. There are some things IMGs can do in order to significantly increase their residency match chances (i.e. research), which I will discuss in future posts.

Unlike Italian medical licensing exams, which are taken only after graduation, the 3 USMLE exams (Step 1, Step 2-clinical knowledge and Step 2-clinical skills) are taken by US students during their medical education. Foreign students are not obliged to follow a specific schedule as to when they should take each exam, and can also take Step 1, Step 2 CK, and Step 2 CS in any sequence.

Depending on the individual’s circumstances, there are some advantages and disadvantages for taking the USMLE exams before or after graduating an Italian medical school. If for instance, you would like to practice medicine in the US as close to your graduation date as possible, it is better to try and do as many of the three exams possible before you finish medical school. This is because each exam requires a tremendous amount of dedicated preparation, and passing all three after graduation will take some time, hence delaying your ability to apply for ECFMG certification. Another factor to consider is the topics covered in each Step of the USMLE and in parallel, the courses taken during each year of our Italian programs. All the English medical programs seem cover the fundamental pre-clinical science courses within the first three years. Such courses include, for example, anatomy, physiology, pathology, biochemistry, microbiology and immunology, which are most of the subjects covered on the first step of the USMLE. This might favor the option to take the first exam of the USMLE not too long after you finish your third year, supposedly when the relevant material is still quite ‘fresh’ in your head. Keep in mind though that the English-language Italian medical programs are structured to meet EU-wide requirements and not (directly) USA’s medical board requirements and thus there are some significant differences between the specific topics covered in Italian vs. American medical schools; finishing the referenced courses at your Italian university will not guarantee a passing score on the USMLE. Simply put, to do well on the USMLE, you will have to study specifically the content covered on such exams. Students might find this difficult to do while studying simultaneously for their Italian courses, which could make the option of doing the USMLE after graduation more attractive.

There are plenty of great learning resources for students who wish to start preparing for the USMLE, and choosing the right ones will depend mostly on your learning style. I find the set of Step 1 Kaplan lecture notes and videos extremely useful, together with the ‘first aid’ book, which is essentially a condensed version of the most high yield topics on the test. Another popular source for Step 1 is the “U-world question bank”, which many students claim includes a very close question- style to the one found on the actual USMLE.

Another tip I find useful is to start preparing for the exam as early as possible. If you consider persuing a medical career in the US in the near future, even if you do not intend on taking the exams during the initial years of medical school, starting early will allow you to be more familiar with the resources when it is time to study. Note that your scores on Steps 1 and 2 will significantly affect your chances of matching into a residency as a foreign doctor. You can read more about scores here. To view official statistics about last year’s residency match, you can visit

Lastly, I can tell you that by exposing myself to the topics covered on the USMLE, I gained a more practical, clinical perspective to similar topics we study in Italy, which I find tend to be a little more on the theoretical side of medicine; this could be beneficial once integrating to hospital settings during and after medical school.

* The USMLEs might, under specific circumstances, replace certification board exams required by Australia, New Zealand and Israel. Please visit each country’s medical board website for further information.

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