Studying for the USMLE in Pakistan

The USMLE Journey as an IMG in Pakistan

Pakistani medical students must understand everything required of them after completion of medical school along their journey to becoming a doctor in America. Before an International Medical Graduate (IMG) from Pakistan can come to the United States to complete their residency and become a doctor in America, they must first obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG). To obtain ECFMG certification, one must graduate from medical school, pass the Occupational English Test (OET), and pass the United States Medical Licensing Examination® (USMLE®) Step 1 and Step 2 CK exams. Studying for the USMLE from Pakistan is not always easy, but with the right guidance, an IMG can conquer these exams and earn passing scores.

How to Become a U.S. Doctor as an IMG From Pakistan

Before we break down how to study for the USMLE from Pakistan, here’s an overview of the step-by-step process to becoming a doctor in America if you are an IMG from Pakistan and where studying for the USMLE fits into that process.

  1. Register for ECFMG certification
  2. Take a USMLE Step 1 prep course and prepare for the exam
  3. Pass the USMLE Step 1 
  4. Take a USMLE Step 2 CK prep course and prepare for the exam
  5. Earn a good score on the USMLE Step 2 CK
  6. Prepare for and pass the OET
  7. Receive your ECFMG certificate 
  8. Submit a MyERAS® application and register for NRMP
  9. Match with a U.S. residency program! 
  10. Take USMLE Step 3

ECFMG Certification for an IMG in Pakistan

First, IMGs from Pakistan will need to apply for certification by the Educational Commission for Foreign Medical Graduates (ECFMG). ECFMG application must be completed before you can take the USMLE exams. Earning this certification proves that you have met all necessary training requirements from a medical school outside of the United States that is listed in the World Directory of Medical Schools.

An IMG cannot become certified until after they complete medical school and receive their diploma. An international medical student may begin their certification process by applying to required exams as soon as they meet their respective requirements; but the ECFMG certificate’s diploma requirement just means certification cannot be completed until after graduating from medical school.

ECFMG Requirements include:

These ECFMG examination requirements must be completed within time limits and/or seasonal application cycles.

How to Prepare for the USMLE Exam in Pakistan

The best way to build a comprehensive, yet personalized study plan and package for the USMLE Step 1 and USMLE Step 2 CK in Pakistan is to enroll in a USMLE prep course with an expert teacher of the exam. Kaplan gives you the option to prepare for the USMLE at your own speed or to prepare for the USMLE live with an instructor.

Often, international medical students and graduates find it easier to utilize Kaplan’s On Demand Course given scheduling and language limitations, among other factors. But if you are not yet sure how to prepare for the USMLE from Pakistan, start your prep journey with our free practice resources.

When to Prepare for the USMLE Exam in Pakistan

The sooner you start to study for the USMLE exam, the better; Kaplan experts recommend studying for six-to-twelve months before taking USMLE Step 1, and four-to-seven months before taking USMLE Step 2 CK. International students who take Step 1 immediately after completing basic science subjects often feel that it’s easier to recall the more difficult subject matter. However, it may not be optimal for everyone to take Step 1 during the summer after completing basic sciences curriculum.

Consider these factors when deciding the best time for you to take Step 1:

  • Most IMGs will find that traditional first-year topics are difficult to recall, and that behavioral science and U.S. epidemiology are not covered in their medical school’s curriculum.
  • Many students educated outside the U.S. are not exposed to the types of integrated clinical vignettes that appear on Step 1, and therefore, are not accustomed to 8-hour computerized exams. Full preparation for Step 1 requires not only a firm understanding of the subject matter, but the ability to integrate information across disciplines, apply knowledge to difficult clinical vignette questions, and to maintain stamina and concentration during a lengthy exam period.
  • Some medical graduates in Pakistan return during semester breaks to complete a live review course.  However, most non-U.S. IMGs are not able to do this until after graduation, when they can attend a Kaplan Medical review course in the U.S. on a student visa, due to time constraints during medical school and/or internship/house surgency.

Does taking the USMLE in a certain month give you a better score?

A common misconception by many international and Pakistani medical students is that taking the USMLE in a particular month will get them a better score. There is no statistical evidence that shows IMG test results are affected by U.S. students’ test-taking trends. Still, if you’re taking the exam in the U.S., it’s possible that your testing site will have less availability in the summer months when U.S.  students are taking Step 1, so be sure to reserve your test date in advance if you must test during the summer months.

Consider Prerequisites and Application Deadlines

If you intend to apply for an elective rotation in the U.S. (which are only available to Pakistani students who have not yet graduated), Step 1 may be a prerequisite. Keep this in mind when weighing the advantages and disadvantages for taking Step 1 while enrolled in medical school. Your goal should be to have all scores available by the time you transmit your ERAS(r) (Electronic Residency Application Service) application. Competitive Pakistani applicants know that their application should be submitted as soon as possible once ERAS begins to accept applications—typically by mid-September. Dates may vary year-to-year.

Should you take Step 2 CK before Step 1?

After coming out of your internship year (house surgency), it’s a great feeling to finally be working on a clinical level. Because your clinical knowledge is fresh, it’s tempting to take the Step 2 CK exam first. Although it may be counter-intuitive, we still recommend taking Step 1 first, and here’s why: Step 2 CK has continued to evolve to include more and more material previously relegated only to Step 1.

If you begin reviewing Step 2 CK first, you’ll inevitably find that your basic science foundation is weaker than you realized, which can slow down your preparation as you backtrack to review Step 1 information. This could eventually cause you to miss important Step 2 CK questions on the exam. Our advising experience has shown us that examinees tend to score higher on Step 2 CK after having taken the Step 1 exam first.

Students who prepare for the exam with Kaplan will learn the crucial ways in which successful candidates are expected to communicate and interrelate with patients in the U.S. system of healthcare.

Can Pakistani medical graduates retake the USMLE exams?

No, you cannot retake the USMLE exams if you earn a passing score. If you do not earn a passing USMLE score, you can retake the exam up to three times in a 12-month period, but it is not recommended. Programs will see how many times you attempted the exam, usually eliminating candidates with multiple attempts. Therefore, it is essential not only to pass the exam, but to do so on the first attempt. If you do not feel confident going into the exam, it may be worth it to delay until you feel more prepared to earn a good USMLE score.

What are USMLE fees and total costs in Pakistan?

On average, it costs $4,000 to $6,000 to take all USMLE exams from Pakistan. To complete the entire USMLE journey, it can cost around an additional $10,000.

Below, we break down all of the main fees involved. Please note that all costs and fees listed are approximate, highly variable, and subject to change.

The fees typically incurred during the fourth year of medical school in Pakistan are:

  • ECFMG Registration Fee: $160
  • USMLE Step 1 Exam Fee: $1,000
  • USMLE Step 1 Exam International Registration Fee: $180-$190

The fees typically incurred during the final year of medical school in Pakistan are:

  • Visa Application Fee: $160
  • Elective Fees
    • Elective Application Fee: varies from $50-$300
    • Elective Course Fees: $3,000
    • Elective Course Travel & Accommodation Costs: $4,000

The fees typically incurred after graduating from medical school in Pakistan are:

  • USMLE Step 2 CK Exam Fee: $1,000
  • USMLE Step 2 CK Exam International Registration Fee: $220
  • OET Medicine Exam Fee: $455
  • ERAS & Interview Fees: $3,000

Frequently Asked Questions About the USMLE in Pakistan

Read more information about studying for and passing the USMLE as an IMG in Pakistan.

Is English language competency required for passing the USMLE Exam in Pakistan?

Yes, English Language Competency is required to pass the USMLE exam in Pakistan. Amongst the ECFMG’s certification requirements is passing OET Medicine or the former USMLE Step 2 CS exam.

Are clinical skills tested on the USMLE Exam in Pakistan?

All international medical graduates from Pakistan should review ECFMG Pathways to determine their personal requirements for finalizing their certification.

How helpful is research and clinical experience for passing the USMLE Exam?

Having hands-on research and/or clinical experience helps to contextualize the clinical knowledge and skills that are tested on the USMLE. Furthermore, both research and clinical experience are important to strengthen your application and make you more competitive for residency programs.

Register with NRMP to Match for Residency

To participate in the Match or Supplemental Offer and Acceptance Program (SOAP) as an IMG from Pakistan, you must first be ECFMG certified. The Match eligibility requirements for IMGs must be met before the rank order list deadline. Research programs you are interested in and review program applications and visa requirements. Individual residency programs ultimately decide if they will consider IMGs and which visa types they will support. 

Once you have decided on a program you are interested in, apply through ERAS. IMGs must request an ERAS token from ECFMG which allows them access to the ERAS website. Applicants must register each year to participate in the main registry match. The match has numerous deadlines, so be sure to stay on top of due dates so you don’t incur late fees. 

After submitting your application, you will interview with programs (if invited), then rank your programs in order of preference. The final step is to wait for match day to see if you Match with a program. If you do, the Match result is binding.

SOAP for Eligible Applicants from Pakistan

If an eligible applicant does not match with a residency program, that doesn’t mean that they have failed to become a U.S. doctor. IMGs who do not match may still take part in the Supplemental Offer and Acceptance Program, or SOAP. This gives (partially or fully) unmatched residency applicants a chance to obtain a residency position that was unfilled by the match process.