From Nepal to the U.S.: My Journey Toward a Medical Residency
- Research Staff
- Apr 9
- 8 min read
Updated: Apr 10
The United States Medical Licensing Examination (USMLE) demands dedication, resilience, and careful preparation. This article provides strategies for success, including active learning, stress management, and maintaining balance, while sharing personal insights from International Medical Graduates (IMGs) pursuing U.S. medical residency.
By Dr. Grishma Wosti, MBBS
Completing the United States Medical Licensing Examination (USMLE) journey requires a sharp and disciplined mind and patience, as it is a long and demanding path. To stay resilient and perform at your best, active learning techniques, engaging in regular practice tests, and participating in research to reinforce your knowledge are essential. Managing stress, maintaining healthy sleep cycles, and striking a balance between work, study, and social life are equally important to prevent burnout. Continuous learning can be mentally exhausting, so incorporating outdoor activities and pursuing hobbies that inspire and motivate you will help sustain your momentum and keep you moving forward with purpose.
Key Takeaways
USMLE preparation helps one understand the U.S. healthcare system, advanced technologies in patient care, and treatment guidelines.
USMLE exams demonstrate proficiency in both basic and clinical sciences.
Passing the USMLE is essential for U.S. medical licensure and practice.
Introduction
International Medical Graduates (IMGs) are a vital part of the U.S. healthcare system, making up around 23% of the physician workforce. For IMGs, applying for a U.S. residency demands careful planning, dedication, financial resources, and perseverance. This article shares my experience preparing for the process and key requirements for IMGs navigating the residency application process.
I grew up in the beautiful landscapes of Nepal, surrounded by mountains and nature. Although my family had a strong law background and expected me to follow that path, my passion for medicine led me in a different direction. My interest in the human body and medical science grew as I saw how medicine could transform lives, providing relief and restoring health. This deep connection to patient care became my true purpose.
I completed my M.B.B.S in Nepal, spending 5.5 years of study, including a one-year internship. During this time, I stayed engaged in academic and extracurricular activities, making my parents proud. Afterward, I worked as a medical officer in a resource-limited healthcare setting, where I encountered various patients with their own medical challenges.
I had always heard from my seniors and friends that the journey to the U.S. was tough—financially demanding, full of visa hurdles, and incredibly time-consuming. But one day, I asked myself, why can’t I be the next one?
Doubts filled my mind—Would I be able to manage the finances? Do I have the patience to stay committed? Can I adapt to a new culture? Are my communication skills strong enough? Can I live far from my family and loved ones?
To find answers, I started learning about the USMLE exams with a friend in the U.S. and read numerous articles about the process. Slowly, confidence replaced my doubts. I realized that I could achieve this dream with hard work and dedication. Though it might take longer than building a career in my home country, the advanced medical practices, technologies, and job satisfaction make it all worth it. So, why not give it my best shot?
With that belief, I set SMART goals (a framework for setting objectives that are Specific, Measurable, Achievable, Relevant, and Time-bound, helping you achieve your goals effectively), balanced work and study, and started saving for this journey—driven by passion, determination, and enthusiasm. I focused on thorough preparation using U World, medical podcasts, First Aid, and National Board of Medical Examiners (NBME) practice tests.
After arriving in the U.S., I actively sought out observerships to better understand the healthcare system. I built relationships with physicians and colleagues, becoming part of a team that fueled my passion even more. I embraced the new lifestyle, made new friends, and gradually improved my communication skills. I am still on this journey, working tirelessly to achieve my dream, and I am confident I will succeed. Little by little, I am making my dream a reality.
What are the Requirements for Residency?
To apply for residency programs in the U.S., here are the key things you need:
Graduation from a medical school recognized by the Educational Commission for Foreign Medical Graduates (ECFMG).
Completion of the United States Medical Licensing Examination (USMLE) steps 1, step 2 Clinical Knowledge and Clinical Skills (C.K) and Occupational English Test (OET). Obtaining ECFMG certification is essential to participate in the National Resident Matching Program (NRMP).
Visa Status: Be eligible for a J1 or H1B visa or have U.S. citizenship or permanent residency.
Hands-on clinical experience in the U.S. is highly valuable. IMGs can participate in:
Clinical Observerships, Externships, Electives (for students still in medical school), and Research opportunities in U.S. hospitals and universities.
Building a Strong Application
Personal Statement: Show passion for medicine and specialty choice.
Curriculum vitae (CV): Highlight education, research, clinical experience, and volunteer work.
Letters of recommendation (LoRs): Obtain at least three strong letters, preferably from U.S. physicians.
Application Process
How do I apply? —This is usually the first question on everyone's mind. Here are the key things you should know before starting the application process.
Program Selection: Research and choose residency programs that match your goals.
ERAS Application: Submit your application through the Electronic Residency Application Service (ERAS).
NRMP Registration: Register with the National Resident Matching Program (NRMP) for the match process.
Personal Statement: Craft a compelling personal statement that showcases your abilities and motivation.
Applications and Costs for The Journey
Below is a table outlining the estimated costs for applying to the USMLE. Please note that these fees may vary slightly in the coming years.
STEPS | COSTS | PROCESS |
Step 1 Test your understanding and application of basic medical sciences, focusing on health, disease, and treatment principles. | $1,020: Examination Fee + International Test Delivery Surcharge, if testing outside the United States and Canada. | Apply online using IWA. |
Step 2 CK (Clinical Knowledge) Test your ability to apply CK and skills for supervised patient care, health promotion and disease prevention. | $1,020: Examination Fee + International Test Delivery Surcharge, if testing outside the United States and Canada. | Apply online using IWA. |
Application to a Pathway for ECFMG Certification. | $925
| Online using Application for Pathways for ECFMG Certification. |
OET (Occupational English Test) Can be given on both paper and computer. Tested for Reading, speaking, writing and listening. | US $455 for the computer-based exam in the United States. This price applies to OET on Computer at a venue and OET at Home in the US. | |
Application for ECFMG Certification. | $160 | Apply On-line using IWA |
STEP 3 (can be given during residency) Step 3 tests your ability to apply medical knowledge for independent practice, focusing on patient management in outpatient settings. It is the final USMLE exam for medical licensure. Can be given only inside the U.S.A. | $935 |
Challenges IMGs Face in USMLE and the Application Process
IMGs face multiple challenges while pursuing USMLE exams in the U.S.
The financial challenges include the high costs of exam fees ($1,000+ per step), expensive study materials, and the significant living expenses during Step 3 exams and Observerships in the U.S.
With only four attempts allowed per step, multiple failures can significantly diminish one’s chances of success.
Residency application barriers include visa issues (not all programs sponsor J-1 or H-1B), and the need for U.S. Clinical Experience (USCE).
Navigating U.S. culture and communication in healthcare presents challenges. Medical practices and patient expectations may differ, and clear English communication is crucial for effective interaction.
IMGs often face several emotional and mental health challenges. The long study hours, exams, and uncertainty about matching can lead to stress and burnout. Being away from family and dealing with cultural differences may cause feelings of isolation and loneliness.
Facts
2024
2025
There were 4,587 active U.S. citizen international medical graduates (IMGs) in the Match.
Non-U.S. citizen IMGs saw a significant increase in participation this year with 11,465 active applicants, up 14.4 percent over 2024.
Final Thoughts
Preparing for the USMLE has helped me better understand the U.S. healthcare system, advanced medical technologies, and evidence-based treatment guidelines. These exams test both basic and clinical knowledge, and passing them is a key step toward medical licensure in the U.S. While the path to residency is highly competitive, my unique journey, strong dedication, and deep passion for medicine keep me focused. I am committed to overcoming every challenge, knowing that each step brings me closer to achieving my dream. The path to securing a residency in the United States is challenging yet rewarding.
Frequently Asked Questions
How do I apply for the USMLE?
Start by reading the USMLE Bulletin of Information ( https://www.usmle.org/bulletin-information) to understand the rules and requirements. Then, apply through the appropriate registration entity based on your medical school and location.
Taking this first step with the right information sets the foundation for your USMLE journey.
Is there a fee for changing my appointment?
Yes, depending on how much notice you give. Check the appointment change fee schedule for details (https://www.usmle.org/reschedule-exam)
Can I bring water and food for my exam?
Yes, you can. However, there are a few rules to keep in mind:
Water: Allowed, but must be in a clear, label-free container.
Food: Not allowed inside the exam room, but you can eat during your scheduled breaks in the designated break area.
What is the passing score for the USMLE exams?
USMLE passing scores can change over time, so it's best to check the official USMLE website for the latest updates
Step 1: Pass/Fail
Step 2 CK: Typically, around 214 (varies annually) Step 3: Around 200 (varies annually)
How long are the USMLE exams?
These exams are long and challenging, but they are the steps toward your dream of becoming a licensed physician in the U.S.
Step 1: 8 hours, Step 2 CK: 9 hours, Step 3: 16 hours (Step 3 is a two-day exam. Day 1 is 7 hours, and Day 2 is 9 hours)
If I pass, can I retake a USMLE exam to get a higher score?
Unfortunately, no. Once you pass a USMLE exam, you cannot retake it to achieve a higher score. You are only allowed to retake the exam if you fail. So, give it your best shot the first time.
Sources Used
Nagarajan, K.K. et al. (2020) Prevalence of US-trained International Medical Graduates (IMG) physicians awaiting permanent residency: A quantitative analysis, Journal of community hospital internal medicine perspectives. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7599012/ (Accessed: 30 March 2025).
Residency application requirements for international medical graduates (2020) AAFP. Available at: https://www.aafp.org/students-residents/medical-students/become-a-resident/applying-to-residency/international-medical-graduates.html (Accessed: 31 March 2025)
Fees overview (no date) ECFMG. Available at: https://www.ecfmg.org/fees/ (Accessed: 31 March 2025)
Summary (no date) How do I book an OET test and where can I book, OET. Available at: https://oet.com/en-us/test/book-a-test (Accessed: 31 March 2025)
FSMB | Step 3 application fees. Available at: https://www.fsmb.org/step-3/step-3-application-fees/ (Accessed: 31 March 2025)
Charting outcomes: Applicant survey results, 2024 main residency match® (2024) NRMP. Available at: https://www.nrmp.org/match-data/2024/09/charting-outcomes-applicant-survey-results-2024-main-residency-match/ (Accessed: 31 March 2025).
Admin (2024) Admin, Kaplan Test Prep. Available at: https://www.kaptest.com/study/usmle/img-match-rates/ (Accessed: 30 March 2025).
NRMP. Available at: https://www.nrmp.org/wp-content/uploads/2024/09/Intro-and-Methods_2024-Applicant-Survey-Report-08232024.pdf (Accessed: 31 March 2025).
Program, N.R.M. (2025) National resident matching program® releases the 2025 Main Residency Match® results, celebrates the next generation of Physicians, PR Newswire: press release distribution, targeting, monitoring and marketing. Available at: https://www.prnewswire.com/news-releases/national-resident-matching-program-releases-the-2025-main-residency-match-results-celebrates-the-next-generation-of-physicians-302408136.html (Accessed: 31 March 2025)
National resident matching program® releases the 2025 Main Residency Match® results, celebrates the next generation of Physicians (2025) NRMP. Available at: https://www.nrmp.org/about/news/2025/03/national-resident-matching-program-releases-the-2025-main-residency-match-results-celebrates-the-next-generation-of-physicians/ (Accessed: 29 March 2025)
Examination results and scoring (no date) USMLE. Available at: https://www.usmle.org/scores-transcripts/examination-results-and-scoring (Accessed: 31 March 2025).
Med School Insiders (2023) How long is the step 1 exam? USMLE Step 1 length & format explained, Med School Insiders. Available at: https://medschoolinsiders.com/pre-med/usmle-step-1-length-and-format/ (Accessed: 28 March 2025).
About Dr. Grishma Wosti, MBBS
Born and raised in Nepal, a scenic Himalayan country, I earned a medical degree and invaluable clinical experience in rural areas, fostering strong communication and leadership skills. An approachable and positive personality shines through, with a passion for cooking, singing, and bicycle riding that adds vibrancy to life outside of medicine. Preparing for the USMLE exams to pursue a medical residency in the United States.