The internet is full of blogs and advisories providing tips and resources to secure that coveted US residency. Thousands of IMGs apply for The Match every year into US Medical institutions, and guiding them are a variety of resources, blogs and residents who have already matched in previous years. Here is a step-by-step explanation of the stepping stones and hurdles that you face while applying for a US residency program.
The STEP 1 exam tests the applicant’s knowledge of the basic sciences.
STEP 1 is a one-day examination with a total duration of 8 hours. The exam is a multiple-choice based exam, with questions being divided into 7 blocks. Each block has upto 40 questions, and the total number of questions do not exceed 280.
A more detailed description is available at the following link:
Q. What is the scope of the prospectus?
A broad generalisation of subjects from where questions are asked in this exam are as follows:
Biochemistry & Nutrition
Gross Anatomy & Embryology
Histology & Cell Biology
Q. What do I need to do to apply?
You would need to apply for an ECFMG (Education Commission for Foreign Medical Graduates) certification online on the IWA website (ECFMG’s Interactive Web Application), from where you get a unique USMLE/ECFMG identification number that can be used for all USMLE-related purposes.
After receiving a USMLE ID number, and on logging into the ECFMG portal, you will notice a link to a Form 186, which needs to be filled and uploaded on the ECFMG portal of Notary Cam website. Then, you need to assign a time for a notary to verify your passport and identification via a scheduled video call. Every information including date and time will be communicated between the applicant and the notary via email. The online session takes about 10-20 minutes. After completion, you will receive an email to notify about the acceptance of your Form 186.
After applying for certification, you need to verify your student or graduate status by your medical school, and upload any additional required documents including Form 183. Afterwards, you get scheduling permits, which provide an eligibility period when you can take the STEP 1, via the Prometric website (Prometric ).
Q. How much will STEP 1 cost me?
Fees for STEP 1 is $975, along with an International Test delivery surcharge of $180 if you’re taking the exam outside of the US/Canada.
Rescheduling, extension of eligibility period, changing of test centers all will incur extra charges.
Q. How much should I score in STEP 1?
In STEP 1, you should try aiming as high as you can! One must also know the average score of the specialty you are applying for, as they differ for different specialties. Competitive specialties need a higher score, while others do not need as high of a score from IMGs.
Q. Now Step 1 is pass/ fail report?
Exactly, on January 26, 2022 step 1 report now is pass/ fail, with a passing score of 196. No more numbers, however you should study very hard as if it was a numeric report, because that will build a strong knowledge for you step 2 ck and step 3 🙌
This is an example of how the new reports looks like:
This does not mean that the exam is easier or harder because the subjects you understand well in Step 1 will help you in Step 2 (50-60% of exams Step 1/ Step 2CK is almost the same)
For more details on Pass/Fail:
You can read on my blog a post that I made about my recommendation on how to study for Step 1
On project IMG we are creating a platform with all the study material for step 1 for free, make sure to start checking out our uploaded video lectures, they are awesome and super well explained 😍
STEP 2 used to comprise of two exams- STEP 2 CK (Clinical Knowledge) and STEP 2 CS (Clinical Skills). While STEP 2 CK can be answered in your home country via an online 9 hour test, the USMLE STEP 2 CS exam has been discontinued permanently.
Q. What is the STEP 2 CK?
Step 2 CK tests the application of medical knowledge, skills, and understanding of clinical science, and emphasises on public health principles. Step 2 CK also tests your knowledge of the principles of clinical sciences and basic patient-centered skills, all to enhance provision of the best patient care that can be provided under supervision.
Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks and administered in one 9-hour testing session. The number of questions per block on a given examination may differ but do not exceed 40. The total number of items on the overall examination are upto 318.
The examination also includes a minimum of 45 minutes of break time and a 15-minute optional tutorial. The time available for breaks may be increased by finishing any test block or the tutorial before the allotted time expires.
Some applicants answer the STEP 2 CK exam before answering STEP 1, although most Residents do not vouch for this method.
Q. What is the scope of the prospectus? What is asked in the exam?
The STEP 2 CK exam asks questions related to body systems just like STEP 1, with more focus on investigations and management. Along with it, another part of the exam design is Physician Tasks and Competencies, where test questions are designed to assess any of the physician competencies listed on the www.usmle.org website. The system specifications are also listed on the website itself. Here is a link to the website:-
Q. How to apply?
Applying for the STEP 2 CK is the same as STEP 1, via the IWA website. You can choose the city and date to answer the exam via the Prometric website, just like STEP 1.
Q. Fees for applying for STEP 2 CK?
Fees for STEP 1 is $975, along with an International Test delivery surcharge of $200 if you’re taking the exam outside of the US/Canada.
Rescheduling, extension of eligibility period, changing of test centers all will incur extra charges.
Q. What are the average scores of different specialties for STEP 2 CK?
The results of STEP 1 and STEP 2 CK are determined by NBME and they issue the score reports. ECFMG sends the email notifications to IMGs on availability of the score reports.
The USMLE program will change score reporting for Step 1 from a three-digit numeric score to reporting only a pass/fail outcome. This policy will begin from January 1, 2022 with further details to be published in late 2021.
Q. Are there any limits on the times the STEPs can be taken?
From July 1, 2021, examinees will be limited to four attempts per Step exam instead of the six allowed currently. This limitation intends to correspond to the attempt limits for AMGs in the majority of the states. After the changes are effective, a student who has attempted any USMLE Step for four or more times will be ineligible to answer other Steps.
Q. What is the importance of OET Medicine in my USMLE application?
Instead of the STEP 2 CS, now applicants need to answer the OET or Occupational English Test that is tailor made for applicants to the healthcare section.
IMG USMLE aspirants are supposed to answer this test (OET- Medicine) along with STEP 1 and STEP 2 CK. OET Medicine should not be misrepresented to be as simple as answering a basic english grammar examination, it has SAT-level questions and reasoning.
The OET Medicine exam has 4 components:
Listening (45 mins, 42 marks)
Reading (60 mins, 42 marks)
Writing (45 mins) ( has 6 criteria; “Purpose” has a maximum score of 3, the rest have a maximum score of 7)
Speaking (20 mins) ( maximum of 6 marks on each of the four linguistic criteria, and a maximum of 3 marks on each of the 5 Clinical Communication Criteria)
The Listening and Reading tests have the same content for all health professions, while Writing and Speaking tests are specific to professions, as they are based on different situations in different workplaces.
Each component requires a score of 350 (grade B) to avail a passing mark. A score of 350 equates to at least 30 marks in each component. According to the ECFMG website, if you do not attain the minimum score of 350 (Grade B) on each of the four measured components of OET Medicine (Listening, Reading, Writing, and Speaking) and you request a score re-mark, this will delay your results by several additional weeks. ECFMG expects OET Medicine results by the 31st of January of your match year. For example, if you are participating in the 2022 Match, ECFMG must receive your OET Medicine results by 31st January, 2022.
For an international medical student or graduate to be eligible to apply to ECFMG for ECFMG Certification and examination, their medical school should meet certain ECFMG requirements. The eligible schools are listed in the World Directory of Medical Schools (World Directory) as those meeting these ECFMG requirements.
www.wdoms.org - Check if your medical school or college is listed here.
ECFMG 2023 policychange: (from the website)
“The ECFMG® has announced that, effective in 2024 (previously 2023), physicians applying for ECFMG Identification number will be required to enrolled/graduated from a medical school that has been appropriately accredited. To satisfy this requirement, the physician’s medical school must be accredited by an accrediting agency recognised by WFME. However, this doesn't mean that the applicants have to give step examinations before 2024 too. Once the ECFMG Id is generated, applicants can apply for step examinations and ECFMG Certification whenever they wish to.”
You can check the post on OET in the blog with all free resources and detailed explanations :)Apparently this year OET won’t be required anymore, we are waiting for official announcement from ECFMG on what will be the replacement
To get an edge in the match applications, many applicants perform from 6 months to upto 2 years of research, either in their home countries or in the United States. Surgical residencies value research work and are more likely to award an interview to applicants with papers published in reputed journals. Very rarely are applicants the lead authors, and this is not a requirement of any program. The more research articles you have published, the higher your chances are of getting an interview into the program of your dreams. The competition is increasing every year as many AMGs (American Medical Graduates) are also taking a year off from medical school for research purposes, especially those interested in orthopaedics and plastics.
Research opportunities are tough to get in the US, and most are unpaid positions. Hence, it is important to have an adequate source of personal finances for living and emergencies. One needs to apply to multiple places, send hundreds of mails, and maybe you will get accepted for a research position.
Networking is important, but with covid and the ensuing travel restrictions imposed by governments of different countries, this part is destined to become something of a roadblock for those wishing for surgical specialties or more competitive specialties like radiology or dermatology.Here are 7 ways to get a research positions:
𝟏. 𝐅𝐈𝐍𝐃 𝐘𝐎𝐔𝐑 𝐋𝐎𝐂𝐀𝐋 𝐌𝐄𝐍𝐓𝐎𝐑
This is the way most of my friends got their research positions in Argentina and then in the USA. It’s 𝒍𝒐𝒏𝒈𝒆𝒔𝒕 𝒐𝒏𝒆 but it’s also the one that 𝙬𝙤𝙧𝙠𝙨 𝙩𝙝𝙚 𝙗𝙚𝙨𝙩.
•𝐇𝐨𝐰 𝐃𝐨𝐞𝐬 𝐢𝐭 𝐖𝐨𝐫𝐤? Talk to doctors in your country, in your University or Hospital. 𝑻𝒉𝒆𝒓𝒆 𝒂𝒓𝒆 𝒕𝒐𝒏𝒔 𝒐𝒇 𝒑𝒉𝒚𝒔𝒊𝒄𝒊𝒂𝒏𝒔 𝒂𝒍𝒍 𝒐𝒗𝒆𝒓 𝒕𝒉𝒆 𝒘𝒐𝒓𝒍𝒅 𝒕𝒉𝒂𝒕 𝒅𝒐 𝒓𝒆𝒔𝒆𝒂𝒓𝒄𝒉, it’s not just in the USA, and the ones that work in research in your country probably know a doctor in the USA that is involved in research too, or knows a doctor that knows a doctor in the USA.
•𝐇𝐨𝐰 𝐭𝐨 𝐝𝐨 𝐢𝐭? 𝑨𝒑𝒑𝒓𝒐𝒂𝒄𝒉 the doctors in your community, 𝒆𝒙𝒑𝒓𝒆𝒔𝒔 your interest, 𝒔𝒉𝒐𝒘 them your passion, 𝒕𝒆𝒍𝒍 them 𝐰𝐡𝐲 this is so important for you, and that you want him/her to 𝐛𝐞 𝐲𝐨𝐮𝐫 𝐦𝐞𝐧𝐭𝐨𝐫. Look up what kind of research they work on and tell them some projects and ideas that you can add to his research. 𝗡𝗲𝘅𝘁 𝘀𝘁𝗲𝗽: Once you start working with them, gaining their trust, getting publications, it will help you a lot to start getting that research experience, and 𝙗𝙪𝙞𝙡𝙙𝙞𝙣𝙜 𝙖 𝙨𝙩𝙧𝙤𝙣𝙜𝙚𝙧 𝘾.𝙑. with publications. After some time they will get you in contact you with 𝒅𝒐𝒄𝒕𝒐𝒓𝒔 𝒊𝒏 𝒕𝒉𝒆 𝑼𝑺𝑨 that can hire you, or make you publish with them!
𝟐. 𝐌𝐄𝐄𝐓 𝐃𝐎𝐂𝐓𝐎𝐑𝐒 𝐈𝐍 𝐓𝐇𝐄 𝐔𝐒𝐀 🇺🇸
•𝐇𝐨𝐰 𝐃𝐨𝐞𝐬 𝐢𝐭 𝐖𝐨𝐫𝐤? If you are going to North America for a 𝗰𝗹𝗲𝗿𝗸𝘀𝗵𝗶𝗽 or 𝗼𝗯𝘀𝗲𝗿𝘃𝗲𝗿𝘀𝗵𝗶𝗽, you will meet a LOT of people. 🙂 •𝐇𝐨𝐰 𝐭𝐨 𝐝𝐨 𝐢𝐭? Talk to the doctors, approach them, tell them the same things that I mentioned before.
𝟑. 𝐔𝐒𝐄 𝐘𝐎𝐔𝐑 𝐂𝐎𝐍𝐓𝐀𝐂𝐓𝐒 •𝐇𝐨𝐰 𝐃𝐨𝐞𝐬 𝐢𝐭 𝐖𝐨𝐫𝐤? If you know people, or have a family member that is a doctor/ professor, talk to them, tell them how important this if for you and ask for their help. Don't be afraid to approach your aunt that still treats you as if you were 10 years old, or that doctor that you met five years ago and haven't talked for a while. •𝐇𝐨𝐰 𝐭𝐨 𝐝𝐨 𝐢𝐭? Simple, just approach them, being very charismatic, showing interest, passion, and enthusiasm!! 😀
𝟒. 𝐄𝐌𝐀𝐈𝐋 𝐃𝐎𝐂𝐓𝐎𝐑𝐒 𝐃𝐈𝐑𝐄𝐂𝐓𝐋𝐘 •𝐇𝐨𝐰 𝐃𝐨𝐞𝐬 𝐢𝐭 𝐖𝐨𝐫𝐤? Simple, just find the doctor’s email and email them expressing your interest and how you can be helpful! 𝐇𝐨𝐰 𝐭𝐨 𝐝𝐨 𝐢𝐭? Make a template email, and send it to as many 𝗨𝗦 𝗱𝗼𝗰𝘁𝗼𝗿𝘀 as you can (Important to check their background, if they are from your country even better!) 😉 •𝐇𝐨𝐰 𝐭𝐨 𝐠𝐞𝐭 𝐭𝐡𝐞𝐢𝐫 𝐞𝐦𝐚𝐢𝐥? Go to the University/ Hospital’s website, look for the doctors/ professors that work in the field that you like. If their email is not published, you can get it very easly too. 99% of the times their email goes like this: 𝐅𝐢𝐫𝐬𝐭𝐍𝐚𝐦𝐞.𝐋𝐚𝐬𝐭𝐍𝐚𝐦𝐞@𝐡𝐨𝐬𝐩𝐢𝐭𝐚𝐥’𝐬 𝐝𝐨𝐦𝐚𝐢𝐧. Just look at any email from the hospital (Human resources, or anyone’s email), and you will get their domain. Eg, 𝗝𝗼𝗵𝗻 𝗛𝗼𝗽𝗸𝗶𝗻𝘀’s domain is: @jhmi.edu, 𝗛𝗮𝗿𝘃𝗮𝗿𝗱 Medical School domain is: @hms.harvard.edu
𝟓. 𝐀𝐏𝐏𝐋𝐘 𝐎𝐍𝐋𝐈𝐍𝐄 𝐅𝐎𝐑 𝐀 𝐑𝐄𝐒𝐄𝐀𝐑𝐂𝐇 𝐏𝐎𝐒𝐈𝐓𝐈𝐎𝐍 All of the Hospital’s have research position posted in their websites. 💻 •𝐇𝐨𝐰 𝐃𝐨𝐞𝐬 𝐢𝐭 𝐖𝐨𝐫𝐤? This will work better if you have a 𝘸𝘰𝘳𝘬𝘪𝘯𝘨 𝘷𝘪𝘴𝘢, 𝘨𝘳𝘦𝘦𝘯 𝘤𝘢𝘳𝘥, or 𝘜𝘚 𝘤𝘪𝘵𝘪𝘻𝘦𝘯. •𝐇𝐨𝐰 𝐭𝐨 𝐝𝐨 𝐢𝐭? Open google and search typing this “𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥 𝐭𝐡𝐚𝐭 𝐲𝐨𝐮 𝐥𝐢𝐤𝐞” + “𝐑𝐞𝐬𝐞𝐚𝐫𝐜𝐡 𝐨𝐩𝐩𝐨𝐫𝐭𝐮𝐧𝐢𝐭𝐢𝐞𝐬” and you will find tons of them. Just apply and wait!!
𝟔. 𝐒𝐓𝐀𝐑𝐓 𝐀𝐒 𝐀 𝐕𝐎𝐋𝐔𝐍𝐓𝐄𝐄𝐑 Just like Drake sings: "Started from the bottom, now we're here" •𝐇𝐨𝐰 𝐃𝐨𝐞𝐬 𝐢𝐭 𝐖𝐨𝐫𝐤? Most of the Hospital’s have volunteer department. This is in fact the way I got my research position and USCE! You can read it on detals on one my 𝒑𝒓𝒆𝒗𝒊𝒐𝒖𝒔 𝒑𝒐𝒔𝒕𝒔on my page. Start a normal volunteer job (probably it won't be research related), but 𝒚𝒐𝒖 𝒘𝒊𝒍𝒍 𝒃𝒆 in the campus, 𝒎𝒆𝒆𝒕 𝒅𝒐𝒄𝒕𝒐𝒓𝒔 there, and 𝙬𝙤𝙧𝙠 𝙮𝙤𝙪𝙧 𝙬𝙖𝙮 𝙪𝙥! If they like you they can ask their Department and Human Resources 𝘁𝗼 𝗼𝗽𝗲𝗻 𝗮 𝗿𝗲𝘀𝗲𝗮𝗿𝗰𝗵 𝗽𝗼𝘀𝗶𝘁𝗶𝗼𝗻 𝗳𝗼𝗿 𝘆𝗼𝘂, they will hire you, and if you really really earn their trust they will let you go to the clinic, 𝘀𝗲𝗲 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀, and sometimes even 𝗴𝗼 𝘁𝗼 𝘁𝗵𝗲𝗶𝗿 𝘀𝘂𝗿𝗴𝗲𝗿𝗶𝗲𝘀!! •𝐇𝐨𝐰 𝐭𝐨 𝐝𝐨 𝐢𝐭? Open google and search typing this: “The Hospital that you like” + “Volunteer opportunities” and you will find tons of them. Just apply and wait!!
This is a great website if you know how to use it, you can find research position, clerkships/ observerships/ extenrships, and meet great people
I'll soon make a post on how to use Linkedin.
Now 𝘥𝘰𝘯'𝘵 𝘴𝘢𝘺 𝘵𝘩𝘢𝘵 𝘵𝘩𝘦𝘳𝘦 𝘢𝘳𝘦 𝘯𝘰𝘵 𝘰𝘱𝘱𝘰𝘳𝘵𝘶𝘯𝘪𝘵𝘪𝘦𝘴, 𝘪𝘵'𝘴 𝘺𝘰𝘶 𝘵𝘩𝘢𝘵 𝘢𝘳𝘦 𝘯𝘰𝘵 𝘴𝘦𝘦𝘬𝘪𝘯𝘨 𝘵𝘩𝘦𝘮!
Applicants may perform volunteer work as a part of non-governmental organizations as a medical professional; any volunteer work can be listed and needs to be backed up by a certificate by the organisation.
In project IMG we also always have open volunteers positions, you can message instagram @projectimg to get on board
You much know that if your join the team, we expect deadlines to be acomplished
USCEs are a necessary part of the USMLE application. It is important to research the specialty you want to get into and accordingly apply for specific electives or observerships. These USCEs generate Letters of Recommendation (LoRs), which help the residency programs to filter candidates on the basis of their knowledge of US medical protocols and methods. An LoR from a doctor (usually an attending or the dean, if possible) is held to a higher standard than an Lor from your home country. Applying for any clinical experience is easier and cheaper if you have given your STEP 1 and have a STEP 1 score at hand. Most of these USCEs have a duration of 1 month per USCE.
The best USCE for an application is an Elective/Clerkship. Available only to those who have not yet graduated from medical school. More often than not, it provides a more personalised LoR. The cost of electives can go upto $5000 per elective.
Very similar to internships undergone by AMGs, sub-internships are when a certain number of patients are assigned to your care. You will be performing duties similar to a PGY1 resident and avail a greater clinical experience. Hence, the LoRs are quite personalised, and these sub-internships are difficult to acquire.
Similar to a sub-internship, but for medical graduates. It provides a good LoR, but is difficult to get. Applicants are allowed to examine and interact with patients, again substantiating the clinical experience.
Observerships are a good choice for graduate medical students, where they shadow an attending on their rounds. They do not allow you to interact with patients, however, this gives you an opportunity to become acquainted with the doctors and the staff, and develop networking opportunities.
With the rise in covid cases and travel restrictions, applicants adopt telerotations in a specialty of their choice. Although this is not an ideal contender for a USCE, something is better than nothing when building a resume. It also generates a generalised LoR. Most telerotations cost from $1500 to $2000 for a month.
lo So far we have cardiology, infectious disease and Pulmonology 😊
A good choice for graduate medical students are research electives in the US. Research with reference to your choice of specialty has a huge potential. These may or may not be paid positions. Research and subsequent publications add to the betterment of a resume as they generate a quality LoR.
Application for ECFMG certification=$150
For Step 1 application=$975+ $180+ extra charges if applicable
For Step 1 resources= $1000-$1100
For Step 2 application= $975+ $200+ extra charges
For Step 2 resources= a minimum of $500- $600
For step 3 application: $875
For OET application = $500
For ECFMG certification via the OET pathway= $900 + $100(for verification of credentials via EPIC)
For Electives or Observerships= $1000-1500 each, at least 3 required; so approx. $4500
Visa and Flight costs= according to the country
Food and accommodation for 3 months of USCEs= $3000-4000
Health insurance for 3 months= $300
Malpractice insurance for 3 months= $900
ERAS token= $150
NRMP token= $85
Sending USMLE transcript= $80
Program Application fee= $99 for the first 10 programs, $16 each for the next 10 programs, $19 each for the next 10 programs, $26 each for next all programs
For application into 100 programs, the total cost is= $2270
Interview costs (to travel to the interviews)= $500 each, for 5 interviews= $2500
This money is saved in case of online interviews
Visa processing fees (J1 visa mostly, for IMGs)= $500-$1000
TOTAL= $22000-25000 (about $3000-4000 less if online interviews occur)
SAP Crystal Reports - (2021 Match Data for AMGs and IMGs)
Many factors prevent students from taking the USMLE route. It can be due to easier lives in their home countries, fear of leaving family alone, shortage of information, fewer resources and financial constraints. Sometimes senior doctors who have settled into the US as IMGs offer hard-hitting advice that is not palatable to many. Medical graduates outside the US might be scared off because opportunities seem low after graduation. Also many become tired of the lengthy process and fail to persevere due to other opportunities and life goals taking precedence.
The most difficult thing in any student’s journey is the ability to keep up their own motivation while chasing a goal. End goals are hyped up in the mind of a student which lead to anxiety, self-doubt, and the ubiquitous imposter syndrome.
There is nothing to prevent exam-related or USMLE-related anxiety or faltering of wills, it happens to everyone. However, some methods can help calm a person down and re-focus on the work that needs to be done.
Have a clear picture of your goal.
Take one day at a time. The future is nothing but a day just after today, and if you can handle today, you can take on tomorrow.
Money is important, but so is your Step 1 score.
Breathe. A severe form of anxiety needs therapists and psychiatrists, and a panic attack can be prevented with the help of breathing exercises.
Take time off from studying and worrying to spend time with family and/or friends.
Learn something new, practise a hobby, or just take a nap at regular intervals.
Keep a list of every requirement in the USMLE pathway that you need to check off when completed.
Do your proper research. There is no such thing as over-research.
Talk to seniors and medical professionals working in the United States, they are friendly and are eager to help, having been on the same path themselves.
Studying is a personal matter. Some people take delight in informing people how they should study and when they should ideally study or that their technique is wrong. Shut out the haters, and pay attention to your mind, how much it can take, and how you can retain the best. Find your ideal time to study. If you can study with a partner, do that, but more than 1 partner hinders the process. Choose the best comfort zone to function in.
If you are passionate about working as a doctor in the US, there is literally nothing that can stop you. It can take some time, but nothing worthwhile ever comes easy. Your patience will be tested, you will face a lot of rejections, naysayers, self-doubt, but having a clear picture of your end goals in your mind will help you tide over any shortcomings to achieve success.
We created #ProjectIMG, a free revolutionary platform where you will find everything needed for USMLE and more!
Including video lectures, research/biostat/EKG/ surgical/ language courses, Qbanks, flashcards, 24/7 emotional support, The Usmle book, weekly podcasts🔥, a 24/7 online study library, volunteer and observerships opportunities, jobs for IMGs and even peer to peer free mentoring.
•It was created to help international doctors, medical students, residents, fellows, and all the medical community😍
•All the content is our own, and created from IMGs and AMGs to their peers :)
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Post written by: By Susmita Sengupta
Edited by: Sebastian Arruarana, MD
To finalize here is a nice Summary of the financial aspect for USMLE