Securing Residency in the USA

In order to secure post-graduate residency in the United States, students should undertake the following steps during medical school in Ireland. It is important to note that medical students at US & Canadian medical schools must follow similar steps.

  1. Take the United States Medical Licensing Examination (USMLE) Step 1

The USMLE Step 1 is a one-day multiple-choice examination that evaluates a medical student’s understanding of the preclinical sciences needed to practice medicine. Students in Ireland usually take the USMLE Step 1 after the preclinical years of medical school are completed. There is a testing center in Dublin.

  1. Undertake a Clinical Elective at an American Teaching Hospital or Clinic

During the clinical years, it is essential that students choose to do clinical elective rotations at a US teaching hospital or clinic. These electives should facilitate letters of reference from the hospital preceptors, which are an important part of the residency application process. In addition, the clinical elective allows the hospital to assess the student’s medical knowledge, clinical and interpersonal skills and often provides a pathway to a place in the hospital’s residency program.

Some of the Irish medical schools have organized clinical and research electives which are taken during the summer months at partnering academic teaching hospitals & clinics in the United States and Canada.

  1. Take the United States Medical Licensing Examination Step 2 Clinical Knowledge (USMLE Step 2 CK)

The USMLE Step 2 CK is a one-day multiple-choice exam that evaluates a student’s applied clinical knowledge in providing supervised patient care. Students in Ireland usually take the USMLE Step 2 CK between the end of the second-to-last year and the fall of the final year of medical school. There is a testing center in Dublin.

  1. Take the United States Medical Licensing Examination Step 2 Clinical Skills (USMLE Step 2 CS)

The USMLE Step 2 CS is a one-day pass/fail assessment that uses simulated patients to measure the student’s history taking, examination, and investigation skills. The test also evaluates the examinee’s communication and interpersonal skills and their proficiency in spoken English. The USMLE Step 2 CS is taken at centers located throughout the United States.

  1. Enter the National Residency Matching Program (NRMP)

Also during the final year, students enter the National Residency Matching Program (NRMP). This is the system used to match medical students to residency positions. Match data from 2016 shows International Medical Graduates filled almost 7,000 of the approximate 28,000 first year residencies which were offered across the US.

All US residencies are available for review in the online database called the Fellowship and Residency Electronic Interactive Database (FREIDA). When applying for a residency students use a single online application called the Electronic Residency Application Service (ERAS) to apply to multiple residencies.

  1. Conduct Interviews at Residency Programs

Around December of the final year, students receive interview invitations from US residency programs.

  1. Graduate Medical School and Begin Residency

After the interviews, students enter a Ranked Order List (ROL) of desired residencies via ERAS. Residency directors also enter their ranked list of candidates via ERAS. Students are matched to residencies and the results are announced online, usually in mid-March. Residency commences shortly after graduation.

Completing Residency in the USA

  1. Take the United States Medical Licensing Examination (USMLE) Step 3

After residency training has commenced, the resident arranges to write the USMLE Step 3, which assesses a resident’s ability to apply clinical knowledge to the unsupervised care of patients.

  1. Take the Specialty Examination

Near the end of residency, the board examination for the resident’s chosen specialty is taken. For example, a family physician would take the American Board of Family Medicine (ABFM) certification examination.

Visa for Canadian Citizens in USA Residency

Canadian citizens who pursue residency training in the United States generally use the J1 visa which permits them to train/work in the United States for the duration of their residency.

When a Canadian student receives an offer of a residency position in the United States they must request a letter from the Canadian Federal Department of Health (Health Canada) which should specify that there is a need for more physicians in Canada. This letter and other documents (e.g. residency position offer letter) are then submitted to the US Government visa office (via the US teaching hospital) and a J1 visa is made ready for the first day of residency.

Useful links:
Fellowship and Residency Electronic Interactive Database
National Residency Matching Program
Electronic Residency Application Service
Educational Commission for Foreign Medical Graduates
Foundation for Advancement of International Medical Education and Research

The information on this page is not official and should be used only as a guideline. Residency placements are competitive and cannot be guaranteed. Candidates are encouraged to seek specific and official information from the relevant state and national organizations (e.g. NRMP, etc.).