IMGs who miss the Match rarely fail because of weak content knowledge — the problem is almost always timing. This guide breaks down exactly when to sit each USMLE Step, what ECFMG requires before programs review your file, and the sequencing mistakes that quietly sink otherwise competitive applications.

The ECFMG certification process just got more complicated with a major system change in January 2026—and most IMGs don't realize what's different until it's too late. This guide breaks down exactly what you need to do, when to do it, and the costly mistakes that derail applications.