All IMG's or FMG's who want to practice in the US must take USMLE Step 1, USMLE Step 2 CK, and USMLE Step 2 CS. Upon passing all three exams, the IMG/FMG will receive an ECFMG certificate. Again, all IMG's or FMG's who want to practice in the US must be ECFMG certified. This includes graduates from SGU, even though the school is approved in all 50 states.