I thought it might be useful to start a list of USMLE tips for IMGs, to supplement SDN's USMLE forum. Please add to this list if you've found something in particular (study method, books, tips, anecdotes) that has helped you out while taking the steps. Although the USMLE is the same for everyone who takes it, the means of achieving our goals are different. The exams are difficult, no matter how smart a person is or how good the training is at your medical school - it requires an extensive committment to self-study. For US medical students, the "normal" amount of preparation time seems to be about 5 weeks. For IMGs, I would recommend at least 8-10 weeks regardless of whether English is your native tongue or not. The reason is this: we have to do a substantial amount of self-teaching for subjects which may not be covered in as much detail as the USMLE wants, and getting used to the style and terminology takes practice. This should not be taken at all as an implication that foreign schools are not of the same standard as US schools, but an indication that there is a difference in the style of education and topics focused on. Step I costs $685 USD, plus surcharges if you're taking it somewhere other than the US or Canada. It focuses on pre-clinical subjects: Anatomy / Neuroanatomy, Behavioral Sciences and Statistics, Biochemistry, Microbiology and Immunology, Pathology, Pharmacology and Physiology. Areas which may require more time for IMGs to become intimately familiar with: behavioral science, biochemistry (especially deficiency of enzymes and resulting syndromes), genetics, cell biology, immunology, selected topics in microbiology, embryology, epidemiology and histopathology. It sounds like a lot, but it isn't too much - they are subsections of the larger subjects. Still, it would be worth your while to invest some time into these subsections. The exam itself is computer-based. 7 60-minute sections of 50 questions each, plus 45 minutes of break time (including lunch. Increases to 60 minutes if you skip the tutorial at the beginning). The goal of the IMG should be to not only pass, but to beat the US national average (the mean is between 200 and 220, usually around 215). You must score a 182 on the 3-digit scale and a 75 on the 2-digit scale to pass. However, hopefuls should aim higher than this because US programs will want a "reason" to select you over another qualified US-educated graduate, and a high Step I score will strengthen your application. But as high as an IMG may aim, putting it into practice is more difficult, so many try to aim for the US average or a comfortably passing score. For Step I, the most essential book to get is each year's most up-to-date edition of First Aid for the USMLE Step I. In it (and in first aid books for the subsequent steps), they have useful information for IMGs including info. on visas, the Ecfmg, and general usmle strategies. Also visit www.usmle.org for information and www.ecfmg.org for registration.