How to pursue medical residency in the US: a step-by-step guide for Brazilian physicians

Doing a medical residency in the United States can seem like a complicated or even distant process, especially when you don't yet know where to start. For physicians who graduated in Latin America, this path involves certifications, specific exams, and an application to residency programs.

But think about what you already faced in medical school: you memorized the Krebs cycle, differentiated dozens of syndromes, and went through exams that required hours of study. Just as those challenges seemed complicated at first, lack of information can also make residency in the U.S. seem harder than it is. With the right information, solid exam preparation, and necessary support during study, everything becomes clearer.

This possibility is already part of the reality of thousands of physicians trained outside the United States. In the 2026 Main Residency Match, 11,944 non-U.S. citizen IMGs participated as active applicants, according to the NRMP report. That number represents active applicants, not physicians matched or positions filled. If you are beginning to consider this option, understanding how the application works and what the main steps are is a good starting point.

In summary, to do a medical residency in the U.S. as a physician trained outside the country, you need to understand eligibility and certification requirements, take the necessary exams, build your clinical experience, and prepare your application to residency programs.

Check our complete guide below!

Illustrative image. Photo: Eric Lozaga / Pexels. MedCof USA Instagram: @medcof.usa.

Can Latin American medical graduates pursue residency in the U.S.?

If you graduated in Medicine in Brazil or another Latin American country, it is natural to ask whether your training can be accepted by a U.S. residency program. The answer is yes, but you must meet specific requirements for physicians trained outside the U.S.

These physicians are classified as International Medical Graduates (IMGs). For physicians trained in Brazil and other Latin American countries, this classification is related to the location of the medical school, not citizenship.

Being an IMG, therefore, does not mean you are out of the running for a position. It means you need to understand the rules of this system and complete the required steps to build your application. This is where ECFMG certification, USMLE exams, U.S. clinical experience, and letters of recommendation come in.

In other words, your training in Latin America is the starting point. From there, you must understand how to turn your training into a competitive application for U.S. residency programs.

Steps to pursue residency in the U.S.

After understanding that physicians trained outside the United States can apply to residency programs, the most important question is: where to start?

For those who graduated in Brazil or another Latin American country, the application involves areas of preparation that have dependencies and can, in part, progress in parallel. They include eligibility for ECFMG certification, USMLE exams, U.S. clinical experience, and finally, application to residency programs.

In general, the path to doing a medical residency in the U.S. can be organized into four main areas:

• Eligibility and certification by ECFMG

• USMLE Step 1 and Step 2 CK

• U.S. clinical experience and letters of recommendation

• ERAS, interviews, and the NRMP Match

Each step has its own requirements and deadlines, and understanding how they connect helps organize preparation and define what needs to be done at each moment.

1. Eligibility and ECFMG certification

The first step is to verify whether you meet the requirements to proceed with certification by the Educational Commission for Foreign Medical Graduates (ECFMG).

To do this, check your school's ECFMG Sponsor Note in the World Directory of Medical Schools (WDOMS), including the years of graduation covered. Being listed in the directory alone is not sufficient. See ECFMG certification requirements.

After that, the applicant follows current ECFMG/Intealth guidance to request certification and submit the required documents. This step is important to confirm that your training meets the requirements necessary to move forward in the other phases of the application.

In addition to exams and documents, it is necessary to meet clinical skills and communication requirements. For applicants following Pathways, this includes the OET Medicine and the requirements of the applicable Pathway. Check the rules, deadlines, and validity of the current cycle.

2. USMLE Step 1 and Step 2 CK

The United States Medical Licensing Examination (USMLE) exams are a central part of the preparation for those intending to do a medical residency in the U.S.

• USMLE Step 1: assesses knowledge of the basic sciences related to medical practice and is reported as Pass/Fail for exams taken on or after January 26, 2022.

• USMLE Step 2 CK (Clinical Knowledge): assesses the application of medical knowledge in clinical practice and has a numeric score.

Consult the official description of results at USMLE.

Besides studying medical content, it is important to know the exam format. Questions present clinical cases (vignettes) and require careful interpretation of information, as well as an appropriate test-taking strategy.

Therefore, preparing for the USMLE involves more than reviewing medical school content. You need to become familiar with the exam methodology, manage time, and build confidence to solve questions in the exam format.

At this point, support from the MedCof USA USMLE preparation course can be part of your planning, helping to organize your study routine and targeted preparation for USMLE Step 1 and Step 2 CK.

3. U.S. clinical experience and letters of recommendation

Another fundamental component of the application is United States Clinical Experience (USCE).

Depending on the modality, it may involve experiences such as clinical rotations (hands-on) or observerships. Besides allowing the physician to better understand clinical practice in the U.S. system, this experience can contribute to building a professional network and obtaining Letters of Recommendation (LoRs), the recommendation letters used in applications.

Observerships are observation experiences; they should not be confused with authorization for direct patient care. Hands-on activities depend on eligibility and the host institution’s rules. Not every program accepts the same modalities as clinical experience.

Possibilities and requirements vary according to the program and the applicant’s profile. Therefore, this step also needs strategic planning according to the specialty and programs of interest.

4. ERAS, interviews, and Match

With the main previous steps in place, it is time to submit your application to residency programs.

• ERAS (Electronic Residency Application Service): used for centralized submission of application information to participating programs. This stage includes elements such as CV, letters of recommendation, and the Personal Statement.

• Interviews: stage in which programs select and evaluate candidates of interest, either in person or online.

• Match via NRMP (National Resident Matching Program): the system in which applicants and programs create their rank order lists. The algorithm matches these preferences and reveals results during Match Week.

Registering for ERAS does not register you for the NRMP. Also confirm the application service used by the specialty and the program, which may differ from ERAS. See NRMP guidance.

How long does it take to be ready to apply for residency in the U.S.?

One of the first questions for those starting to research U.S. medical residency is: how long until you are ready to apply?

There is no single timeline. Time depends on factors such as career stage, level of preparation for exams, need to obtain U.S. clinical experience, and the Match cycle you intend to enter.

Therefore, rather than thinking of a fixed number of months, it is useful to organize the steps according to your starting point:

For those still in medical school: Students in the last years of medical school can begin preparing in advance, mainly to understand ECFMG certification requirements, organize study for the exams, and plan U.S. clinical experiences. Starting before graduation allows you to spread the steps over time instead of concentrating all preparation into a short period.

For medical graduates: Graduates can structure preparation based on remaining requirements they need to fulfill. In this case, planning may involve exams, certification, clinical experience, letters of recommendation, and application preparation for the Match. Time to application will depend on which of these steps have already been completed.

For those who have completed residency or are specialists in Brazil: Having a residency or specialization in Brazil does not remove the steps required to apply for U.S. residency. Still, that solid medical experience is part of building your application and helps the physician define more clearly the specialty and programs to pursue.

Planning prevents missing a Match cycle

The Match occurs in annual cycles, and different application steps have their own deadlines. Leaving exams, documentation, or clinical experience to the last minute can mean the applicant must wait until the next cycle.

Therefore, the ideal is to start with planning: decide which cycle you intend to enter, understand the requirements for that period, and organize each step backwards from the deadline.

Do I need U.S. citizenship or native-level English?

No. Physicians trained outside the United States can apply to residency as IMGs, provided they meet the certification and application requirements that apply.

Visa issues, however, must be part of planning. The type of visa available varies by program and institution. The J-1 visa has a sponsorship pathway for clinical training through the ECFMG physician exchange program. Other possibilities, such as H-1B, depend on immigration requirements and institutional policy; confirm the option with the program before relying on it.

And English? You do not need to speak like a native. You need sufficient proficiency to meet the requirements applicable to the application, take the USMLE exams, and communicate clearly in the clinical environment.

Therefore, citizenship, visa, and English should not be seen as barriers before you start. They are aspects to include in your application planning and should be checked according to your profile and the programs of interest.

Frequently asked questions about U.S. medical residency

Are ECFMG certification and a medical license the same thing?

No. ECFMG certification is related to verifying medical education and meeting the requirements necessary for physicians trained outside the United States to proceed with Match application steps.

A medical license, on the other hand, is regulated individually at the state level in the U.S. Authorization to practice during residency depends on state training and licensing rules and the institution. See FSMB on medical licensing.

Can a physician specialized in Brazil do residency in the U.S.?

Yes. Having completed residency or specialization in Brazil does not prevent a physician from seeking a U.S. residency position.

However, specialization completed in Brazil does not automatically substitute for U.S. residency. Requirements for professional practice, specialty certification, and entry into programs are distinct. There are additional licensing pathways for some internationally trained physicians with their own rules; these do not automatically equate to specialty certification. Check the state authority and the specialty board. See the FSMB overview of IMG licensing. Your previous experience can help contextualize your application, but it does not guarantee a position.

Is it possible to do U.S. medical residency after graduating in Brazil?

Yes. Physicians trained in Brazil are classified as International Medical Graduates (IMGs) and can apply to U.S. residency programs, provided they meet the applicable eligibility, certification, and application requirements.

How long does it take to do a U.S. medical residency?

Preparation time varies according to each applicant’s starting point. Exams such as the USMLE, ECFMG certification, U.S. clinical experience, and application preparation may occur at different times. Therefore, there is no single timeline to be ready for the Match.

How much does it cost to do a U.S. medical residency?

Investment varies depending on the stages each applicant must complete. Major costs include exams, certification, USMLE preparation, U.S. clinical experience, program applications, and possible travel, document translation, and visa expenses. Since fees and costs can change, it is important to check updated costs before planning the process.

Organize your next step with MedCof USA

Doing a medical residency in the U.S. requires planning, preparation, and knowledge of the steps that are part of the application. For physicians trained in Latin America, the first step is not to try to solve everything at once but to understand how each part connects.

ECFMG certification, the USMLE, U.S. clinical experience, letters of recommendation, ERAS, and the Match are part of a path that can be organized according to your career stage. The sooner you understand which requirements you already meet and which you still need to achieve, the clearer your next steps will be.

If your goal is to start preparing for the exams with guided, specialized support, learn about the USMLE preparatory course MedCof USA and see how to structure your studies for USMLE Step 1 and Step 2 CK.