There is a question that comes up in every group of Canadians studying abroad: do I sit the USMLE, the MCCQE, or both?
We do not think there is a single right answer, and we would be suspicious of anyone who offers one with confidence. What we can do is lay out what each exam is, who runs it, what it costs, and what is still unknown. The point is to make the decision a decision, instead of something that happens to you in fourth year.
What the USMLE Is
The United States Medical Licensing Examination is a series of exams used for licensure in the US. For international medical graduates seeking ECFMG certification, the relevant ones are Step 1 and Step 2 Clinical Knowledge, which ECFMG says you must pass to meet the medical science requirement. [1]
There is a Step 3 as well. It is not part of ECFMG certification, but we have seen it come up in visa discussions, because some programs sponsoring H-1B visas require it. [2] We cover that in our J-1 versus H-1B article.
Who Runs It Now
The USMLE is co-sponsored by the Federation of State Medical Boards and the National Board of Medical Examiners. Starting with the January 2026 service transition, the FSMB provides all Step exam services for IMGs. [1] ECFMG still handles certification and receives your exam outcomes directly from the USMLE program as scores become available. [1]
If you are using older materials that say you register through ECFMG, treat them as out of date and read the current USMLE bulletin. ECFMG says you must review the bulletin before applying. [1]
What It Costs
The NBME’s page lists the 2026 fee for both Step 1 and Step 2 CK at $695, but states that those amounts apply to students and graduates of LCME-accredited US medical schools. [3] It does not list a figure for international graduates and it does not give an international test centre surcharge, directing readers to contact the USMLE office. [3]
We are therefore not printing a total. Treat $695 per step as a reference point only, and confirm what you will actually pay.
The Clock
Because ECFMG counts seven years from your first passing exam, when you take Step 1 matters. ECFMG says all exam requirements must be met within seven years, and that the clock starts on the date of the first exam passed. [4]
The practical effect is that a student who passes Step 1 early in a long degree, and then adds a graduate year or a gap before applying, can find the clock getting short. We would put the date on a calendar the day we pass.
How It Compares With the MCCQE
The two exams serve different gatekeepers. The USMLE steps lead to ECFMG certification and the US match. The MCCQE and the NAC lead to the CaRMS match in Canada. The MCC describes the MCCQE as a one-day, 230-question exam assessing knowledge and clinical decision-making at the level of a graduating Canadian medical student. [5]
We have not compared the content of the two exams ourselves and we are not going to claim the preparation overlaps by any particular percentage. Students tell us there is substantial overlap, but we do not have a source for that and you should ask people who have sat both.
What we can say is that they are separate registrations with separate fees, separate rules and separate calendars. Doing both is a real cost in money and study time, and we compare the totals in our residency application cost article.
Deciding Whether to Do Both
Some questions we would put to ourselves. How certain am I about Canada, or about the US? If I am genuinely split, how much does it cost to keep both doors open? Does my school offer protected study time, and when? Do I know what my programs of interest expect?
Another consideration is the match order. In 2027 the CaRMS match results arrive before the NRMP’s, and a matched applicant is withdrawn from the other match. [6] That does not make the American exams wasted if you match in Canada, but it does mean you should think about the probability of needing them.
Timing in Practice
We would not plan the USMLE around the last year. ECFMG says it is solely the applicant’s responsibility to finish exams in time for NRMP or other deadlines, and that it does not guarantee exam space. [1] Test centre availability, especially outside the US, can be a constraint.
The Bottom Line
Canadian students abroad who want US residency need to pass USMLE Step 1 and Step 2 CK, now administered through the FSMB for IMGs, within a seven-year window that starts at the first pass. The $695 fee on the NBME page applies to US-school students, so check the current IMG fee before you budget.
Whether to also sit the MCCQE depends on how open you are to Canada, and there is no free answer. Use the official USMLE and MCC pages to decide, and our Resources page for the other sources we trust.
References
- Intealth ECFMG. (2026). Medical science examination requirement. https://www.ecfmg.org/2026ib/exam-requirements.html
- Council of Residency Directors in Emergency Medicine. (n.d.). Advising international medical graduates on U.S. visa pathways for residency training. https://www.cordem.org/wp-content/uploads/CORD-Residency-Director-Toolkit-Advising-International-Medical-Graduates-on-U.S.-Visa-Pathways-for-Residency-Training-3.pdf
- NBME. (2026). Taking the United States Medical Licensing Examination. https://www.nbme.org/examinees/united-states-medical-licensing-exam-usmle
- Intealth ECFMG. (2026). Time limit for completing examination requirements. https://ecfmg.org/2026ib/time-limit-complete-exams.html
- Medical Council of Canada. (2026). MCCQE. https://mcc.ca/examinations-assessments/mccqe-part-i/
- NRMP. (2026). Early matches. https://www.nrmp.org/residency-applicants/get-ready-for-the-match/early-matches/