Graduate medical education in the U.S is one of most challenging and competitive medical training system in the world.Each year, 15,000 US Medical graduate and others medical graduate (15,000) compete for 23,000 residency slots offered by 3,720 residency programs accredited by ACCME (Accreditation Council for Graduate Medical Education).These programs were federally funded by CMS (Center of Medicare).To be eligible for gradate medical training in the U.S, one must possess an valid diploma from medical schools recognized by the US medical licensing authorities or FAIMER under ECFMG (Education Commission of Foreign Medical Graduate) for FMGs.All candidates must have passed USMLE (U.S.Medical License Exam)step Ⅰ and Ⅱ administered by National Board of Examiners (NBE).FMGs must also pass the CSA (Clinical Skill Assessment)administered by FSMB (Federation of State Medical Board) to obtain a temporary ECFMG certificate.The candidate must also complete hectic interview process (if lucky) before he or she can be matched into the National Residency Matching program (NRMP).The supporting documents include: dean s letter, transcript, letters of recommendations, diploma, scores of USMLE step Ⅰ and Ⅱ as well as the scores of CSA, ECFMG certificate (if FMGs) to be mailed directly from the respective office.