here's the honest big picture. As an IMG, you're proving you can perform at the level of US grads, so every piece is a brick in that case. USMLE scores get your application looked at, they're the threshold, especially Step 2 CK now, so score well. US Clinical Experience (USCE), electives, sub-internships, observerships, is critical because programs want evidence you can function in the US system, and it's where you earn your US letters of recommendation, which carry huge weight. Strong rotations build the clinical skill that shows in your CK score, your letters, and your interviews. Then there's the application narrative, your personal statement and chosen specialty fit. Plan backward target specialty, then needed scores, then USCE and letters in that specialty, then electives at programs you'd love to match. it's a multi-year campaign, but the pieces reinforce each other beautifully when you sequence them right.