Some hospitals and institutions throughout the United States require IMGs to pass the TOEFL exam, or Test Of English as a Foreign Language. This test’s scores are designed to evaluate a non-native speaker’s ability to use and understand the English language as it is used in North America. Most people taking this test plan to continue their education in the United States, where courses are taught in English. There are two versions of the TOEFL, there is a paper based test, which costs between $160 to $240 USD, depending on which country you are located in. The paper based version of the TOEFL is approximately 1.5 hours half in duration, divided into four sections; Listening comprehension, Structure and Written Expression, Reading Comprehension, and Writing. The total paper based test consists of 140 questions and one written section. There is also an electronic version of the test, that costs $160 USD, but it is not available in all testing locations. The electronic version of the TOEFL exam is approximately 4 hours in length, divided into four sections, Listening, Reading, Speaking, & Writing.