ECFMG 2021 Information Booklet

Eligibility for Examination

The eligibility requirements for examination differ depending on whether you are a medical school student or a medical school graduate.

Medical School Graduates

To be eligible for Step 1 and Step 2 CK, you must be a graduate of a medical school located outside the United States and Canada that is listed in the World Directory as meeting ECFMG eligibility requirements. Your graduation year must be included in the "Graduation Years" listed in the ECFMG note in your medical school’s World Directory listing. See Medical School Requirements. You must have been awarded credit for at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) by a medical school that is listed in the World Directory as meeting ECFMG eligibility requirements. An authorized official of your medical school must certify your status as a graduate of the school; instructions will be provided at the time of application for examination.

You must submit a copy of your medical diploma at the time of exam application if your diploma has not been sent to ECFMG previously. The exact degree title of the final medical diploma you must have earned (and must provide) in order to be eligible for ECFMG Certification and the examinations required for Certification is listed in the Reference Guide for Medical Education Credentials on the ECFMG website. If you have graduated and met all requirements for your medical diploma but your medical diploma has not yet been issued, a letter signed by an authorized official of your medical school must be submitted with your exam application. The letter you submit must be the original document and must be written on your medical school’s letterhead. The letter must include the following statement:

This is to confirm that [applicant name] has graduated and completed all requirements to receive the [degree title] degree from [medical school/university name]. The degree will be issued [month and year].

You must then submit a copy of your medical diploma to ECFMG as soon as your diploma is issued. See Medical Education Credentials.

All documents that are not in English must be accompanied by an official English translation that meets ECFMG’s translation requirements. See English Translations in Medical Education Credentials.

Important Notes: If your eligibility for an exam changes after you apply but before you take the exam, you are required to inform ECFMG immediately in writing of this change in your status. Such notification must be sent to ECFMG’s Applicant Information Services. Use the contact information for General Inquiries on the Contact ECFMG page of the ECFMG website. Failure to inform ECFMG that you may no longer be eligible to take the examination may result in a finding of irregular behavior and permanent annotation of your ECFMG record. See Policies and Procedures Regarding Irregular Behavior.
If you take a Step or Step Component for which you are not eligible, results for that exam may not be reported or, if previously reported, may be canceled.
If you have already been granted a physician license by a U.S. medical licensing authority based on other licensure examinations, such as the Federation Licensing Examination (FLEX), the NBME certifying examinations, or the National Board of Osteopathic Medical Examiners COMLEX-USA, you may not be eligible to take the USMLE. Please contact ECFMG if you have questions about your eligibility.

The American Medical Association’s Council on Medical Education no longer supports the Fifth Pathway as a mechanism for eligibility to enter ACGME-accredited graduate medical education programs. Additionally, the USMLE Program no longer accepts Fifth Pathway Certificates to meet eligibility requirements to take Step 3. Individuals who hold Fifth Pathway Certificates and wish to apply to ECFMG for examination must apply for ECFMG Certification and meet the requirements for ECFMG Certification established for all medical school graduates.