Intealth ECFMG

Educational Commission for Foreign Medical Graduates

ECFMG 2023 Information Booklet

Eligibility for Examination


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

International 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 with an ECFMG note stating it meets 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 with an ECFMG note stating it meets 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.

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.

All credentials and documentation required to complete your exam application must be received within four weeks of the date you submit the on-line portion of your application, or your exam application will be rejected.

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 record. See Policies and Procedures Regarding Irregular Behavior.
If you take a Step 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 Medical Council of Canada Qualifying Examination, 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.

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[Last update: September 14, 2022]

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