Requirements for ECFMG Certification for 2021 Match

Frequently Asked Questions (FAQs)

General

1. How do I begin the pathway process to meet the requirements for ECFMG Certification?

You can apply using the Application for Pathways for ECFMG Certification for 2021 Match. Before you begin your application, you must read the eligibility requirements for all pathways and the additional requirements and instructions for the pathway to which you will apply.

Please note: The deadline for submission of a pathways application was December 31, 2020. Please be advised that due to the time required to process applications, if your application is submitted after December 31, 2020, ECFMG may be unable to determine the outcome of your pathways application in time for you to participate in the 2021 Match.

2. Why are you adding the pathways as requirements?

The requirement to demonstrate clinical skills is not new; it always has been a requirement for ECFMG Certification. Prior to Step 2 Clinical Skills (CS), ECFMG required international medical graduates (IMGs) to pass its Clinical Skills Assessment (CSA) for ECFMG Certification. Prior to CSA, ECFMG required IMGs to document that they had an unrestricted license or full registration to demonstrate clinical skills proficiency. In the absence of Step 2 CS, the pathways provide IMGs with options to meet the clinical skills requirement for ECFMG Certification.

3. Why aren’t U.S. medical graduates subject to these requirements?

IMGs always have had to meet additional requirements for entry into the U.S. health care system. There are more than 3,000 medical schools around the world with different education systems. Program directors rely on ECFMG Certification as an indicator that IMGs are ready to enter accredited U.S. GME programs. Many countries have similar requirements for IMGs to enter their health care systems.

4. I do not plan to apply to U.S. GME for the 2021-2022 academic year. Can I continue to pursue ECFMG Certification?

Yes. You may continue to pursue meeting other requirements for ECFMG Certification, such as passing Step 1 and Step 2 Clinical Knowledge (CK). However, the pathways are intended only for IMGs who plan to enter U.S. GME in 2021.

English Language Proficiency Assessment

1. What is the latest I can take OET Medicine in order to be considered eligible for the Match?

You must take OET Medicine on or before the last scheduled test date in 2020 to help ensure that your test score is reported in enough time for ECFMG to determine the status of your pathway application and to report that status to the National Resident Matching Program® (NRMP®) by the NRMP’s rank order list (ROL) deadline. However, the earlier you take the test, the better chance you will have of obtaining another test date if you fail the test.

Visit the OET website for the latest information on available test dates.

2. English is my native language. Can I be exempted from the English language proficiency requirement?

No. Demonstration of English language proficiency always has been a requirement for ECFMG Certification. Residency program directors rely on ECFMG Certification as an indicator that international medical graduates (IMGs) are ready to enter accredited U.S. graduate medical education (GME); this readiness includes English language proficiency. Since 2004, the English language component of Step 2 Clinical Skills (CS) has been used to meet this requirement. All applicants who are pursuing ECFMG Certification through one of these pathways, regardless of native language, language of instruction at medical school, or citizenship, must take and achieve a satisfactory score on an English language proficiency assessment deemed acceptable to ECFMG. There will be no exceptions.

3. I failed only the Spoken English Proficiency (SEP) subcomponent of Step 2 CS. Why can’t the rest of my Step 2 CS performance be combined with a passing score on TOEFL?

Step 2 CS consists of three separate subcomponents, and each of the three subcomponents must be passed in a single administration in order to achieve a passing performance on Step 2 CS. ECFMG will not combine passing performance on individual subcomponents to meet the requirements for Certification. This is consistent with USMLE requirements, which always have stipulated that each of the three subcomponents must be passed in a single administration in order to achieve a passing performance on Step 2 CS. There will be no exceptions.

4. I passed the SEP portion of Step 2 CS. Why can’t I be exempted from the English language proficiency requirement?

Step 2 CS consists of three separate subcomponents, and each of the three subcomponents must be passed in a single administration in order to achieve a passing performance on Step 2 CS. ECFMG will not combine passing performance on individual subcomponents to meet the requirements for Certification. This is consistent with USMLE requirements, which always have stipulated that each of the three subcomponents must be passed in a single administration in order to achieve a passing performance on Step 2 CS. There will be no exceptions.

5. Can I take the test remotely?

OET offers OET@Home, a version of the test that certain applicants can take at home through remote proctoring. OET@Home currently is offered by invitation only. Visit OET@Home on the OET website for more information.

6. The cost of the test is listed as $587AUD. What is the cost in U.S. currency?

The web page that displays the cost of the test includes a currency converter tool. Please use this tool to determine the current cost in U.S. dollars since exchange rates can fluctuate.

7. If OET Medicine involves an assessor who administers the test in person, what is the difference between taking OET Medicine and Step 2 CS?

There is no assessor present during the test. An interlocutor is present only for the speaking portion of OET Medicine, which is a brief, 20-minute experience. The interlocutor does not assess the applicant’s performance.

In addition, OET Medicine is designed to assess an individual’s English language proficiency, communication, and interpersonal skills in a health care environment. It does not assess clinical skills through physical examination.

8. How many times can I take the test?

There is no limit on the number of OET Medicine attempts, subject to scheduling availability.

9. Can I change the test date and/or location after I select them?

Yes, however, if you already have booked the test, you will need to pay a fee to change your booking to another date or location. For information on how to change your booking, including relevant fees, visit the OET website.

10. If I failed OET Medicine, but did not fail all four components of the test, will I need to retake all four components again in order to pass, or only those components that I failed?

The minimum score of 350 (Grade B) on each of the four measured components must be achieved in one test administration. Applicants who do not attain the minimum score on one or more of the measured components must retake all OET components (Listening, Reading, Writing, and Speaking) and achieve the minimum score on all components in a single test administration to meet ECFMG’s English language proficiency requirement.

11. How long will it take for test results to be released?

OET Medicine results will be released to you typically 14 business days after the test date. Please allow eight additional business days for your results to be added by ECFMG to your submitted pathway application and to be available to you in the ECFMG pathways application portal. Please be sure you give OET your consent to release the results to ECFMG through the application process and be sure you provide ECFMG with your OET Candidate ID# when submitting your pathway application to avoid any delays.

12. It has been more than eight business days since OET released my scores to me. Why haven’t they been added to my pathway application?

Various factors may delay the availability of your OET scores in the pathways application portal, including the following:

13. I requested that OET re-mark my test. Will this delay my ECFMG pathway application?

Yes. If you do not attain the minimum score of 350 (Grade B) on each of the four measured components of OET Medicine (Listening, Reading, Writing, and Speaking) and you request a score re-mark, this will delay your test results, and therefore your ECFMG pathway application, by several additional weeks.

Once your re-marked scores are released to you, you will still need to allow eight additional business days for your results to be added by ECFMG to your submitted pathway application and to be available to you in the ECFMG pathways application portal. Please be sure you give OET your consent to release the results to ECFMG through the application process and be sure you provide ECFMG with your OET Candidate ID# when submitting your pathway application to avoid further delays.

In addition, please note that because of the additional delay, if you take OET Medicine on certain test dates in December, and you request a score re-mark, your OET results may not be available to ECFMG in time for ECFMG to determine the outcome of your pathways application, and you may be ineligible to participate in the 2021 Match. ECFMG must receive your OET Medicine results by January 31, 2021. See the test results schedule for detailed information.

14. I am planning to take OET Medicine in December 2020. If I do not pass the test, can I retake it after December 31, 2020 and still be eligible to continue with my pathway application?

No. You must take OET Medicine on or before the last scheduled test date in 2020 and attain a minimum score of 350 (Grade B) on each of the four measured components (Listening, Reading, Writing, and Speaking). If you take the test in December 2020 and do not pass all four measured components, you may request that OET re-mark your test; however, please be aware that your OET re-mark results may not be available to ECFMG in time for ECFMG to determine the outcome of your pathways application, and you may be ineligible to participate in the 2021 Match. ECFMG must receive your OET Medicine results by January 31, 2021. See the test results schedule for detailed information.

15. Will my OET Medicine results be sent to ERAS?

No. OET Medicine is required for each pathway. ERAS will receive confirmation only that an applicant has or has not met the requirements for a pathway. ERAS will not receive the applicant’s OET Medicine results.

16. Will my OET Medicine results be needed in time for the rank order list (ROL) deadline?

Yes. To participate in the Match, IMGs must have satisfied all exam requirements for ECFMG Certification by NRMP’s ROL deadline. Passing OET Medicine is one component of completing a pathway and satisfying ECFMG’s English language proficiency and clinical skills requirements. Therefore, to be eligible for the Match, applicants must fulfill all components of one of the five pathways (in addition to passing USMLE Step 1 and Step 2 CK) successfully by the NRMP’s ROL deadline at 9:00 p.m., U.S. Eastern Time, on March 3, 2021.

17. I will not be participating in the 2021 Match. Should I take OET Medicine?

No. OET Medicine is required only for those applicants who are eligible for and pursuing one of the five pathways to participate in the 2021 Match. If you are ineligible for the pathways and/or do not plan to enter the 2021 Match, you should monitor the ECFMG website, since we are developing longer-term plans for applicants to future Matches. In the interim, you can continue to pursue other requirements for ECFMG Certification, such as passing Step 1 and Step 2 CK.

18. I have a test date booked, but my pathway application was rejected as ineligible. Will I receive a refund for OET Medicine when I cancel?

If you have not yet taken OET Medicine and ECFMG determines you are ineligible for a pathway, you can withdraw from OET and request a refund, subject to OET’s conditions and fees.

19. Why did ECFMG choose OET?

ECFMG chose OET because it is designed for health care professionals, and there is a version, OET Medicine, specifically for physicians. In addition to assuring proficiency in spoken and written English, OET Medicine assesses a physician’s communication and interpersonal skills in the context of a health care setting. This includes the ability to show empathy and to break down complex medical terminology and procedures into language that can be easily understood by patients.

OET Medicine simulates real workplace scenarios and assesses relevant language skills needed for the practice of medicine. It will allow applicants for ECFMG Certification to demonstrate language skills that are important for success in U.S. graduate medical education. OET is recognized widely by health care boards, councils, and commissions around the world.

20. Will OET test materials reflect the health care workplace in the United States?

OET has been designed to reflect health care workplaces in English-speaking countries. Subject matter experts (SMEs), who are practicing doctors and/or leading academics in their medical fields, provide input into all test materials to ensure that the questions and tasks accurately reflect the health care workplace. OET’s pool of SMEs includes physicians who are based in the United States. They check that the terminology and concepts used are appropriate and will neither advantage nor disadvantage those who aim to work in the United States.

21. I want to work/train in the United States, so why do I have to take a test that includes non-U.S. accents and British spelling?

OET has been designed for the international workplace and reflects the diverse reality of most health care settings. The test, therefore, includes British spelling and a range of accents, including Australian, British, American, and more. Professionals today are regularly required to communicate with colleagues and patients from different linguistic backgrounds, so OET ensures that you are prepared for this reality.

22. What accents will I hear in OET?

For the Listening sub-test, across all three parts, a range of accents is used to reflect the global nature of the health care workforce. The main accents are Australian, American, and British. Other accents are Canadian, Irish, New Zealand, and South African.

For the Listening, Reading, and Writing sub-tests, you will not lose marks if you accurately use any variation of English.

23. Will I lose marks for using U.S. spelling?

No. OET accepts both U.S. and British spelling as correct.

Eligibility

1. How do I know if I am eligible for one of the pathways?

Applicants who wish to enter an ACGME-accredited graduate medical education (GME) program for the 2021-2022 academic year and are unable to take Step 2 Clinical Skills (CS) due to the suspension may be able to meet the requirements for ECFMG Certification through one of five pathways. Please refer to the eligibility requirements for all pathways and to the additional requirements for Pathway 1, Pathway 2, and Pathways 3-5. Pathway applicants also must meet all other requirements for ECFMG Certification.

2. I do not plan to enter the 2021 Match. Can I still use a pathway to meet the requirements for ECFMG Certification?

No. If you have no intention of participating in the 2021 Match, you should not pursue the pathway process in order to meet the clinical skills requirement for ECFMG Certification. ECFMG Certificates based on one of the pathways will expire if you do not enter an ACGME-accredited GME program for the 2021-2022 academic year, and you will not receive a refund of any application fees.

3. How will ECFMG know that I intend to enter the 2021 Match?

If you pursue ECFMG Certification based on one of the pathways, you must signal your intention to participate in the 2021 Match by purchasing a 2021 ERAS Residency Token.

4. What if I obtain a GME position for the 2021-2022 academic year outside of The Match; for example, what if I participate in the San Francisco Match?

The pathways may be used by individuals seeking to enter an ACGME-accredited or approved non-standard training program. If you do not participate in the Main Residency Match®, please contact us for assistance with applying.

5. Why is this only for people entering the 2021 Match? I want to use one of these pathways too.

Because Step 2 CS was suspended for a period of 12-18 months, ECFMG has focused on the individuals most immediately affected, i.e., those entering the 2021 Match. Longer-term plans for other applicants currently are in process.

6. I have passed Step 2 CS. Am I eligible to apply to a pathway?

No. Applicants who have a passing performance on Step 2 CS that is valid for ECFMG Certification are ineligible for the pathways and do not need the pathways to meet the requirements for ECFMG Certification or participation in the 2021 Match.

7. I have failed the same USMLE exam two times. Am I eligible for the pathways?

No. An applicant who has failed the same USMLE Step or Step Component two or more times is ineligible for all of the pathways. There will be no exceptions.

8. I have failed Step 1 once and Step 2 CK once, for a total of two USMLE fails. Am I eligible for the pathways?

Yes, provided you meet all other eligibility requirements. Only applicants who have failed the same Step or Step Component two or more times are ineligible.

9. I passed Step 1 and Step 2 CK in 2017 but never registered for Step 2 CS. Am I eligible for the pathways?

No. Only applicants who have taken or been registered for any USMLE Step or Step Component since January 1, 2018 are eligible. However, ECFMG will consider an exception to this eligibility requirement in limited circumstances. See the Exceptions page for more information.

10. I passed Step 1 in 2017 but haven’t been registered for a USMLE Step or Step Component since then. I plan to apply for Step 2 CK. Am I eligible for the pathways?

Currently, you are ineligible for the pathways because you have not taken or been registered for a USMLE Step or Step Component since January 1, 2018. If you apply for Step 2 CK and are registered, you will be eligible to apply for the pathways, provided you meet all other pathway eligibility requirements.

11. I passed Step 1 in 2005 and Step 2 CK in 2006, but those scores are no longer valid for ECFMG Certification because I did not pass all exams required for ECFMG Certification, including Step 2 CS, within seven years of each other. Can I use the pathways to meet certification requirements?

No. To be eligible for the pathways, you must have taken or been registered for a USMLE Step or Step Component since January 1, 2018. Additionally, applicants who use the pathways must meet all other requirements for ECFMG Certification; this means you would need to retake and pass Step 1 and Step 2 CK to obtain passing performances that are valid for ECFMG Certification.

If you reapply for Step 1 and/or Step 2 CK and are registered for one of these exams, you will be eligible to apply for the pathways, provided you meet all other pathway eligibility requirements. To be eligible for ECFMG Certification to enter U.S. GME in 2021, you must pass Step 1 and Step 2 CK; meet all requirements for one of the pathways, including the English language proficiency assessment; and meet all other requirements for ECFMG Certification in time to participate in the ERAS 2021 application season and the 2021 Match.

12. I was registered for Step 1 in 2017 for an eligibility period in 2018. Am I eligible for the pathways?

Yes. Because you had an active USMLE exam registration during 2018, you meet the requirement to have taken or been registered for a USMLE Step or Step Component since January 1, 2018. You must meet all other eligibility requirements.

13. I was registered for Step 1 in 2018 but did not take the exam. Am I eligible for the pathways?

Yes. Because you had an active USMLE exam registration during 2018, you meet the requirement to have taken or been registered for a USMLE Step or Step Component since January 1, 2018. You must meet all other eligibility requirements.

14. I currently am barred by ECFMG from pursuing ECFMG Certification. Can I pursue a pathway?

No. Applicants who currently are barred by ECFMG from pursuing ECFMG Certification are ineligible for the pathways. There will be no exceptions.

15. Are applicants eligible for the pathways if ECFMG has suspended or revoked their ECFMG Certificate?

No. These applicants are ineligible for the pathways. There will be no exceptions.

16. The USMLE program has barred me from taking a Step or Step Component from August 1, 2020 to January 31, 2021. Can I apply for a pathway?

No. This makes you ineligible for the pathways. There will be no exceptions.

17. I do not qualify for any of the pathways, and I planned to enter the 2021 Match. What do I do?

ECFMG will consider exceptions to certain pathway eligibility requirements in limited circumstances. See the Exceptions page for more information.

If you are ineligible for the pathways and the limited exceptions for the 2021 Match, you should monitor the ECFMG website, since we are developing longer-term plans for applicants to future Matches. In the interim, you can continue to pursue other requirements for ECFMG Certification, such as passing Step 1 and Step 2 CK.

18. No one from my country will qualify for these pathways. You are purposely blocking us.

These pathways, along with the English language proficiency requirement, were developed to be a reasonable, objective substitute for Step 2 CS. They also are designed to be implemented as soon as possible to enable individuals to apply to the 2021 Match. Longer-term plans for applicants who may not qualify for the pathways currently are in process.

19. The usual rules allow individuals who have failed an exam two or more times to become certified. Why did ECFMG reduce the number of exam attempts as part of the pathways process?

If an applicant has two or more fails on the same USMLE Step or Step Component, it is prudent for ECFMG to require the applicant to demonstrate clinical skills through a structured, measured examination, given in the United States, before entering the U.S. health care system.

20. Based on the answer to the preceding question, why aren’t you allowing applicants with two or more fails to do just that, by applying to Pathway 2 (Already Passed a Standardized Clinical Skills Exam for Medical Licensure)?

The USMLE is the common standard for evaluating applicants for initial medical licensure in the United States. If any applicant has two or more fails on the same USMLE Step or Step Component, it is prudent to require the applicant to demonstrate clinical skills through a structured, measured examination, given in the United States and designed to evaluate physicians for U.S. practice, before allowing them to enter the U.S. health care system.

21. My medical school is in the process of pursuing accreditation by an agency recognized by the World Federation for Medical Education (WFME). Am I eligible for Pathway 3?

No. Applicants from medical schools that are located in a country/region served by a WFME-recognized agency and that are not accredited by that agency (or were not accredited by that agency when the applicant matriculated) are ineligible for Pathway 3. There will be no exceptions.

Pathway-specific Questions

1. How do I know if my school currently is accredited by an agency recognized by the World Federation for Medical Education (WFME) (Pathway 3)?

For a list of schools that currently are accredited by an agency recognized by WFME and that meet ECFMG’s other medical school requirements, click here.

2. My school is accredited, but not by an agency recognized by WFME or by one that has received a determination of comparability by the National Committee on Foreign Medical Education and Accreditation (NCFMEA). Why am I left out of Pathways 3 and 4?

Research on medical school accreditation has shown that the standards and processes used by accrediting agencies vary widely across the world. Recognition of an accrediting agency by WFME, or by an agency that has received a determination of comparability by NCFMEA, ensures that the agency has met globally accepted criteria and that its policies and procedures are at an appropriate and rigorous standard.

3. Aren’t you just advancing the accreditation requirement for ECFMG Certification?

To put these pathways in place in enough time to allow individuals to continue to apply for the 2021 Match, ECFMG has incorporated quality assurance programs already in place in order to continue to issue ECFMG Certification in accordance with its purpose. The WFME Recognition Programme, which has been in operation since 2012, is just one program to be included as a pathway (Pathway 3). ECFMG also includes medical schools currently accredited by agencies that have received a determination of comparability by NCFMEA (Pathway 4).

4. For the attestation of clinical skills (Pathways 3-5), does my school have to use ECFMG’s attestation form? Can an official from my medical school submit a letter instead?

Your school must submit the ECFMG Clinical Skills Attestation Form. You will be ineligible for Pathways 3-5 if your medical school submits a letter or other document instead.

5. Some of the pathways require a medical school graduation date in 2018 or later. Why can’t international medical graduates (IMGs) who graduated before 2018 apply to one of these pathways?

Residency program directors rely on ECFMG Certification as an indicator that IMGs are ready to enter accredited U.S. graduate medical education (GME); this readiness includes clinical skills proficiency. The graduation date requirement ensures that applicants received recent training in clinical skills as part of their medical education. However, ECFMG will consider an exception to this eligibility requirement in limited circumstances. See the Exceptions page for more information.

6. How do I know if my school currently participates in the U.S. Federal Loan Program or has been accredited by an agency that has received a determination of comparability by NCFMEA (Pathway 4)?

For a list of eligible schools that also meet ECFMG’s other medical school requirements, click here.

7. I obtained a license to practice medicine in 2010, and it remained active until 2017. Am I eligible to apply to Pathway 1 (Already Licensed to Practice Medicine in Another Country)?

Yes. You are eligible to apply to Pathway 1 if you held a license to practice medicine and/or participate in postgraduate medical education for any amount of time on or after January 1, 2015, regardless of when your license was issued, provided the license was not subject to disciplinary action.

Score Reporting

1. I failed my initial attempt at Step 2 Clinical Skills (CS). If I obtain Certification through one of the pathways, will ECFMG still report my failed attempt to programs?

Yes, if you request and pay for a USMLE transcript to be sent to programs. The USMLE transcript is required by many ACGME-accredited residency programs as part of the ERAS application process. The USMLE transcript contains your examination history on Step 1, Step 2 Clinical Knowledge (CK), Step 2 CS, and, if taken, Step 3. All attempts at USMLE Steps and Step Components (passed, failed, incomplete, etc.) will be included, regardless of whether you meet the clinical skills requirement for ECFMG Certification through one of the pathways.

Expiration of ECFMG Certificate Based on a Pathway

1. Why do the certificates expire?

The pathways are directed toward individuals who wish to begin U.S. graduate medical education (GME) in the 2021-2022 academic year. To ensure they are used for that purpose, if you do not enter a U.S. GME program in the 2021-2022 academic year, your certificate will expire.

2. What do I have to do to make sure my ECFMG Certificate based on one of the pathways does not expire?

You must enter an ACGME-accredited GME program for the 2021-2022 academic year and satisfactorily complete the first year of training.

3. Why do I have to complete a full year of residency before my certificate is valid indefinitely?

Given that the pathways are being used in place of Step 2 Clinical Skills (CS), it is important to require at least one year of training as an additional measure to assure the public and regulatory authorities that those obtaining certificates through these pathways are vetted appropriately.

4. What happens if I obtain ECFMG Certification based on a pathway but fail to obtain a position in the 2021 Match?

If you obtain an ECFMG Certificate based on one of the pathways, it will expire if you do not enter an ACGME-accredited GME program for the 2021-2022 academic year. If you intend to participate in a future Match, you will be required to meet the requirements for clinical skills in place at that time in order to revalidate your certificate.

Fees

1. What is the fee to apply to a pathway?

The fee to apply to a pathway is $900. If you apply for an exception in conjunction with your pathway application, the total fee is $1,200.

2. If there is no exam, how can you charge for this?

There is significant work required by ECFMG to determine applicant eligibility, process applications, and verify the documentation required.

Other

1. Will I be eligible to apply for J-1 visa sponsorship if I am issued an ECFMG Certificate based on one of the pathways?

Yes.

2. I was scheduled to take Step 2 CS on a date that would have satisfied ECFMG’s requirement to pass all exams within a seven-year period. Now that my Step 2 CS testing appointment has been canceled, how will I meet ECFMG’s seven-year requirement?

Applicants who were scheduled to take Step 2 CS during their seven-year window, were unable to test due to the suspension of Step 2 CS as a result of COVID-19, and are certified based on one of the pathways will satisfy ECFMG’s requirement to pass all exams required for ECFMG Certification within a seven-year period.

The preceding information is current as of January 14, 2021 and is subject to change. Please visit the ECFMG website frequently for updates regarding these requirements.