Requirements for ECFMG Certification for 2022 Match

Frequently Asked Questions (FAQs)

General

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

You can apply now to Pathway 1, 2, 3, 4, or 5 using the Application for Pathways for ECFMG Certification for 2022 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.

The on-line application process for Pathway 6 is expected to open in August. Please see the Pathway 6 page for the steps that you can take to prepare for Pathway 6 before August.

2. Why are the Pathways required for ECFMG Certification?

The requirement to demonstrate clinical and communication 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 and communication skills requirements 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. graduate medical education (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 by the 2022-2023 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 or 2022.

Assessment of Communication Skills, Including English Language Proficiency

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

You must take the Occupational English Test (OET) Medicine on or before the last scheduled test date in 2021 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 do not obtain a satisfactory score. We recommend that you take the OET Medicine test as soon as you are able.

Visit the OET website for information on booking the OET Medicine test.

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) programs; 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 the 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.

Applicants who pursue one of the Pathways for the 2022 Match are required to attain a satisfactory score on OET Medicine to satisfy the communication skills requirement, including English language proficiency, for ECFMG Certification. Preparation for OET Medicine is key, even for those with a high level of English proficiency. OET is not a multiple-choice test and the test tasks are designed to be challenging. All applicants should prepare thoroughly before attempting OET Medicine, including those with a high level of English language proficiency. OET’s Education team emphasizes the importance of becoming familiar with both the test construct and the assessment criteria and offers a variety of preparation materials for both non-native and native speakers of English:

Preparation for non-native speakers of English

Preparation for native speakers of English

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 United States Medical Licensing Examination® (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@Home, a version of the test that can be taken at home through remote proctoring, is available to certain Pathways applicants. OET@Home is available only to applicants who do not have a physical test venue (for paper-based or computer-based testing) in their country. Applicants with a test venue in their country should plan to take OET on paper or OET on computer at a physical test center to ensure that they test in time to meet Pathways requirements for participation in the 2022 Match. To determine whether there is a test venue in your country, see Test Dates and Locations on the OET website. You must take OET Medicine on or before the last scheduled test date in December 2021.

Eligible applicants can book OET@Home now on the OET website.

If you have questions about OET@Home, please contact OET.

6. How many times can I take the test?

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

7. 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.

8. 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.

9. 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. If you successfully pass OET Medicine in one test administration and you provided your USMLE/ECFMG ID as part of OET’s booking process, your passing score results will be electronically transmitted to ECFMG within three business days after they are released to you.

If you did not provide your USMLE/ECFMG ID when you booked OET Medicine, or if you are unsure whether you did, you can release your results to ECFMG by following these instructions. Your results will be transmitted to ECFMG within three business days after you release them.

10. It has been more than three (3) business days since OET released my scores to me. Why haven’t they been added to my Pathways application?

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

11. 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.

12. 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 clinical and communication skills requirements. Therefore, to be eligible for the Match, applicants must fulfill all components of a Pathway (in addition to passing USMLE Step 1 and Step 2 Clinical Knowledge (CK)) successfully by the NRMP’s ROL deadline.

13. I will not be participating in the 2022 Match. Should I take OET Medicine?

No. OET Medicine is required only for those applicants who are eligible for and pursuing one of the Pathways to participate in the 2021 or 2022 Match. If you are ineligible for the Pathways and/or do not plan to enter the 2022 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.

14. 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.

15. Why did ECFMG choose OET?

ECFMG chose OET because it is designed for health care professionals, and there is a version, OET Medicine, that is designed specifically for physicians, in consultation with physicians. The test assesses the health care-specific English language competency of physicians. It emphasizes the type of language physicians will need to communicate effectively in a clinical setting with peers and patients, including the ability to show empathy and to break down complex medical terminology and procedures into simpler language.

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. GME. OET is recognized widely by health care boards, councils, and commissions around the world.

16. 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.

17. 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.

18. 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.

19. 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 Accreditation Council for Graduate Medical Education (ACGME)-accredited graduate medical education (GME) program for the 2022-2023 academic year and were unable to take Step 2 Clinical Skills (CS) due to its suspension and subsequent discontinuation may be able to meet the requirements for ECFMG Certification through one of six Pathways. Please refer to General Eligibility for All Pathways and to the additional requirements for Pathway 1, Pathway 2, Pathways 3-5, and Pathway 6. Pathway applicants also must meet all other requirements for ECFMG Certification.

2. I do not plan to enter GME by 2022. Can I still use a Pathway to meet the requirements for ECFMG Certification?

No. If you have no intention of entering a GME program for the 2021-2022 or 2022-2023 academic years, you should not pursue the Pathway process in order to meet the clinical and communication skills requirements for ECFMG Certification. ECFMG Certificates based on one of the Pathways will expire for the purpose of entering GME if you do not enter an ACGME-accredited GME program for the 2021-2022 or 2022-2023 academic year, and you will need to complete ECFMG’s clinical and communication skills requirements in place for the academic year in which you plan to enter GME in order to revalidate the Certificate. You will not receive a refund of any application fees.

3. Why is this only for people entering GME in 2021-2022 and 2022-2023 academic years? I want to use one of these Pathways too.

ECFMG has developed the Pathways to support those individuals most immediately affected by the suspension and subsequent discontinuation of Step 2 CS. Longer-term plans for other applicants currently are in process.

4. 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.

5. I have failed the same USMLE exam two times. Am I eligible for the Pathways?

Yes. For the 2022 Match, an applicant who has failed the same United States Medical Licensing Examination® (USMLE®) Step or Step Component two or more times is eligible for the Pathways. Please note that if you have failed Step 2 CS one or more times, you will be required to apply to Pathway 6 in order to meet the clinical and communication skills requirements for ECFMG Certification, regardless of whether you meet the eligibility requirements for other Pathways.

6. I have failed Step 2 CS previously, but I am eligible for another Pathway. Why am I required to apply to Pathway 6?

If an applicant has failed Step 2 CS previously, it is prudent for ECFMG to collect more information about the applicant’s clinical skills through a standardized process before certifying a candidate to enter U.S. GME. Pathway 6 was designed to collect this information using an accepted assessment tool adapted to meet the needs of the ECFMG Certification process, ECFMG’s Mini-Clinical Evaluation Exercise (Mini-CEX) for Pathway 6. The ability to apply to Pathway 6 is expected to become available in August. Please see the Pathway 6 page for the steps that you can take to prepare for Pathway 6 before August.

7. 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.

8. 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.

9. I do not qualify for Pathways 1-5, and I planned to enter the 2022 Match. What do I do?

For the Pathways for the 2022 Match, ECFMG has added a new Pathway, Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians. Pathway 6 is for applicants who do not meet the eligibility requirements for Pathway 1, 2, 3, 4, and 5 and/or have failed Step 2 CS one or more times. To meet the requirements for Pathway 6, the applicant’s clinical skills must be evaluated by licensed physicians using ECFMG’s Mini-Clinical Evaluation Exercise (Mini-CEX) for Pathway 6. The application process for Pathway 6 is expected to become available in August. Please see the Pathway 6 page for the steps that you can take to prepare for Pathway 6 before August.

10. I plan to enter a U.S. GME fellowship program in the 2022-2023 academic year. Am I able to use the Pathways to satisfy the clinical and communication skills requirements for ECFMG Certification?

Yes, if you plan to enter a GME program for the 2022-2023 academic year, you may apply to the Pathways to satisfy the clinical and communication skills requirements for ECFMG Certification. If you satisfy the clinical and communication skills requirements through the Pathways and do not enter an ACGME-accredited training program in 2021 or 2022, your ECFMG Certificate will expire for the purpose of entering GME. Should you wish to enter a GME program in the future, you will be required to meet the clinical and communication skills requirements for ECFMG Certification in place at that time in order to revalidate your ECFMG Certificate.

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, see the Pathway 3 schools in the list of Medical Schools Eligible for 2022 Pathways.

2. 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 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.

3. 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 can I not apply to Pathways 3 or 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. If you do not meet the eligibility requirements for Pathways 1-5, you can apply to Pathway 6. The application process for Pathway 6 is expected to become available in August. Please see the Pathway 6 page for the steps that you can take to prepare for Pathway 6 before August.

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

To establish the Pathways in enough time to allow individuals to continue to meet the requirements for ECFMG Certification, ECFMG has incorporated quality assurance programs already in place. The WFME Recognition Programme, which has been in operation since 2012, is just one program to be included as a Pathway (Pathway 3). ECFMG has also included medical schools currently accredited by agencies that have received a determination of comparability by NCFMEA (Pathway 4).

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

Your school must complete and submit ECFMG’s Clinical Skills Attestation, either on-line through the Clinical Skills Evaluation and Attestation Portal if it participates in using the ECFMG Medical School Web Portal (EMSWP), or by e-mail if it does not participate in using EMSWP. You will be informed of the method by which your school must complete the Clinical Skills Attestation when you submit your Pathway application. A letter or other document from your school will not meet the requirements for Pathways 3-5.

6. 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) programs; 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. If you graduated prior to 2018, you can apply to Pathway 6. The application process for Pathway 6 is expected to become available in August. Please see the Pathway 6 page for the steps that you can take to prepare for Pathway 6 before August.

7. How do I know if my school 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, see the Pathway 4 schools in the list of Medical Schools Eligible for 2022 Pathways.

8. 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 without supervision 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.

9. I do not meet the requirements for Pathways 1–5 and I am unable or prefer not to apply to Pathway 6. Are there exceptions to any of the Pathways?

No. There are no exceptions to any of the Pathways or the general eligibility requirements. If you do not meet the requirements for Pathway 1, 2, 3, 4, or 5 and/or you failed Step 2 Clinical Skills (CS) one or more times, you are required to apply to Pathway 6 in order to meet the clinical and communication skills requirements for ECFMG Certification.

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 United States Medical Licensing Examination® (USMLE®) transcript to be sent to programs. The USMLE transcript is required by many Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs as part of the ERAS application process. USMLE requires that its 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 and 2022-2023 academic years. To ensure they are used for that purpose, if you do not enter a U.S. GME program in the 2021-2022 or 2022-2023 academic years, your certificate will no longer be valid for the purpose of entering GME. Should you wish to enter an accredited GME program in the future, you will be required to meet the clinical and communication skills requirements for ECFMG Certification in place at that time in order to revalidate your certificate.

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 Accreditation Council for Graduate Medical Education (ACGME)-accredited GME program for the 2021-2022 or 2022-2023 academic years 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 individuals obtaining certificates through these Pathways are vetted appropriately.

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

If you obtained an ECFMG Certificate based on one of the 2021 Pathways and you do not enter an ACGME-accredited GME program for the 2021-2022 academic year, your previously accepted Pathway application will remain valid for the 2022 Match and for entry to U.S. GME during 2022. If you do not enter an ACGME-accredited GME program for the 2022-2023 academic year and intend to participate in a future Match, you will be required to meet the clinical and communication skills requirements for ECFMG Certification 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.

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 unable to take Step 2 Clinical Skills (CS) on a date that would have satisfied ECFMG’s requirement to pass all exams within a seven-year period. How will I meet ECFMG’s seven-year requirement?

If your Pathway application is accepted within your seven-year period, this will meet ECFMG’s requirement to pass all exams required for ECFMG Certification within a seven-year period and no further action will be required. If your Pathway application is not accepted within the seven-year period and your Step 1 and/or Step 2 Clinical Knowledge (CK) score becomes invalid for ECFMG Certification as a result, you must contact ECFMG to determine whether your invalid passing performance on Step 1 and/or Step 2 CK meets ECFMG’s requirements to be extended. Please note that it is your responsibility to track your progress toward meeting the exam requirements for ECFMG Certification. ECFMG will not notify you of upcoming deadlines to meet the seven-year requirement and will not notify you if one (or more) of your passing performances becomes invalid for ECFMG Certification because you failed to meet the seven-year requirement.

The preceding information is current as of July 26, 2021 and is subject to change. Please visit the ECFMG website frequently for updates regarding these requirements.