Intealth ECFMG

Educational Commission for Foreign Medical Graduates

Frequently Asked Questions (FAQs)


General


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

You can apply now using the Application for Pathways for ECFMG Certification for 2023 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, in the Requirements for ECFMG Certification for 2023 Match section of the ECFMG website.

2. Why are the Pathways required for ECFMG Certification?

The Pathways allow international medical graduates (IMGs) to meet the clinical and communication skills requirements 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 the Pathways, ECFMG required that IMGs pass the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination® (USMLE®). Prior to Step 2 CS, ECFMG required 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.

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.

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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 December 2022 to help ensure that your test score is reported in enough time for ECFMG to determine the status of your Pathways application and to report that status to the National Resident Matching Program® (NRMP®) by the NRMP’s Rank Order List (ROL) Certification 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. 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 2023 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 Clinical Skills (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 2023 Match. To determine whether you need to take OET Medicine on paper or on computer at a test venue, or whether you are eligible for OET@Home, visit the OET website and select your country.

You should take OET Medicine on or before the last scheduled test date in December 2022 to help ensure that your test score is reported in enough time for ECFMG to determine the status of your Pathways application and to report that status to the NRMP by the NRMP’s ROL Certification deadline.

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?

You will need to take all four components again. 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. See Test Dates on the booking page on the OET website for test dates and the dates on which results are scheduled to be released. 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:

  • You did not release your results to ECFMG. Follow these instructions for releasing your results and allow three business days for the information to be transmitted to ECFMG and made available in your Pathways application. You must provide your USMLE/ECFMG ID to OET.
  • There are errors or inconsistences in the information you provided to OET or to ECFMG. Examples include:
    • Erroneously entering your USMLE/ECFMG ID when booking with OET or releasing your results to ECFMG.
    • Your date of birth on record with OET does not match the date of birth on record with ECFMG. First confirm your date of birth is accurate with OET and make any corrections, if necessary. If your USMLE/ECFMG ID and date of birth are both accurate in your OET record, please contact ECFMG for further assistance.

11. Will my OET Medicine results be sent to the Electronic Residency Application Service (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 ROL Certification deadline?

Yes. To participate in the Match, IMGs must have satisfied all exam requirements for ECFMG Certification by NRMP’s ROL Certification 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 successfully (in addition to obtaining passing results on USMLE Step 1 and Step 2 Clinical Knowledge (CK) that are valid for ECFMG Certification) by the NRMP’s ROL deadline.

13. I will not be participating in the 2023 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 2023 Match. If you are ineligible for the Pathways and/or do not plan to enter the 2023 Match, you should monitor the ECFMG website for the clinical and communication skills requirements for ECFMG Certification for 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 Pathways 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.

20. Are testing accommodations available for OET Medicine?

Yes. OET allows individuals to request reasonable Special Arrangements/Testing Accommodations that they may require in order to take OET Medicine. Testing accommodations are available for OET candidates who meet certain eligibility criteria and properly document their request. Information on eligibility criteria and the process for requesting Special Arrangements/Testing Accommodations can be found in the OET Test Regulations section of the OET website. ECFMG does not assess eligibility for OET’s testing accommodations nor grant these accommodations.

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Eligibility


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

Please refer to General Eligibility for All Pathways and to the specific requirements for Pathway 1, Pathway 2, Pathways 3-5, and Pathway 6 to determine which Pathway you are eligible for. Pathways applicants also must meet all other requirements for ECFMG Certification.

2. I do not plan on participating in the 2023 Match. Can I still use a Pathway to meet the requirements for ECFMG Certification?

If you meet the clinical and communication skills requirements for ECFMG Certification through a Pathway, your certificate will be subject to expiration. The expiration date is the date through which your certificate remains valid for entry into a U.S. graduate medical education (GME) program accredited by the Accreditation Council for Graduate Medical Education (ACGME). ECFMG Certificates earned based on a 2023 Pathway will expire on December 31, 2024. If you do not enter an accredited GME program before your certificate expires, you will need to meet 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. You should plan the timing of your Pathways application accordingly.

3. I have passed Step 2 CS and my Step 2 CS score is still valid for ECFMG Certification. 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 may not use the Pathways to meet the requirements for ECFMG Certification.

4. I have failed Step 2 Clinical Skills (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 the applicant 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.

5. 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.

6. 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.

7. I plan to enter a U.S. GME fellowship program in the 2023-2024 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 2023-2024 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 by December 31, 2024, your ECFMG Certificate will expire. If your certificate expires and you have not yet entered an accredited GME program, 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.

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Pathways 1 through 5


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 2023 Pathways.

2. My medical school is in the process of pursuing accreditation by an agency recognized by WFME. Am I eligible for Pathway 3?

No. Applicants from medical schools located in a country/region served by a WFME-recognized agency that are not accredited by that agency 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 Pathway 1, 2, 3, 4, or 5, you can apply to Pathway 6. Please see the Pathway 6 page for more information, including eligibility requirements and application instructions.

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

To establish the Pathways and provide international medical graduates (IMGs) with the opportunity to meet the requirements for ECFMG Certification, ECFMG has incorporated medical school 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 EMSWP. You will be informed of the method by which your school must complete the Clinical Skills Attestation when you submit your Pathways 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 2021 or later. Why can’t IMGs who graduated before 2021 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 2021, you can apply to Pathway 6. Please see the Pathway 6 page for more information, including eligibility requirements and application instructions.

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 2023 Pathways.

8. I obtained a license to practice medicine in 2013, and it remained active until 2019. 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, 2018, 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.

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Pathway 6


1. Can a specialized physician, such as a neurologist or pediatrician, evaluate the applicant in a primary care/general practice encounter?

Yes, Mini-Clinical Evaluation Exercise (Mini-CEX) evaluations may be completed by specialized physicians if they meet the Criteria for Acceptable Physician Evaluators. The encounter itself must meet the Criteria for Acceptable Clinical Encounters, which indicate, among other criteria, that the encounter must:

  • Be primary care/general practice in nature and not subspecialized, and
  • Focus on the diagnosis and treatment of acute and/or chronic illnesses in a primary care setting, such as general internal medicine, family medicine, pediatrics, or obstetrics and gynecology, in which each of the four components of the Mini-CEX (Medical Interviewing Skills, Physical Examination Skills, Professionalism/Communication Skills, Clinical Reasoning & Judgment) can be assessed.

2. What is considered a general medical encounter?

The Criteria for Acceptable Clinical Encounters indicate, among other criteria, that the encounter must:

  • Be primary care/general practice in nature and not subspecialized, and
  • Focus on the diagnosis and treatment of acute and/or chronic illnesses in a primary care setting, such as general internal medicine, family medicine, pediatrics, or obstetrics and gynecology, in which each of the four components of the Mini-CEX (Medical Interviewing Skills, Physical Examination Skills, Professionalism/Communication Skills, Clinical Reasoning & Judgment) can be assessed.

3. Can a clinical encounter be completed outside of the United States?

Yes, the encounter may take place outside of the United States. Each encounter must meet the Criteria for Acceptable Clinical Encounters and each evaluator must meet the Criteria for Acceptable Physician Evaluators.

4. Can a clinical encounter be performed on a standardized patient?

No. Each of the six required clinical encounters must be a real, in-person encounter. Standardized patient encounters will not be accepted. See Criteria for Acceptable Clinical Encounters for detailed criteria.

5. Can a clinical encounter be conducted via telemedicine or virtually?

No. Each of the six required clinical encounters must be a real, in-person encounter. Telemedicine and virtual encounters will not be accepted. See Criteria for Acceptable Clinical Encounters for detailed criteria.

6. Is there a time limit for completing a clinical encounter?

No. There is no time limit for completing an individual clinical encounter. Each encounter must meet the Criteria for Acceptable Clinical Encounters. For information on the deadlines for submitting your Pathways application and completion of the six required Mini-CEX evaluations, please refer to Application Timing on the Pathway 6 page.

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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). To ensure they are used for that purpose, if you do not enter a U.S. GME program in the 2023-2024 or 2024-2025 academic years, your certificate will expire. 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 a GME program accredited by the Accreditation Council for Graduate Medical Education (ACGME) before the expiration date and satisfactorily complete the first year of training. Information on how to document completion of the first year of training so that your certificate becomes valid indefinitely is forthcoming. Please monitor this website for information.

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

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 the Pathways are well qualified.

4. What happens if I obtained ECFMG Certification based on a 2021 or 2022 Pathway but failed to obtain a position in the 2021 or 2022 Match?

If you obtained an ECFMG Certificate based on the 2021 or 2022 Pathways, the expiration of your ECFMG Certificate has been extended to December 31, 2024. This means that your certificate remains valid for you to apply to positions in the 2023 Match. If you do not enter an ACGME-accredited GME program before your Certificate expires 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.

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Fees


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

The fee to apply to a Pathway is $925.

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.

3. If I submit my Pathways application but I no longer wish to participate in the 2023 Match, can I withdraw my application and receive a refund or credit?

No. The Pathways application fee is non-refundable.

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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 Pathways 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 Pathways 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 May 12, 2022 and is subject to change. Please visit the ECFMG website frequently for updates regarding these requirements.

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[Last update: May 12, 2022]

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