Intealth ECFMG

Educational Commission for Foreign Medical Graduates

Pathways 2, 3, 4, and 5: Information for Medical Schools


Overview


The Pathways for ECFMG Certification for the 2023 Match allow qualified international medical students and graduates (IMGs) to meet the clinical and communication skills requirements for ECFMG Certification and to participate in the 2023 National Resident Matching Program® (NRMP®) Main Residency Match® (The Match®). Please see Requirements for ECFMG Certification for 2023 Match for an overview of the Pathways.

The information on this page is intended for medical schools whose students and/or recent graduates will be applying to Pathway 2, 3, 4, or 5 as part of the 2023 Pathways application process.

  • All applicants to Pathways 2, 3, 4, and 5 must have a medical school graduation date on or after January 1, 2021.
  • Applicants to Pathway 2 are required to have their medical school
    • complete an Objective Structured Clinical Examination (OSCE) Attestation if the applicant has not yet been issued the final medical diploma, or
    • primary-source verify the applicant’s final medical diploma if the diploma has been issued.
  • Applicants to Pathways 3, 4, and 5 are required to have their medical school complete a Clinical Skills Attestation.

To find out if applicants from your medical school are eligible to apply to Pathway 2, 3, 4, or 5, please search the list of Medical Schools Eligible for 2023 Pathways. Please note that schools that meet the eligibility requirements for both Pathways 3 and 4 will be listed as eligible for Pathway 3 only, and applicants from those schools will be required to apply to Pathway 3. If ECFMG determines that additional medical schools are acceptable for Pathways 2, 3, 4, or 5, they will be added to the list accordingly.

Please review the information and instructions below on your school’s role in the Pathways application process based on the Pathway to which applicants from your school are eligible to apply.

If your students/graduates have any questions regarding the Pathways application process, please direct them to contact ECFMG for assistance.

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Information and Instructions for Medical Schools that Meet Eligibility Requirements for Pathway 2


If students and graduates of your medical school are eligible to apply to Pathway 2, authorized officials from your school may be asked to complete OSCE Attestation forms for applicants or primary-source verify their final medical diplomas, depending on whether the applicant’s final medical diploma has been issued. To be eligible for this Pathway, the applicant must be a student or a recent graduate, with a graduation date on or after January 1, 2021.

Students or Graduates Whose Final Medical Diploma Has Not Been Issued

A student or graduate of the medical school applying to Pathway 2 whose final medical diploma has not yet been issued is required to have the medical school confirm eligibility for Pathway 2 by completing an ECFMG OSCE Attestation form. The form is available to the applicant for download after submission of the Pathways application.

All information requested on the form must be provided. Among other attestations, the form requires an authorized official of the medical school to confirm that the applicant is a student or graduate of the medical school, and that the applicant has successfully completed the school’s OSCE. The official must sign and date the form and affix the school’s seal. The signature must match the authorized signature on file with ECFMG. The form must be sent via e-mail by the school directly to ECFMG at msattestations@ecfmg.org.

Please note that it is the applicant’s responsibility to ensure that the medical school completes and sends the OSCE Attestation form in support of the application; an applicant’s Pathways application cannot be approved until the completed attestation is received and accepted by ECFMG.

The OSCE Attestation form must be received by ECFMG no later than January 31, 2023. Any applicant for whom ECFMG does not receive an acceptable OSCE Attestation by this deadline may not meet the clinical and communication skills requirements for ECFMG Certification in time to participate in the 2023 Match.

Graduates Whose Final Medical Diploma Has Been Issued

A graduate of the medical school applying to Pathway 2 whose final medical diploma has been issued is required to upload a copy of the diploma when submitting the Pathways application. If ECFMG has not previously obtained primary-source verification of the diploma, ECFMG will request that the medical school primary-source verify the document. If ECFMG has already obtained primary-source verification of the final medical diploma, ECFMG will use the prior verification to complete the application. The medical school does not need to complete an OSCE Attestation for an applicant whose final medical diploma has been issued.

Verification of the final medical diploma must be received by ECFMG no later than January 31, 2023. Any applicant for whom ECFMG does not receive an acceptable verification by this deadline may not meet the clinical and communication skills requirements for ECFMG Certification in time to participate in the 2023 Match.

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Information and Instructions for Medical Schools that Meet Eligibility Requirements for Pathway 3, 4, or 5


If students and graduates of your medical school are eligible to apply to Pathway 3, 4, or 5, authorized officials from your medical school may be asked to complete Clinical Skills Attestations for applicants.

To satisfy this requirement:

  1. The applicant’s clinical skills must first be evaluated by appropriate medical school faculty, and those evaluations must be reviewed by the medical school’s dean or a designee of the dean. The Mini-Clinical Evaluation Exercise (Mini-CEX) form for Pathways 3, 4, and 5 outlines the skills on which the applicant should be evaluated and instructions for completing the clinical encounters. Please review the Mini-CEX instructions and form carefully.
  2. An authorized official from the medical school must then attest to the applicant’s clinical skills.

The process for attesting to clinical skills will vary depending on whether your medical school participates in using the ECFMG Medical School Web Portal (EMSWP). Detailed instructions are provided below.

Medical School Participates in Using EMSWP

Authorized officials from your school will use the secure, on-line Clinical Skills Evaluation and Attestation Portal to complete electronic Clinical Skills Attestations for applicants. Do not complete and submit Clinical Skills Attestation forms for applicants via e-mail.

Requests will be posted to your school in the Clinical Skills Evaluation and Attestation Portal for applicants that require a Clinical Skills Attestation in support of a Pathways application. For these requests, follow the instructions below to complete the attestation.

The Mini-Clinical Evaluation Exercise (Mini-CEX) form for Pathways 3, 4, and 5 outlines the skills on which the applicant should be evaluated and instructions for completing the clinical encounters. Please review the Mini-CEX instructions and form carefully.

Instructions:

  1. Assessment of Three In-Person Clinical Patient Encounters by Faculty. The applicant’s clinical skills must be assessed by appropriate medical school faculty, and those evaluations must be reviewed by the medical school’s dean or a designee of the dean.
    • For students who have not yet completed their clinical rotations, this should include three in-person clinical patient encounters lasting 10 to 20 minutes each. At least one of the encounters must be on the general medical hospital service. Each patient should be new to the applicant, and each encounter must be observed directly by a different faculty member who routinely evaluates medical students. The observed encounters must take place at the applicant’s medical school or affiliated clinical rotation site.
    • The Mini-Clinical Evaluation Exercise (Mini-CEX) form for Pathways 3, 4, and 5 outlines the skills on which the applicant should be evaluated. To evaluate each encounter, the observing faculty member may use the Mini-CEX form or the institution’s own form, if that form uses the same clinical skills as those outlined on the Mini-CEX form. Each completed Mini-CEX form should be signed by both the applicant and the observing faculty member.
    • For graduates and for students whose clinical rotations are complete, patient encounters that were evaluated previously are acceptable, provided they were assessed using the same clinical skills as those outlined on the Mini-CEX form and under the same conditions as students who have not yet completed their clinical rotations.
    • The medical school’s dean, or the dean’s designee, must review the completed Mini-CEX forms, or equivalent forms, and confirm that they indicate a satisfactory level of clinical skills. The Mini-CEX forms should not be submitted to ECFMG.
  2. Completion of Electronic Clinical Skills Attestation. Only an authorized official of an applicant’s medical school may complete the Clinical Skills Attestation for the applicant. To complete the Clinical Skills Attestation:
    1. Log in to the Clinical Skills Evaluation and Attestation Portal using your EMSWP username and password.
    2. View the list of requests from applicants of your medical school on the Attestation Dashboard. Note that only applicants who have submitted a Pathways application for which attestation by your medical school is required will appear on this screen.
    3. Select the applicant for whom you want to complete the Clinical Skills Attestation and select Review.
    4. Review all the applicant’s information, including name, date of birth, and USMLE/ECFMG Identification Number to confirm it matches your medical school records.
    5. Review the Clinical Skills Attestation statements that you must certify.
    6. If you can certify all the statements, select Certify.
    7. If you cannot certify all the statements, select Cannot Certify. You will then be requested to provide ECFMG with the reason you are unable to certify the applicant’s Clinical Skills Attestation and submit your response to ECFMG.

ECFMG must receive all Clinical Skills Attestations submitted through the Clinical Skills Evaluation and Attestation Portal by February 15, 2023. Any applicant for whom ECFMG does not receive an acceptable electronic Clinical Skills Attestation by this deadline may not meet the clinical and communication skills requirements for ECFMG Certification in time to participate in the 2023 Match.

Medical School Does Not Participate in Using EMSWP

Authorized officials from your school will use the Clinical Skills Attestation form to complete Clinical Skills Attestations and send the form to ECFMG via e-mail. The form will be available for applicants to download once they have submitted their Pathways application.

When you receive the form from the applicant, follow the instructions below to complete the attestation and submit it to ECFMG for processing.

The Mini-Clinical Evaluation Exercise (Mini-CEX) form for Pathways 3, 4, and 5 outlines the skills on which the applicant should be evaluated and instructions for completing the clinical encounters. Please review the Mini-CEX instructions and form carefully.

Instructions:

  1. Assessment of Three In-Person Clinical Patient Encounters by Faculty. The applicant’s clinical skills must be assessed by appropriate medical school faculty, and those evaluations must be reviewed by the medical school’s dean or a designee of the dean.
    • For students who have not yet completed their clinical rotations, this should include three in-person clinical patient encounters lasting 10 to 20 minutes each. At least one of the encounters must be on the general medical hospital service. Each patient should be new to the applicant, and each encounter must be observed directly by a different faculty member who routinely evaluates medical students. The observed encounters must take place at the applicant’s medical school or affiliated clinical rotation site.
    • The Mini-Clinical Evaluation Exercise (Mini-CEX) form for Pathways 3, 4, and 5 outlines the skills on which the applicant should be evaluated. To evaluate each encounter, the observing faculty member may use the Mini-CEX form or the institution’s own form, if that form uses the same clinical skills as those outlined on the Mini-CEX form. Each completed Mini-CEX form should be signed by both the applicant and the observing faculty member.
    • For graduates and for students whose clinical rotations are complete, patient encounters that were evaluated previously are acceptable, provided they were assessed using the same clinical skills as those outlined on the Mini-CEX form and under the same conditions as students who have not yet completed their clinical rotations.
    • The medical school’s dean, or the dean’s designee, must review the completed Mini-CEX forms, or equivalent forms, and confirm that they indicate a satisfactory level of clinical skills. The Mini-CEX forms should not be submitted to ECFMG.
  2. Completion and Submission of Clinical Skills Attestation Form. An authorized school official must complete the ECFMG Clinical Skills Attestation form. All information requested on the form must be provided. The official must sign and date the form and affix the school’s seal. The signature must match the authorized signature on file with ECFMG. The form must be sent via e-mail by the school directly to ECFMG at msattestations@ecfmg.org.

ECFMG must receive all Clinical Skills Attestation forms via e-mail by January 31, 2023. Any applicant for whom ECFMG does not receive an acceptable Clinical Skills Attestation form by this deadline may not meet the clinical and communication skills requirements for ECFMG Certification in time to participate in the 2023 Match.

Please note that it is the applicant’s responsibility to ensure that the applicant’s medical school completes and submits the clinical skills attestation, whether through the Clinical Skills Evaluation and Attestation Portal or via a Clinical Skills Attestation form, in support of the applicant’s Pathways application. The applicant’s Pathways application cannot be approved until the completed attestation is received and accepted by ECFMG.


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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