Intealth ECFMG

Educational Commission for Foreign Medical Graduates

Pathway 2: Already Passed an Objective Structured Clinical Examination for Medical Licensure Administered by an Acceptable Medical School


Who Should Apply


Pathway 2 is for applicants who do not meet the eligibility requirements for Pathway 1, but who attend or have graduated from a medical school that administers an Objective Structured Clinical Examination (OSCE) specifically required for medical licensure by the medical regulatory authority (MRA) in that country. The medical school must meet certain ECFMG requirements and the applicant must have successfully completed the OSCE.

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Eligibility Requirements


  • Applicant attends or has graduated from a medical school that administers an OSCE specifically required by the medical regulatory authority (MRA) in that country for all medical students, and the applicant has successfully completed that exam. The following also apply:
    • The medical school is located in a region/country that is not served by an accrediting agency recognized by the World Federation for Medical Education (WFME) or the National Committee on Foreign Medical Education and Accreditation (NCFMEA);
    • The medical school is accredited by the MRA or MRA-designated accrediting agency in that region/country;
    • The MRA’s requirement was established before 2020; and
    • The applicant’s graduation date is on or after January 1, 2021.
  • Applicant has not failed the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination® (USMLE®) one or more times. Applicants who failed Step 2 CS one or more times must apply to Pathway 6 in order to meet the clinical and communication skills requirements for ECFMG Certification. For information on applying to Pathway 6, see the Pathway 6 page.

To determine whether a medical school’s students and recent graduates are eligible to apply to Pathway 2 because the school administers an OSCE specifically required by the MRA in that country, search the list of Medical Schools Eligible for 2023 Pathways. If ECFMG determines that additional medical schools are acceptable for this Pathway, they will be added to the list.

In addition to the requirements listed above, the applicant must meet the requirements in General Eligibility for All Pathways and Assessment of Communication Skills, Including English Language Proficiency, as well as all other eligibility requirements for ECFMG Certification.

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Application Timing


If you meet the eligibility requirements for Pathway 2, you may apply using the on-line Application for Pathways for ECFMG Certification for 2023 Match.

Your application must be submitted no later than January 31, 2023.

In order for you to participate in the 2023 Match, ECFMG must determine the outcome of your Pathways application; determine your overall eligibility for the 2023 Match, including verifying your passing performance on USMLE Step 1 and Step 2 Clinical Knowledge (CK); then report your eligibility status to the National Resident Matching Program® (NRMP®) by the NRMP Rank Order List Certification deadline. ECFMG will not determine the outcome of your Pathways application until all required supporting documentation and/or verification(s) have been received. Therefore, the time needed to complete the processing of your application is contingent upon receipt of all supporting documentation and verifications, including the ECFMG OSCE Attestation form, if required for your application (see Application Instructions below). The OSCE Attestation form must be received by ECFMG by January 31, 2023.

If you have not met all requirements for your Pathways application when the current application season ends, your application will be rejected and you will be required to reapply and pay any and all required application fee(s) in a future application season in order to meet the clinical and communication skills requirements for ECFMG Certification.

Please plan the timing of your application accordingly.

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Application Instructions


  1. Access the Application for Pathways for ECFMG Certification for 2023 Match and determine general eligibility.
    • To begin the application, you will need to log in with your USMLE/ECFMG ID and ECFMG On-line Services password. Once you begin the application, you will have five days to complete and submit it. If the application is not submitted within five days, it will be deleted, and you will need to begin a new application if you wish to apply to a Pathway.
    • After you log in, the application will indicate whether you meet the eligibility requirements that pertain to all Pathways.
    • If you have failed Step 2 CS one or more times, the application will indicate that you will be required to apply to Pathway 6. For information on applying to Pathway 6, see the Pathway 6 page.
  2. If you meet the general eligibility requirements, you will proceed to questions regarding your eligibility for the specific Pathways. If you do not meet the Pathway 1 eligibility requirements, the application will automatically determine whether your medical school and graduation date meet the eligibility requirements for Pathway 2, 3, 4, or 5 based on the information in your ECFMG record.
    • If the application indicates that your medical school and graduation date meet the eligibility requirements for Pathway 2, and you are a graduate of the medical school:
      • Upload a copy of your final medical diploma.
      • If the diploma is not in English, also upload an English translation of the document (see Important Information on Documentation Submitted in Support of Your Application below for more information).
      • ECFMG will primary-source verify your diploma directly with the medical school. Please note: If your final medical diploma already has been primary-source verified by ECFMG, ECFMG will use the prior verification to complete your application.
    • If the application indicates that your medical school and graduation date meet the eligibility requirements for Pathway 2 and you are a student or a graduate of the medical school whose final medical diploma has not yet been issued:
      • Your medical school will be required to confirm your eligibility by completing the ECFMG OSCE Attestation form. The form will be available for you to download once you have submitted your application.
      • The OSCE Attestation form must be completed by an authorized official of your medical school and sent directly to ECFMG by the medical school.
      • It is your responsibility to ensure that your medical school completes and sends the OSCE Attestation form in support of your application; your application cannot be approved until the completed attestation is received and accepted by ECFMG. The form must be received by ECFMG no later than January 31, 2023.
    • If the application indicates that you are not eligible for Pathway 2 and you believe your ECFMG record is incorrect, please contact us for assistance.
  3. Complete and submit the application. After providing the required information and uploading supporting documentation, you will be asked to certify your application, provide payment, and submit your application to ECFMG.

Once your application is received, ECFMG will evaluate it. A case manager will contact you if there are any issues with your application or if we require additional information.

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Important Information on Documentation Submitted in Support of Your Application


  • Primary-source verification. ECFMG will verify the authenticity of any document that you provide directly with the authority that issued the document. ECFMG also may verify with the issuing authority any documents submitted on your behalf.
    • If the authority charges a fee for verification, payment of the fee is your responsibility. If you are unsure whether the authority charges a fee for verification, please contact the authority.
    • Your Pathways application cannot be approved until verification is received and accepted by ECFMG.
  • Documents not in English. Any document submitted to ECFMG that is not in English must be accompanied by an English translation that meets ECFMG’s translation requirements. ECFMG strongly encourages you to obtain translations from its recommended translation service, Straker Translations . See Translation Service for more information. If a document submitted on your behalf is not in English, ECFMG will have the document translated and will charge your financial account for this service. Fees charged by Straker Translations vary depending on the source language and number of pages in the document.
  • The name on your document. If the name on your document does not match the name in your ECFMG record, ECFMG may contact you to request documentation to confirm your name as it appears on your document.

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Fees and Payment


The fee for applying to a Pathway is $925. Full payment is due when you submit your application. If the application is not submitted within five days of when you begin it, it will be deleted, and you will need to begin a new application if you wish to apply to a Pathway.

You must use a Visa, MasterCard, Discover, or American Express credit card with a security code; credit available in your ECFMG Financial Account cannot be used to pay for a Pathways application.

Fees related to your application are not refundable. If you submit a Pathways application and ECFMG determines that you are ineligible for the Pathway, your application will be rejected and the fee will not be refunded. In addition, if ECFMG does not receive all required documentation in support of your application, as well as any required verifications of submitted documentation from the issuing authority, your application will not be complete, and the application fee will not be refunded.

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Application Processing Time


Once your application has been submitted, you can use the on-line Application for Pathways for ECFMG Certification for 2023 Match to check the status of your application. The following guidelines may be helpful:

  • Please allow five business days after submission of your application for a case manager to begin reviewing your application.
  • If any documentation is required for your Pathways application, such as documentation demonstrating that you have completed an OSCE or an attestation from your medical school, please allow five business days for the submitted document to be added to your previously submitted application.
  • Once your eligibility review has been completed, ECFMG will conduct a final review of your application. Please allow five business days for this final review.

The time needed to complete the processing of your application is contingent upon receipt of all supporting documentation and verifications.

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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