Intealth ECFMG

Educational Commission for Foreign Medical Graduates

Pathway 3: Medical School Accredited by Agency Recognized by World Federation for Medical Education (WFME)

Pathway 4: Medical School Accredited by Agency that Has Received a Determination of Comparability by National Committee on Foreign Medical Education and Accreditation (NCFMEA)

Pathway 5: Medical School Issues Degree Jointly with a U.S. Medical School Accredited by Liaison Committee on Medical Education (LCME)


Who Should Apply


Pathways 3, 4, and 5 are for applicants who do not meet the eligibility requirements for Pathway 1 and are students or recent graduates of a medical school that meets eligibility requirements established by ECFMG for Pathway 3, 4, or 5.

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Eligibility Requirements


Requirements for all applicants to Pathways 3, 4, and 5:

  • Date of medical school graduation must be on or after January 1, 2021.
  • An authorized official of your medical school must attest to the applicant’s clinical skills.
  • 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.

Pathway-specific medical school requirements:

  • Pathway 3. Applicant’s medical school is currently accredited by an agency recognized by the World Federation for Medical Education (WFME).
  • Pathway 4. Applicant’s medical school is currently accredited by an agency that has received a determination of comparability by the National Committee on Foreign Medical Education and Accreditation (NCFMEA).
  • Pathway 5. Applicant’s medical school grants an MD degree issued jointly with a U.S. medical school accredited by the Liaison Committee on Medical Education (LCME).

To determine whether a medical school’s students and recent graduates are eligible to apply to Pathway 3, 4, or 5, search the list of Medical Schools Eligible for 2023 Pathways. Please note: Schools that meet the eligibility requirements for both Pathways 3 and 4 will be listed as eligible for Pathway 3 only, and applicants from that school will be required to apply to Pathway 3.

If ECFMG determines that additional medical schools meet the requirements for Pathway 3, 4, or 5, they will be added to the list accordingly.

If you believe your medical school meets the requirements listed above and is not included on the list of eligible schools, please contact ECFMG.

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 3, 4, or 5, 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 Clinical Skills Attestation by your medical school. See Applicant Instructions below for more information and deadlines.

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 eligibility requirements for Pathway 1, the system will automatically determine your eligibility to apply to Pathway 2, 3, 4, or 5, based on the information in your ECFMG record.
    • If you are eligible to apply to Pathway 3, 4, or 5, your medical school will be required to attest to your clinical skills, as described in Clinical Skills Attestation by Medical School below.
    • If the application indicates that you are not eligible for Pathway 3, 4, or 5, you will be required to apply to Pathway 6. For information on applying to Pathway 6, see the Pathway 6 page.
    • If the application indicates you are ineligible for Pathway 3, 4, or 5 and you believe your ECFMG record is incorrect, please contact us for assistance.
  3. Complete and submit the application. After your eligibility to apply to Pathway 3, 4, or 5 is confirmed, 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.

Clinical Skills Attestation by Medical School

In order to meet the requirements for Pathway 3, 4, or 5, your medical school must attest to your clinical skills. After you submit your Pathways application, the Application Summary will indicate the method your school must use to attest to your clinical skills.

If your medical school participates in using the ECFMG Medical School Web Portal (EMSWP):

  • Your medical school must attest to your clinical skills through the Clinical Skills Evaluation and Attestation Portal, following the steps outlined in Information and Instructions for Medical Schools that Meet Eligibility Requirements for Pathway 3, 4, or 5 on the Information for Medical Schools page. A request to complete the attestation will be automatically posted to your school through the Clinical Skills Evaluation and Attestation Portal when you submit your Pathways application.
  • Please note that it is your responsibility to ensure that your medical school completes the electronic Clinical Skills Attestation in support of your application; your application cannot be approved until the completed attestation is received and accepted by ECFMG. The electronic attestation must be received by ECFMG no later than February 15, 2023.
  • Submission of the electronic Clinical Skills Attestation does not guarantee that it will be accepted by ECFMG.

If your medical school does not participate in the ECFMG Medical School Web Portal (EMSWP):

  • Your medical school must attest to your clinical skills using the Clinical Skills Attestation form, following the steps outlined in Information and Instructions for Medical Schools that Meet Eligibility Requirements for Pathway 3, 4, or 5 on the Information for Medical Schools page. You will be able to download the form from the Application Summary screen after you submit your Pathways application.
  • The form must be completed by an authorized official of your medical school and sent directly to ECFMG by the medical school. Instructions for completing and submitting the form are included with the form.
  • Please note that it is your responsibility to ensure that your medical school completes a Clinical Skills 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.
  • Submission of the Clinical Skills Attestation form does not guarantee that it will be accepted by ECFMG.

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Important Information on Documentation Submitted in Support of Your Application


  • 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 a Clinical Skills 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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