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Overview

Overview

The requirements for ECFMG Certification include passing examinations in medical sciences, clinical skills, and communications skills. Step 1 and Step 2 Clinical Knowledge (CK) of the United States Medical Licensing Examination^® (USMLE^®) are the exams currently administered that satisfy the medical science examination requirement.

Prior to its suspension by the USMLE program in early 2020, the former USMLE Step 2 Clinical Skills (CS) exam was the exam that satisfied the clinical and communication skills requirements for ECFMG Certification. In response to the suspension and subsequent discontinuation of Step 2 CS by the USMLE program, ECFMG FAIMER has offered Pathways to allow international medical graduates (IMGs) to meet the clinical and communication skills requirements for ECFMG Certification. ECFMG FAIMER first offered the Pathways to IMGs participating in the 2021 Match and is continuing and expanding the Pathways for IMGs participating in the 2022 Match.

The Pathways allow ECFMG Certification to continue to perform its critical function of providing assurance to the public and U.S. graduate medical education (GME) programs that IMGs are ready to enter supervised training. They also allow qualified IMGs to continue to pursue ECFMG Certification and to compete for positions in U.S. GME.

The Pathways for the 2022 Match outlined below expand on the Pathways offered for the 2021 Match. Pathways 1, 2, 3, 4, and 5 will continue to be offered with some modifications, and a sixth Pathway has been added. Additionally, there have been changes to the general eligibility requirements for all Pathways.

To meet the clinical and communication skills requirements for ECFMG Certification using a Pathway, you must complete a Pathways application. See Applying to the Pathways.

There will be no exceptions to the eligibility requirements for the Pathways.

If you applied to a Pathway for the 2021 Match or familiarized yourself with the 2021 Pathway requirements, you should review the 2022 Pathway information carefully to ensure an understanding of 2022 Pathway eligibility and requirements. You also should review the Important Information for 2021 Pathway Applicants.

Important Note: If you satisfy the clinical and communication skills requirements for ECFMG Certification through a Pathway, you also must:

• Have passed Step 1 and Step 2 CK to participate in the 2022 Match, and
• Satisfy all other requirements for ECFMG Certification to be certified by ECFMG.

Who Should Use the Pathways?

The Pathways outlined below are directed toward IMGs who intend to participate in the 2022 Match and who need to meet the clinical and communication skills requirements for ECFMG Certification.

Important Note: Applicants who already have satisfied the clinical and communication skills requirements for ECFMG Certification do not need to (and are not eligible to) pursue a Pathway to meet the requirements for ECFMG Certification or for participation in the 2022 Match. These individuals include:

• IMGs who have a passing performance on Step 2 CS that is valid for ECFMG Certification (even if they previously failed Step 2 CS),
• IMGs who are certified by ECFMG, and
• IMGs with an approved Pathways 2021 application.

If you applied to a Pathway for the 2021 Match, please see the Important Information for 2021 Pathway Applicantsbefore applying to a Pathway.

Assessment of Communication Skills, Including English Language Proficiency

Applicants who pursue one of the Pathways are required to attain a satisfactory score on the Occupational English Test (OET) Medicine to satisfy the communication skills requirement for ECFMG Certification. All Pathway applicants, regardless of citizenship or native language, must satisfy this requirement.

See the Assessment of Communications Skills, Including English Language Proficiency page for more information.

Important Note: OET Medicine is only one of the requirements for completing a Pathway. Applicants also must submit an on-line application for the appropriate Pathway. See below.

General Eligibility for All Pathways

Applicants who are eligible to pursue ECFMG Certification based on one of the Pathways include those who:

• Have not already met the clinical and communication skills requirements for ECFMG Certification. (If you have a passing performance on Step 2 CS that is valid for ECFMG Certification or your Pathways application for the 2021 Match was approved, you have already met the clinical and communication skills requirements for ECFMG Certification and are not currently eligible to pursue a Pathway.)
• Are not barred by ECFMG from pursuing certification.
• Have completed an Application for ECFMG Certification.
• Have previously been registered for a USMLE Step or Step Component. This means that, if you have never been registered to take a USMLE Step or Step Component, you must apply for and be registered for a USMLE exam before you can submit a Pathways application.

The Pathways

In addition to meeting the requirements in General Eligibility for All Pathways, Pathway applicants also must meet all requirements for the Pathway to which they apply.

Important Note: 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, regardless of whether they meet the eligibility requirements for other Pathways.

As a reminder, applicants who have a passing performance on Step 2 CS that is valid for ECFMG Certification do not need to (and are not eligible to) apply to a Pathway, even if they previously failed Step 2 CS.

• Pathway 1: Already Licensed to Practice Medicine in Another Country
  Pathway 1 is for applicants who currently hold or have recently held a license/registration to practice medicine without supervision. Applicants who meet the eligibility requirements for Pathway 1 must apply to Pathway 1 in order to meet the clinical and communication skills requirements for ECFMG Certification, unless they failed Step 2 CS; see Important Note.
  See the Pathway 1 page for more information.

• Pathway 2: Already Passed a Standardized Clinical Skills Exam for Medical Licensure
  This Pathway is for applicants who do not currently hold, or have not recently held, a license/registration to practice medicine without supervision (Pathway 1), but who successfully completed a secure, standardized clinical skills exam as a requirement for medical licensure or registration in a country other than the United States.
  See the Pathway 2 page for more information.

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• 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)
  Pathways 3, 4, and 5 are for applicants who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1) and who have not already passed an acceptable standardized clinical skills exam for medical licensure (Pathway 2). An applicant to Pathway 3, 4, or 5 must be a student or a recent graduate of a medical school that meets eligibility requirements established by ECFMG.
  See the page for Pathways 3, 4, and 5 for more information.

• 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, or 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.
  See the Pathway 6 page for more information.

Applying to the Pathways

To meet the clinical and communication skills requirements for ECFMG Certification through one of the Pathways:

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• Determine your eligibility to apply to a Pathway by reviewing all information on this website carefully.
• If you believe you are eligible to apply to a Pathway, complete and submit your Application for Pathways for ECFMG Certification for 2022 Match. You will receive an e-mail confirming that your application has been submitted. Your application must be submitted by December 15, 2021.
  • You can apply to Pathways 1-5 now.
  • The on-line application process for Pathway 6 is expected to open in August 2021. Please see the Pathway 6 page for the steps that you can take to prepare for Pathway 6 before August.
• Meet the communication skills requirement by attaining a satisfactory score on each of the four sub-tests (Listening, Reading, Writing, and Speaking) of the OET Medicine test. You must take OET Medicine on or before the last available test date in December 2021.
• Release your OET Medicine scores to ECFMG. See Assessment of Communication Skills, Including English Language Proficiency for instructions. ECFMG must receive your scores directly from OET by January 15, 2022.
• Ensure that all required documentation in support of your Pathway application is received by ECFMG. See the detailed instructions for the Pathway to which you are applying for complete information on required documentation and deadlines. It is your responsibility to ensure that ECFMG receives all required documentation.
• Monitor the status of your application by logging into the Application for Pathways for ECFMG Certification for 2022 Match. You will be notified by e-mail when processing of your application is complete.

Information on Expiration of the ECFMG Certificate for the Purpose of Entering GME

ECFMG Certificates issued to applicants who satisfy the clinical and communication skills requirements for ECFMG Certification through a Pathway will be valid for entry to positions beginning in 2021 and 2022 at U.S. GME programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Once the applicant successfully completes the first year of ACGME-accredited training, the ECFMG Certificate will no longer be subject to expiration for the purpose of entering GME.

If you 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.

If you were certified by ECFMG based on a 2021 Pathway and your ECFMG Certificate lists an expiration date in 2021, this expiration date has been extended through December 31, 2022. Please see the Important Information for 2021 Pathway Applicants page for more information.

Impact of Pathways on the Time Limit for Completing Examination Requirements

ECFMG requires that IMGs pass the USMLE exams required for ECFMG Certification within a seven-year period. This means that once you pass an exam, you will have seven years to pass the other exam(s) required for ECFMG Certification. This seven-year period begins on the date of the first exam passed and ends exactly seven years from that date.

The exams currently required for ECFMG Certification are Step 1 and Step 2 CK. Prior to its suspension and subsequent discontinuation, the Step 2 CS exam was also required. ECFMG established the Pathways in response to the suspension and subsequent discontinuation of Step 2 CS to allow IMGs who have not passed Step 2 CS to meet the clinical and communication skills requirements for ECFMG Certification. If you pass USMLE Step 1 and Step 2 CK within the seven-year period, and your Pathways application also is accepted within the seven-year period, this will meet ECFMG’s requirements to pass all exams required for ECFMG Certification within a seven-year period.

If your Pathways application is not accepted within the seven-year period and you have a passing Step 1 and/or Step 2 CK score that 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.

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Other Information

• Step 2 CS Exam History & USMLE Transcripts
  The USMLE transcript contains your examination history on Step 1, Step 2 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 and communication skills requirements for ECFMG Certification through one of the Pathways. If you have questions about your USMLE transcript, please contact the USMLE program.

The preceding information is current as of July 6, 2021 and is subject to change. Please visit the ECFMG website frequently for updates regarding these requirements.