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ECFMG Certification Information

The Educational Commission for Foreign Medical Graduates (ECFMG®), through its program of certification, assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).

The ECFMG and its organizational members define an international medical graduate (IMG) as a physician who received his/her basic medical degree or qualification from a medical school located outside the United States and Canada. The physician’s medical school and graduation year must be listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER®). The Directory contains information supplied by countries about their medical schools. FAIMER is not an accrediting agency. The FAIMER IMED is available on the ECFMG Web site. US citizens who have completed their medical education in schools outside the United States and Canada are considered IMGs; non-US citizens who have graduated from medical schools in the United States and Canada are not considered IMGs.

ECFMG Certification assures directors of ACGME-accredited residency and fellowship programs, and the people of the United States, that IMGs have met minimum standards of eligibility required to enter such programs. ECFMG Certification does not, however, guarantee that such graduates will be accepted into these programs, since the number of applicants often exceeds the number of available positions.

ECFMG Certification is one of the eligibility requirements to take Step 3 of the United States Medical Licensing ExaminationTM (USMLETM). Medical licensing jurisdictions in the United States also require ECFMG Certification to obtain an unrestricted license to practice medicine.

ECFMG Certification Requirements

Examination Requirements
The examination requirements for ECFMG Certification include passing Step 1 and Step 2 of the USMLE. Step 2 has two separately administered components, the Clinical Knowledge (CK) component and the Clinical Skills (CS) component.

To meet the examination requirements for ECFMG Certification, applicants must satisfy the following requirements:

1. Medical Science Examination Requirement.
Step 1 and Step 2 CK of the USMLE are the exams currently administered that satisfy this requirement. To meet the medical science examination requirement for ECFMG Certification, applicants must pass both Step 1 and Step 2 CK within a specified period of time. See Time Limit for Completing Examination Requirements, below.

Former Examinations Accepted for ECFMG Certification:
The ECFMG also accepts a passing performance on the following former medical science examinations for the purpose of ECFMG Certification: ECFMG Examination, Visa Qualifying Examination (VQE), Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), and Part I and Part II Examinations of the National Board of Medical Examiners (NBME). Additionally, the ECFMG accepts, for the purpose of its certification, a score of 75 or higher on each of the 3 days of a single administration of the former Federation Licensing Examination (FLEX), if taken prior to June 1985.

Certain combinations of examinations are also acceptable. Applicants who have passed only part of the former VQE, FMGEMS, or the NBME Part I or Part II may combine a passing performance on the basic medical science component of one of these examinations or USMLE Step 1 with a passing performance on the clinical science component of one of the other examinations or USMLE Step 2 CK, provided that the components are passed within the period specified for the examination program.*

* This policy applies only to ECFMG Certification. Use of the former FLEX Components or the former NBME Parts to fulfill eligibility requirements for Step 3 is no longer accepted. Applicants taking the Steps for the purpose of licensure should refer to Formerly Administered Examinations in the USMLE Bulletin of Information. Applicants should also contact the medical licensing authority of the jurisdiction where they plan to apply for licensure or the FSMB for specific information on licensure requirements. Additionally, although the ECFMG Examination and FLEX, if taken prior to June 1985, satisfy the medical science examination requirement for ECFMG Certification, they have not been recognized by the US Secretary of Health and Human Services as meeting the medical science examination requirement to obtain a visa to enter the United States (see Visas, p. 95).

2. Clinical Skills Requirement.
This requirement includes demonstration of data-gathering and communication skills (including spoken English). Step 2 CS of the USMLE is the exam currently administered that satisfies the clinical skills requirement for ECFMG Certification. Specific time limits for passing Step 2 CS for ECFMG Certification may apply. See Time Limit for Completing Examination Requirements, below.

Former Examinations Accepted for ECFMG Certification:
Applicants who have both passed the former ECFMG Clinical Skills Assessment (CSA®) and achieved a score acceptable to ECFMG on an English language proficiency test (such as the Test of English as a Foreign Language™ [TOEFL®] or the former ECFMG English Test) can use these passing performances to satisfy the clinical skills requirement.

Time Limit for Completing Examination Requirements†

† This policy applies only to ECFMG Certification. The USMLE program has made specific recommendations to state medical licensing authorities regarding the time to complete all three Steps and the number of attempts allowed to pass each Step or Step component. Refer to Time Limit and Number of Attempts Allowed to Complete All Steps, Retakes, and Official Performance of Record for Examinees Retaking a Previously Passed Step in the USMLE Bulletin of Information. Applicants should also contact the medical licensing authority of the jurisdiction where they plan to apply for licensure or the FSMB, since licensure requirements vary among jurisdictions.

ECFMG policy requires that applicants pass those USMLE Steps and Step Components required for ECFMG Certification within a 7-year period. Once an applicant passes a USMLE Step or Step Component, the applicant will have 7 years to pass the other USMLE Step(s) or Step Component(s) required for ECFMG Certification. If an applicant does not pass all required USMLE Steps and Step Components within a maximum of 7 years, the applicant’s earliest USMLE passing performance will no longer be valid for ECFMG Certification.

Before implementation of Step 2 CS on June 14, 2004, applicants were required to pass Step 1 and Step 2 CK within a 7-year period for ECFMG Certification. Effective June 14, 2004, applicants must pass Step 1, Step 2 CK, and Step 2 CS within a 7-year period for ECFMG Certification; this new 7-year requirement applies to applicants whose earliest USMLE passing performance that is valid for ECFMG Certification is on or after June 14, 2004, as described below.

Earliest USMLE Passing Performance Before June 14, 2004
If an applicant’s earliest USMLE passing performance that is valid for ECFMG Certification took place before June 14, 2004, the applicant is required to pass only Step 1 and Step 2 CK within a 7-year period for ECFMG Certification. (If the applicant is required to pass Step 2 CS to satisfy the clinical skills requirement for ECFMG Certification, the applicant will not be required to pass Step 2 CS during the same 7-year period in which the applicant must pass Step 1 and Step 2 CK.)

Earliest USMLE Passing Performance On or After June 14, 2004
If an applicant’s earliest USMLE passing performance that is valid for ECFMG Certification took place on or after June 14, 2004, the applicant is required to pass Step 1, Step 2 CK, and Step 2 CS within a 7-year period for ECFMG Certification.

3. Medical Education Credential Requirements
The physician’s medical school and graduation year must be listed in the International Medical Education Directory (IMED). All IMGs must have had at least 4 credit years (academic years for which credit has been given toward completion of the medical curriculum) in attendance at a medical school listed in IMED.

Applicants for ECFMG Certification must document the completion of all requirements for, and receipt of, the final medical diploma. ECFMG verifies every applicant’s medical school diploma with the appropriate officials of the medical school that issued the diploma. When ECFMG sends the applicant’s medical diploma to the medical school for verification, ECFMG will request the medical school to include the applicant’s final medical school transcript when the school returns the verification of the medical diploma to ECFMG. An applicant’s credentials are not considered complete until ECFMG receives verification of the medical diploma and final medical school transcript directly from the medical school.

Standard ECFMG Certificate

The ECFMG issues the Standard ECFMG Certificate to applicants who meet all of the examination and medical education credential requirements. Applicants must also pay any outstanding charges on their ECFMG financial accounts before their certificates are issued. Standard ECFMG Certificates are sent approximately 2 weeks after all of these requirements have been met.

A Standard ECFMG Certificate includes:
• The name of the applicant
• The applicant’s USMLE/ECFMG Identification Number
• The dates that examination requirements were met
• The date that the certificate was issued
If applicable, the date(s) through which the passing performance on certain exam(s) remain valid for the purpose of entry into graduate medical education (GME). (See Validity of Examinations for Entry into GME, below).

The Standard ECFMG Certificate may be used for entry into accredited GME programs in the United States.

Validity of Examinations for Entry into GME

Clinical Skills Examinations
For applicants who satisfy the clinical skills requirement by passing Step 2 CS, this passing performance is not subject to expiration for the purpose of entering GME programs.

For applicants who satisfied the clinical skills requirement for ECFMG Certification by passing the former ECFMG CSA and an English language proficiency test, passing performance on the CSA may be subject to expiration for the purpose of entering GME programs, as described below.

• Passing performances on CSA administrations that took place on or after June 14, 2001, are not subject to expiration for the purpose of entering GME programs. Applicants who are certified by ECFMG and whose Standard ECFMG Certificate lists a “valid through” date for an administration of the CSA that took place on or after June 14, 2001, may request a permanent validation sticker on-line by accessing OASIS or by completing a Special Request for Permanent Validation Sticker (Form 295) and submitting it to ECFMG. Applicants can access OASIS and Form 295 on the ECFMG website.

• Passing performances on CSA administrations that took place before June 14, 2001, are valid for 3 years from the date passed for the purpose of entering GME programs. The date through which passing performance on the CSA remains valid for entry into GME (the CSA “valid through” date) will be listed on the applicant’s Standard ECFMG Certificate. If the applicant has entered a program before expiration of the valid through date, the applicant may request permanent validation. This means that the CSA date is no longer subject to expiration. To request permanent validation, the applicant and an authorized official of the training institution must complete a Request for Permanent Validation (Form 246). On receipt of such official documentation, ECFMG will provide a permanent validation sticker to be affixed to the certificate. If an applicant who passed CSA before June 14, 2001, does not enter a GME program within 3 years of the CSA pass date, the applicant’s CSA passing performance will expire for the purpose of entering GME. Before entering a program, these applicants must pass Step 2 CS. Passing performance on Step 2 CS does not expire for the purpose of entry into GME.