ECFMG certification

ECFMG (the Educational Commission for Foreign Medical Graduates) assesses whether international medical graduates are ready to enter US graduate medical education. Its certification is the gateway to US training for doctors who studied at medical schools outside the USA.

ECFMG says a valid, unexpired certificate is required to enter a US residency programme accredited by the Accreditation Council for Graduate Medical Education (ACGME). All international graduates also need ECFMG Certification to be eligible for USMLE Step 3.

• Application and credentials: an Application for ECFMG Certification through MyIntealth, with your final medical diploma and transcript verified at source.
• Medical science requirement: pass USMLE Step 1 and Step 2 Clinical Knowledge (CK).
• Clinical and communication skills requirement: complete a Pathway. Pathway 1 is for doctors who hold or recently held a licence to practise without supervision. Pathways 2 to 5 depend on your medical school, including Pathway 2 for graduates of schools running an OSCE required for licensure. Pathway 6 uses evaluations of your clinical encounters by licensed physicians.
• English: every Pathway applicant must score at least 350 on OET Medicine Listening, Reading and Speaking and 300 on Writing, in one sitting. For 2027 Pathways the score must be from on or after 1 January 2025.

1. Create a MyIntealth account and submit the Application for ECFMG Certification.
2. Have your credentials verified through ECFMG.
3. Register for Step 1 and Step 2 CK through the FSMB, which checks your eligibility with ECFMG.
4. Take OET Medicine and release your scores to ECFMG using your MyIntealth ID.
5. Apply to the right Pathway. To take part in the 2027 Match, ECFMG says you must apply by 31 January 2027.
6. Once all requirements are met, ECFMG issues your certificate.

ECFMG lists a MyIntealth account fee of US$110, US$580 for the Application for ECFMG Certification, US$220 to verify your diploma and transcript, and US$945 for a Pathway application. USMLE fees are paid separately.

A certificate based on a Pathway expires when the Pathway does: 31 December 2029 for 2027 Pathways. It becomes valid indefinitely once you meet ECFMG's conditions, such as completing at least 12 months of clinical education in an ACGME-accredited programme. Certificates based on the former Step 2 CS exam do not expire.

ECFMG also sponsors J-1 exchange visitor visas for physicians in US training. It lists a US$370 fee for J-1 sponsorship applications, plus a US$220 SEVIS fee payable to the Department of Homeland Security for initial applicants.

• Missing the Match deadline for completing Pathway and OET requirements.
• An expired Pathway, which must be revalidated before the Match or certification.
• Failing Step 2 CS in the past, which means you must use Pathway 6.

For the full US route, see our USMLE guide.