ECFMG (Intealth): Certification, Exams and Fees

• ECFMG certification: the certificate IMGs need to enter ACGME-accredited residency and fellowship programs and to be eligible for USMLE Step 3.
• Certification Verification Service (CVS): confirms a doctor's ECFMG certification status directly to state medical boards, hospitals and other organizations.
• EPIC (Electronic Portfolio of International Credentials): primary source verification of medical diplomas, transcripts and licenses, used by US boards and by regulators abroad.
• Exchange Visitor Sponsorship Program (EVSP): ECFMG is the US Department of State designated sponsor of J-1 physicians in graduate medical education.
• ERAS Support Services: ECFMG issues ERAS tokens and transmits IMG documents for residency applications.

• Graduation (or current enrollment) at a medical school outside the US and Canada that is listed in the World Directory of Medical Schools and meets ECFMG's requirements for your graduation year. Check your school's sponsor note in the World Directory before you start.
• A MyIntealth account, which ECFMG requires before you can apply for any service. Identity is confirmed with a notarized identification form.
• An Application for ECFMG Certification with a status of Accepted or Pending Credential Verification before you can apply to a Pathway.
• Verification of your final medical diploma and final medical school transcript directly with your medical school. Documents must be uploaded through MyIntealth; paper copies by mail or email are not accepted.
• A pass on USMLE Step 1 and Step 2 CK (the medical science examination requirement).
• An accepted Pathway to meet the clinical skills and communication skills requirements, including OET Medicine scores of at least 350 in Listening, Reading and Speaking and 300 in Writing in one sitting, taken on or after January 1, 2025 for the 2027 Pathways.
• All exam requirements met within a seven-year period that starts on the date of the first exam you pass.
• To be eligible for Step 3 and to start residency, a valid, unexpired ECFMG certificate.

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   1. Check your medical school in the World Directory

   Look up your school in the World Directory of Medical Schools and read the ECFMG sponsor note for your graduation year. If your school or graduation year does not meet ECFMG's requirements, your students and graduates are not eligible to apply. This check takes minutes and is the most common reason applications fail later.
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   2. Open a MyIntealth account

   Create your MyIntealth account and complete identity verification. ECFMG charges $110 for account establishment, which includes a $50 fee for online notarization of the identification form through NotaryCam. Use your name exactly as it appears on your passport and medical diploma; name mismatches are a frequent cause of delays.
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   3. Apply for ECFMG certification and verify your credentials

   Submit the Application for ECFMG Certification ($580) and the credential verification request ($220: $110 for your final diploma and $110 for your final transcript). ECFMG sends these to your medical school for primary source verification. Translations are needed for non-English documents; if you do not supply an acceptable one, ECFMG translates at $52 per page and charges your account.
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   4. Register for and pass USMLE Step 1

   Apply for Step 1 through FSMB. The 2026 and 2027 exam fee is $695, plus a $210 region fee if you test outside the US and Canada. Step 1 is reported only as pass or fail. You can attempt a Step no more than four times in total, and no more than three times in any 12 months.
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   5. Pass USMLE Step 2 CK

   Step 2 CK is also booked through FSMB for $695, with a $235 region fee outside the US and Canada. The minimum passing score is 218 for exams taken on or after July 1, 2025. Residency programs see your three-digit score, so many applicants treat it as the most important exam in their application.
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   6. Take OET Medicine

   Book OET Medicine on paper or on computer at a test venue; OET@Home is allowed only if there is no test venue in your country. You need 350 in Listening, Reading and Speaking and 300 in Writing in one test administration, and if you miss one sub-test you retake all four. Give OET your MyIntealth ID so results go to ECFMG automatically.
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   7. Apply to the right Pathway

   The 2027 Pathways application costs $945 and must be submitted by January 31, 2027 (Eastern Time) for the 2027 Match. If you have held an unsupervised license to practice in any country on or after January 1, 2022, you must use Pathway 1. Pathway 2 covers schools with a licensing OSCE, Pathways 3 to 5 cover schools meeting accreditation criteria, and Pathway 6 uses six Mini-CEX evaluations by licensed physicians. Anyone who ever failed Step 2 CS must use Pathway 6.
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   8. Send supporting documents on time

   For Pathway 1, ask each licensing authority to send a Certificate or Letter of Good Standing directly to ECFMG. If it arrives before you apply, you must submit your Pathways application within 90 days of its issue date. ECFMG will not decide your application until every document and verification has arrived, and an incomplete application is rejected at the end of the season with no refund.
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   9. Apply for residency and receive your certificate

   Request an ERAS token from ECFMG ($185 for the 2027 season), register for the NRMP Main Residency Match and rank programs by the March 3, 2027 deadline. Once every requirement is met and verified, ECFMG issues your certificate. Programs check your status through CVS at no cost; a CVS report for a state medical board costs $70.
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    10. Watch the expiration date

    If you were certified through a Pathway, your certificate expires when your Pathway expires (December 31, 2029 for a 2027 Pathway). You need a valid certificate to start residency and to sit Step 3, so revalidate in time or meet ECFMG's requirements for permanent validation. ECFMG does not send reminders.

• USMLE Step 1

  A one-day computer-based exam of basic medical science, taken at Prometric centers in the US and abroad. From May 14, 2026 it is delivered as fourteen 30-minute blocks of up to 20 questions in an eight-hour day, with at least 55 minutes of break time. Results are reported as pass or fail only.

  Read the guide

• USMLE Step 2 Clinical Knowledge (CK)

  A one-day exam of clinical science and patient care under supervision. From May 7, 2026 it has sixteen 30-minute blocks of up to 20 questions in one nine-hour session. The minimum passing score is 218 for exams on or after July 1, 2025, and results usually arrive two to four weeks after the test.

  Read the guide

• OET Medicine (communication skills)

  ECFMG's communication skills requirement for every Pathways applicant, regardless of native language or where you studied. You need 350 in Listening, Reading and Speaking and 300 in Writing in a single administration. There is no limit on retakes, and results are usually released about 10 business days after the test.

• Pathways (clinical skills)

  Not an exam, but the way IMGs now meet the clinical skills requirement that the discontinued Step 2 CS used to cover. Pathway 1 is for licensed physicians, Pathway 2 for graduates of schools with a licensing OSCE, Pathways 3 to 5 for accredited or jointly accredited schools, and Pathway 6 requires six in-person clinical encounters rated by licensed physicians on ECFMG's Mini-CEX.

• USMLE Step 3 (after certification)

  A two-day exam taken only in the United States and its territories, open to IMGs with a valid ECFMG certificate. Day 1 has 232 multiple-choice questions; Day 2 has 180 questions plus 13 to 14 computer-based case simulations. The passing score is 200, and the FSMB fee for 2026 and 2027 is $955.

  Read the guide

• OET Medicine is the only English and communication test ECFMG accepts for certification. IELTS and TOEFL are not part of ECFMG's requirements.
• Minimum scores: 350 in Listening, 350 in Reading, 350 in Speaking and 300 in Writing, all in one test administration.
• For the 2027 Pathways, the passing result must be from a test taken on or after January 1, 2025. Earlier passing results do not count.
• There are no exemptions: native English speakers and graduates of English-language schools must also pass OET Medicine.
• OET on paper or on computer is available at venues worldwide, including the US. OET@Home is allowed only for candidates with no physical test venue in their country.
• To be safe for the 2027 Match, ECFMG advises taking OET Medicine no later than the last test date in December 2026.

Estimate your total cost

• Exam window: ECFMG requires you to meet all exam requirements within seven years of the first exam you pass, and it will not remind you of the deadline.
• USMLE results usually arrive two to four weeks after the test, but USMLE advises allowing at least eight weeks when planning.
• OET Medicine results come about 10 business days after the test, and ECFMG says to allow three business days for them to show in your Pathways application.
• 2027 Match: NRMP registration opened September 15, 2026; the Pathways application deadline is January 31, 2027; rank order lists close March 3, 2027; Match Day is March 19, 2027.
• Pathways processing: ECFMG says to allow about five business days for a case manager to start review and five more for final review, once all documents are in.
• A 2027 Pathway expires on December 31, 2029 (a 2026 Pathway on December 31, 2028), and a Pathway-based certificate expires with it.