Frequently Asked Questions
ECFMG Certification
1. What is ECFMG Certification?
Medical schools outside the United States and Canada vary in their educational standards and curricula. The purpose of ECFMG Certification is to assess the readiness of graduates of these schools to enter U.S. residency and fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). To be certified by ECFMG, you must pass a series of exams; you must also fulfill ECFMG’s medical education credential requirements. These requirements include providing ECFMG with copies of your medical education credentials, which ECFMG will verify directly with your medical school. See ECFMG Certification.
2. Why would I want to be certified by ECFMG?
If you are an international medical graduate and wish to enter an ACGME-accredited residency or fellowship program in the United States, you must be certified by ECFMG before you can enter the program. You must also be certified by ECFMG if you wish to take Step 3 of the three-step United States Medical Licensing Examination (USMLE). ECFMG Certification is also one of the requirements to obtain an unrestricted license to practice medicine in the United States. See ECFMG Certification.
3. How can I find out if students/graduates of my medical school are eligible for ECFMG Certification?
To be eligible for certification by ECFMG, among other requirements, your medical school must be listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER®). If you are a medical school student and you want to apply for examination, your medical school must be listed in IMED and your medical school’s "Graduation Years" must be listed as 'Current," both at the time you apply for the exam and at the time you take the exam. If you are a medical school graduate, your medical school and graduation year must be listed in IMED to be eligible for examination and for ECFMG Certification. To verify that you meet these requirements, access IMED on this website. See ECFMG Certification.
4. How do I begin the certification process?
The certification process begins when you submit your first exam application to ECFMG.
5. How do I get a USMLE/ECFMG Identification Number?
When you access IWA to apply for examination, you will receive instructions for obtaining a number online. You must have your number before you can proceed with the application process.
6. How long does the certification process take?
The time required to complete the certification process is different for each applicant. You may apply for the required exams as soon as you meet the eligibility requirements for examination. All of the exams required for ECFMG Certification are offered continuously throughout the year.
Both medical school students and graduates may begin the certification process. However, since one of the requirements for ECFMG Certification is that your medical education credentials be verified by ECFMG with your medical school, you cannot complete the certification process until you graduate. The time required for some aspects of the certification process, such as the time required by your medical school to verify your medical education credentials, is beyond the control of ECFMG. See ECFMG Certification.
7. In what order do I take the exams required for ECFMG Certification?
To be eligible for ECFMG Certification, you must, among other requirements, pass USMLE Step 1, Step 2 CK, and Step 2 CS. See Examination Requirements. Once you meet the eligibility requirements for examination, you can take these exams in any order. See Eligibility for Examination.
8. How can I have ECFMG confirm to a medical licensing authority or residency/fellowship program that I am ECFMG-certified?
ECFMG will confirm your certification status when it receives a request directly from a medical licensing authority, residency/fellowship program official, or other appropriate organization. For status reports sent to medical licensing authorities, the request can also be sent to ECFMG by you. Approximately two weeks are required for the confirmation to be completed. Please note that there may be a fee for this service. See Confirmation of ECFMG Certification Status. If you apply to residency programs through ERAS, ECFMG will send an electronic status report automatically to all of the programs to which you apply. See Electronic Residency Application Service.
USMLE Step 1 and Step 2 (CK and CS)
9. How can I apply?
Apply on-line using ECFMG’s Interactive Web Application (IWA).
10. How can I prepare for the exams?
Information on preparing for the exams is available in this booklet and in the USMLE Bulletin of Information. Sample test materials for all Steps and Step Components are available on the USMLE Orientation Materials Compact Disc (CD), which ECFMG sends to applicants when they are registered. The sample test materials on the CD and additional information on examination content and test formats are available on the USMLE website. See Preparation.
11. When and where can I take Step 1 and Step 2?
Step 1 and Step 2 (CK and CS) are offered continuously throughout the year. Applicants registered for these exams are assigned an eligibility period during which they must take the exam. See When to Apply and Eligibility Periods.
Step 1 and Step 2 CK are offered worldwide at test centers of Thomson Prometric, a part of the Thomson Corporation. For information on Prometric test centers offering USMLE, visit the Prometric website. Step 2 CS is administered at test centers in Atlanta, Chicago, Houston, Los Angeles, and Philadelphia in the United States. For all exams, see Testing Locations.
12. Do I need to graduate from medical school before taking the exams?
Both students and graduates may take the exams. To take the exams, medical school students must have completed at least two years of medical school. This eligibility requirement means that students must have completed the basic medical science component of the medical school curriculum. Other eligibility requirements apply to both students and graduates. See Eligibility for Examination.
13. What if I cannot take an exam once I have registered?
Once registered, you cannot cancel or postpone your registration (except as described below for Step 1/Step 2 CK). If you do not take the exam, you will not receive a refund or credit of your exam fee(s). For detailed information on ECFMG’s payment policy, see Payment.
Although you cannot cancel your registration, there are options that provide flexibility. Registered applicants can change their test date and/or test center, subject to availability. See Rescheduling. If you are unable to take Step 1/Step 2 CK during your assigned eligibility period, you can request an extension of your eligibility period for a fee. See Eligibility Period Extension. If you are unable to obtain the appropriate visa to enter the United States to take Step 2 CS, you may request a full refund of the exam fee. See Refunds.
14. Is there a limit to the number of times I can take an exam?
For the purpose of ECFMG Certification, there is no limit on the number of times you can take a Step or Step Component you have not passed. If you fail or do not complete a Step or Step Component, you may retake it, but you must reapply and pay the appropriate fee(s). Certain restrictions apply when retaking the same Step or Step Component. Once you pass a Step or Step Component, you may not repeat it, and you will have seven years to pass the other Step(s) or Step Component(s) required for ECFMG Certification. See Time Limit for Completing Examination Requirements and Reexamination and Reapplication.
For the purpose of medical licensure, the USMLE program recommends to state medical licensing authorities that they require applicants to pass the full USMLE sequence (including Step 3, which is not required for ECFMG Certification) within a seven-year period. The USMLE program also recommends to state medical licensing authorities a limit on the number of attempts allowed to pass each Step or Step Component. See Time Limit and Number of Attempts Allowed to Complete All Steps and Retakes in the USMLE Bulletin of Information. Some state medical licensing authorities accept the USMLE-recommended limits, but others do not. You should contact the FSMB for general information and the medical licensing authority of the jurisdiction where you plan to apply for licensure for definitive information, since licensure requirements vary among jurisdictions.
Interactive Web Application (IWA)
15. What is a Certification of Identification Form (Form 186)?
The Certification of Identification Form (Form 186) is the paper certification required by ECFMG for graduates who apply for exams on-line using IWA. Form 186 requires that an authorized official certify the applicant’s identity. Once submitted to and accepted by ECFMG, Form 186 remains valid for five years. See Applying for Examination.
16. What is the difference between a Certification Statement (Form 183) and a Certification of Identification Form (Form 186)?
The Certification Statement (Form 183) is the paper certification required by ECFMG for students who submit on-line exam applications. A new Form 183 is generated with each on-line application. Form 183 must be completed by the student and an authorized medical school official and submitted to ECFMG for each on-line application, or the application will be rejected. See Applying for Examination.
The Certification of Identification Form (Form 186) is the paper certification required by ECFMG for graduates who submit on-line exam applications. Once the form is received and accepted by ECFMG, it remains valid for five years. During this five-year period, graduates may submit on-line exam applications without submitting another paper certification. See Applying for Examination.
It is expected that the Certification of Identification Form (Form 186) will replace the Certification Statement (Form 183) for students. See Certification News and monitor this website.
17. Do I have to submit a new Certification of Identification Form (Form 186) every time I apply for an examination?
No. Once the Certification of Identification Form (Form 186) is accepted by ECFMG, it is valid for five years. Applicants with a valid Certification of Identification Form (Form 186) can apply for exams using IWA by completing only the on-line part of the application.
18. I am a medical school graduate and have submitted a Certification Statement (Form 183) previously. Do I still have to submit a Certification of Identification Form (Form 186)?
Yes. The Certification of Identification Form (Form 186) must be submitted by graduates who apply for an exam.
ECFMG Clinical Skills Assessment (CSA)
19. How do I fulfill the clinical skills requirement for ECFMG Certification?
USMLE Step 2 CS has replaced the ECFMG CSA as the exam that satisfies the clinical skills requirement for ECFMG Certification. Applicants who have not passed the ECFMG CSA must take USMLE Step 2 CS. See Clinical Skills Requirement.
20. What if I have already passed the ECFMG CSA?
If you have passed the ECFMG CSA, you will not be required to pass Step 2 CS for ECFMG Certification. See Examination Requirements. Additionally, applicants who have passed the CSA will not be required to pass Step 2 CS to meet the eligibility requirements for Step 3, provided their most recent clinical skills performance (ECFMG CSA or USMLE Step 2 CS) is a pass. See Who Is Required to Take Step 2 CS? and Official Performance of Record for Examinees Retaking a Previously Passed Step in the USMLE Bulletin of Information.
Effective June 14, 2004, passing performances on the CSA that took place on or after June 14, 2001 do not expire for the purpose of entering graduate medical education. If you are certified by ECFMG and the CSA pass date on your certificate is June 14, 2001 or later, you may request a permanent validation sticker for your CSA date. See Validity of Examinations for Entry into Graduate Medical Education.
If you passed the CSA before June 14, 2001, your passing performance on the CSA remains subject to expiration for the purpose of entry into graduate medical education. See Validity of Examinations for Entry into Graduate Medical Education.
Medical Education Credentials
21. What is a final medical school transcript?
The final medical school transcript is an official document that is the record of the graduate’s medical education, issued by the medical school or university, upon or after graduation.
The format of the final medical school transcript may vary among institutions. The final medical school transcript contains the name of the medical school or university and the name of the graduate. Other items that may be contained in the final medical school transcript include, but are not limited to, the dates of attendance, courses taken, credits for each course, grade in each course, summary of transfer credit accepted and the name of the institution from which the credit was accepted, title of the degree awarded, date degree was awarded, program of study (i.e., medicine), and date the transcript was issued.
22. Do I need to send my final medical school transcript to ECFMG?
When ECFMG sends your medical diploma to your medical school for verification, ECFMG will request the medical school to include your final medical school transcript when the school returns the verification of your medical diploma to ECFMG. If ECFMG is unable to obtain your final medical school transcript directly from your medical school, ECFMG will contact you and request that you submit to ECFMG two copies of your final medical school transcript. If ECFMG has previously verified your medical diploma with your medical school but not the final medical school transcript, you must send copies of the final medical school transcript to ECFMG. See Provision of Credentials and Translations.
23. How will I know if ECFMG has received verification of my medical diploma and transcript from my medical school?
ECFMG will notify you when it sends the request for verification of your medical education credentials to your medical school. After ECFMG receives the verification of your diploma and/or your final medical school transcript from your medical school and evaluates it, ECFMG will send you another notification. You can check the status of your medical education credentials using OASIS. See Verification of Credentials.
Fifth Pathway Program
24. What if I plan to attend a Fifth Pathway program?
If you intend to complete a Fifth Pathway program, you are required to notify ECFMG of this intent. See The Fifth Pathway Program.
ERAS
25. What medical specialties are participating in the Electronic Residency Application Service (ERAS) in 2007?
Most specialties participate in ERAS. For the list of participating specialties, visit the ERAS website of the Association of American Medical Colleges (AAMC). Programs participating in ERAS will, in principle, no longer accept paper applications. However, there may be exceptions by individual program directors. You should contact the programs directly for their policies.
Payment
26. How do I pay for the exam(s)?
If you apply for an exam or request a service on-line, you can pay the required fees on-line with a credit card (Visa, MasterCard, or Discover) or with an electronic payment from your U.S. checking account. If you submit a paper request for service and you have a USMLE/ECFMG Identification Number, you can pay in advance using OASIS. All applicants submitting paper requests can pay by credit card, check, or wire transfer by completing the payment section of the request form. Payment for all services is due at the time of application. If you do not include full payment, your application/request for service will be rejected. See Payment.