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Medical Education Credentials

An international medical graduate must have had at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) in attendance at a medical school that is listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER). There are restrictions on credits transferred to the medical school that awards an applicant’s medical degree that can be used to meet this requirement. See Transfer Credits. The physician’s graduation year must be included in the medical school’s IMED listing. The FAIMER IMED contains information supplied by countries about their medical schools. FAIMER is not an accrediting agency.

Note Regarding Ineligible Practitioners: Graduates not eligible for admission to the exams or for ECFMG Certification include, but are not limited to: Graduates licensed only in stomatology, ayurvedic or homeopathic medicine, or those awarded only the diploma of Physician-Epidemiologist-Hygienist, Physician-Biochemist, Physician-Cyberneticist, Physician-Biophysicist, Licensed Medical Practitioner, or Assistant Medical Practitioner.

Applicants for ECFMG Certification must document the completion of all requirements for, and receipt of, the final medical diploma. ECFMG verifies every applicant’s final medical diploma with the appropriate officials of the medical school that issued the diploma. 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. Verification by ECFMG with the issuing school may also be required for transcripts that are submitted by applicants to document transferred academic credits. An applicant’s credentials are not considered complete until ECFMG receives verification of the final medical diploma, final medical school transcript, and, if required, transfer credit transcript(s) directly from the issuing school(s).

Please do not send any credentials not required by ECFMG (such as licenses, certificates of full registration, high school diplomas, academic awards, etc.). Submission of unnecessary documents can delay the processing of your application.

Transfer Credits

For the purpose of ECFMG Certification, academic credits earned on or after January 1, 2008 that are transferred to the medical school that awarded or will award an applicant’s medical degree must meet all of the following criteria:

• Credits must be transferred from one IMED-listed medical school to another IMED-listed medical school.
• Credits must be for courses taken at one medical school within seven years of the date of graduation at the medical school that accepts the transferred courses.
• Credits must be for courses that were passed at the medical school at which the course was taken.

Applicants who have transferred credits to the medical school that awarded or will award their medical degree will be required to document these credits when they apply to ECFMG for examination. See Credentials for Exam Registration.

Applicants whose transferred credits do not comply with the policy outlined above will not meet the requirements to be registered by ECFMG for examination or the requirements for ECFMG Certification. Applicants whose transferred credits do not meet all the criteria listed above may request an exception from the ECFMG Medical Education Credentials Committee.

Provision of Credentials and Translations

Credentials for ECFMG Certification

You may not submit your credentials to ECFMG until you apply for an exam. If you send credentials to ECFMG before you apply for an exam, they will not be processed.

If you are a medical school graduate when you submit your first exam application, send your medical education credentials with this initial exam application.

If you are a medical school student when you submit your first exam application, send your medical education credentials as soon as you graduate and receive them.

You must include your full name and USMLE/ECFMG Identification Number on the front of all credentials and the back of photographs before sending them to ECFMG. See Credentials for Exam Registration.

After you have applied for an exam, if you need to send credentials to ECFMG separately from an exam application, you must send the credentials to the following address:

Educational Commission for Foreign Medical Graduates (ECFMG)
3624 Market St., 4th Floor
Philadelphia, PA 19104-2685
USA

ECFMG will not accept letters or other deliveries that arrive with postage or other fees due.

When your credentials have been processed, ECFMG will notify you. You can also check the status of your credentials by accessing OASIS.

Final Medical Diploma

ECFMG requires all medical school graduates to submit copies of their final medical diploma.

You must send two photocopies of your final medical diploma to ECFMG. Do not send an original diploma. The exact name of the final medical diploma you must provide is listed in the Reference Guide for Medical Education Credentials. The Reference Guide lists these medical credential qualifications by country of medical school. Although this Reference Guide is based upon information that was current at the time of publication, this information is subject to change.

The photocopies of your medical diploma must be 216 mm x 279 mm (8½ in x 11 in). If these documents are larger than 216 mm x 279 mm (8½ in x 11 in), you must send reduced photocopies that are 216 mm x 279 mm (8½ in x 11 in). You must send the copies of your diploma to ECFMG by mail or courier service. ECFMG does not accept these documents by fax or e-mail. You must send one full-face, passport-sized, color photograph with the copies of your medical diploma. The photograph that you send must be current; it must have been taken within six months of the date that you send it. A photocopy of a photograph is not acceptable.

You must submit the copies of the final medical diploma in the original language, containing the issue date and all of the appropriate signatures of the medical school and/or university officials. Documents that are not in English must be accompanied by an official English translation. ECFMG will not accept copies of a medical diploma that is not in English without an official English translation. Likewise, ECFMG will not accept an English translation of a diploma without copies of the original language document from which the English translation was prepared. (See English Translations.)

Do not submit professional evaluations of your final medical diploma. ECFMG does not accept such evaluations in lieu of your final medical diploma.

You must also complete and submit with your medical diploma the ECFMG Medical Education Credentials Submission Form (Form 344) and two copies of the Medical School Release Request (Form 345).

Final Medical School Transcript

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 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. ECFMG will then send a copy of the final medical school transcript to the medical school for verification. In such cases, you must send two photocopies of your final medical school transcript to ECFMG. The photocopies of your medical school transcript must be 216 mm x 279 mm (8½ in x 11 in). If these documents are larger than 216 mm x 279 mm (8½ in x 11 in), you must send reduced photocopies that are 216 mm x 279 mm (8½ in x 11 in). You must send the copies of your transcript to ECFMG by mail or courier service. ECFMG does not accept these documents by fax or e-mail.

You must send one full-face, passport-sized, color photograph with the copies of your final medical school transcript. The photograph that you send must be current; it must have been taken within six months of the date that you send it. A photocopy of a photograph is not acceptable.

You must submit the copies of the final medical school transcript in the original language. Documents that are not in English must be accompanied by an official English translation. ECFMG will not accept copies of a medical school transcript that is not in English without an official English translation. Likewise, ECFMG will not accept an English translation of a transcript without copies of the original language document from which the English translation was prepared. (See English Translations.)

Do not submit professional evaluations of your final medical school transcript. ECFMG does not accept such evaluations in lieu of your final medical school transcript.

Transcript(s) to Document Transferred Academic Credits

If you have transferred academic credits to the medical school that awarded or will award your medical degree, you must document these credits when you apply for examination by sending to ECFMG two photocopies of an official transcript issued by the school or institution at which the course was taken. The photocopies must be 216 mm x 279 mm (8½ in x 11 in). If these documents are larger than 216 mm x 279 mm (8½ in x 11 in), you must send reduced photocopies that are 216 mm x 279 mm (8½ in x 11 in). To submit the transcript to ECFMG, follow the instructions for additional documentation in Applying for Examination.

You must submit the copies of the transcript in the original language. Documents that are not in English must be accompanied by an official English translation. ECFMG will not accept copies of a transcript that is not in English without an official English translation. Likewise, ECFMG will not accept an English translation of a transcript without copies of the original language document from which the English translation was prepared. (See English Translations.)

Do not submit professional evaluations of your transcript. ECFMG does not accept such evaluations in lieu of a transcript.

Name on Medical Diploma and Transcript(s)

The name on your medical diploma and transcript(s) must match exactly the name in your ECFMG record. If the names do not match exactly, you must submit legal documentation that verifies the name on your medical diploma/transcript(s) is (or was) your name. The legal documentation must show your name exactly as it appears on your medical diploma/transcript(s). (See Name of Applicant and Changing or Verifying Your Name.)

An example of a discrepancy between the name in your ECFMG record and the name on your medical diploma/transcript(s) would be if your ECFMG record lists your married name, but your medical diploma/transcript(s) lists your maiden name.

Other examples of a discrepancy include, but are not limited to, the following:

• Use of initials for the first name or last name (surname) on the medical diploma/transcript(s)

  Example: “Mary Smith” in your ECFMG record, but “M. Smith” or “Mary S.” on your medical diploma/transcript(s).

• Difference in the sequence of names

  Example: “John James Clark” in your ECFMG record, but “James John Clark” or “Clark James John” on your medical diploma/transcript(s).

• Hyphenations and separations in names

  Example: “Alice Al Quigley” in your ECFMG record, but “Alice Al-Quigley” or “Alice Alquigley” on your medical diploma/transcript(s).

Credentials for Exam Registration

If you are a medical school graduate, you must send the two copies of your medical diploma and the current color photograph with your application for examination (if you have not submitted your diploma and photograph to ECFMG previously). If you have graduated and met all requirements for your medical diploma but your medical diploma has not yet been issued, you must submit with the application a current, full-face, passport-sized, color photograph and a letter signed by your Medical School Dean, Vice Dean, or Registrar. The letter must include the following statement:

This is to confirm that [applicant name] has graduated and completed all requirements to receive the [degree title] degree from [medical school/university name]. The degree will be issued [month and year].

For instructions on how to submit these items to ECFMG, see Applying for Examination.

You must then send the photocopies of your diploma to ECFMG as soon as the diploma is issued. You must also complete and submit with your medical diploma the ECFMG Medical Education Credentials Submission Form (Form 344) and two copies of the Medical School Release Request (Form 345). See Credentials for ECFMG Certification.

If you graduated from medical school and do not submit your medical diploma or a letter from your medical school, as described above, and this documentation has not been received previously by ECFMG, your application will be rejected.

If the name on your diploma does not match the name in your ECFMG record and you do not submit acceptable legal documentation, your application will be rejected. (See Name of Applicant and Changing or Verifying Your Name.)

If you are a medical school student, you should send the copies of your medical diploma and current, full-face, passport-sized, color photograph to ECFMG as soon as you graduate and receive the diploma. See Credentials for ECFMG Certification.

Students and graduates who have transferred academic credits to the medical school that awarded or will award their medical degree must submit a transcript to document these credits when they apply for examination. Failure to provide appropriate documentation of transfer credits may prevent exam registration. See Credentials for ECFMG Certification.

If your credentials are complete, you are generally not required to resend these documents when you apply for subsequent exams. After receiving your medical diploma, ECFMG will notify you and advise if additional credentials are required.

If you have questions or concerns about your credentials, you can contact ECFMG by e-mail at credentials@ecfmg.org or by telephone or fax (see General Inquiries).

English Translations

Any document submitted to ECFMG that is not in English must be accompanied by an English translation, prepared by and certified to be correct by a government official (for example, a Consular Officer), medical school official (for example, a Dean or Registrar), or a professional translation service.

The translation must appear on official stationery and must bear the original signature and title of the government or medical school official or representative of the translation service. If the translation service is a private company, the letterhead stationery must identify the company as a translation service. The translation must be a word-for-word translation of the original language document. An abstract or summary translation of the document is not acceptable.

An English language certificate issued by the medical school that is not a word-for-word English language version of the degree, transcript, or other document in the original language is not acceptable as a translation. English translations that do not meet the requirements above will not be accepted. Examples of unacceptable translations include, but are not limited to:

• translations prepared by a notary who is not a government or medical school official or representative of a professional translation service,
• a translation that was not signed by the translator or official or representative of the translation service, and
• a translation that is not a word-for-word translation of the original language document.

Additionally, applicants are not permitted to translate their own documents.

ECFMG does not endorse or recommend individual translation services. However, if you are in the United States, you can locate a translation service by consulting the telephone directory under the heading of “Translation Services.”

Verification of Credentials

ECFMG verifies every applicant’s final medical diploma with the appropriate officials of the medical school that issued the diploma and requests the medical school to include the final medical school transcript when the school returns the verification of the medical diploma to ECFMG. Verification by ECFMG with the issuing school may also be required for transcripts that are submitted by applicants to document transferred academic credits. You will not fulfill the ECFMG medical education credential requirements until verification of your final medical diploma, final medical school transcript, and, if required, transfer credit transcript(s) is received directly from the issuing school(s) and accepted by ECFMG.

In some instances, the verification process can be lengthy due to the processing time required by the institutions and prevailing postal conditions. ECFMG will notify you to advise when your diploma is sent to your medical school for verification. If ECFMG does not receive a response from your medical school within the anticipated time period, ECFMG will send subsequent verification requests to your medical school. ECFMG will notify you when it sends these subsequent requests. ECFMG will also notify you after receiving and evaluating the verification from your medical school. You can check the status of these medical education credentials on-line using OASIS.

Important Note: Applicants are responsible for any fees associated with the verification of the final medical diploma and final medical school transcript. If your medical school charges a fee for the verification of your diploma and/or transcript, ECFMG will advise you to contact your medical school directly regarding the fee and the method of payment. If the final medical school transcript provided by your medical school is not in English, ECFMG will have the transcript translated into English by an independent translation service, will charge your ECFMG financial account for the translation, and will notify you of the charge. The current translation fee is $205. See Payment for information on how to make a payment to your ECFMG financial account.

Irregular Behavior

The ECFMG Medical Education Credentials Committee reviews allegations of irregular behavior. As defined by ECFMG, irregular behavior includes, “all actions or attempted actions on the part of applicants, examinees, potential applicants, others when solicited by an applicant and/or examinee, or any other person that would or could subvert the examination, certification or other processes of the ECFMG.” Examples of irregular behavior include, but are not limited to, submission of any falsified or altered document to ECFMG; submission of any falsified or altered ECFMG document to other entities or individuals; falsification of information on applications or through other means; and failing to comply with a USMLE or ECFMG policy, procedure, and/or rule.

A finding of irregular behavior by ECFMG may be sufficient cause for ECFMG to bar you from an exam, to terminate your participation in an exam, to withhold and/or invalidate the results of your exam, to withhold a certificate, revoke a certificate, or to take other appropriate action. ECFMG will report instances of altered or falsified documents to the FSMB Board Action Databank, state medical licensing authorities, and directors of graduate medical education programs, among others. ECFMG may also report such instances to the USMLE Committee on Irregular Behavior and to any other organization or individual who, in the judgment of ECFMG, has a legitimate interest in such information.

In all cases when the ECFMG Medical Education Credentials Committee has made a finding of irregular behavior, a permanent annotation will be included in the individual’s ECFMG Status Report and ECFMG Certification Verification Service (CVS) Report. Additional information explaining the basis for the finding of irregular behavior and the resulting action will accompany every ECFMG Status Report and CVS Report and may also be provided to legitimately interested entities; this additional information will be provided if there is a finding of irregular behavior made on or after August 31, 2006, regardless of the date of the conduct or activity that gave rise to the finding.

Representative Examples of Irregular Behavior

Representative examples of allegations of irregular behavior and actions taken by the ECFMG Medical Education Credentials Committee include:

• Altering or Fabricating Letters of Recommendation
  
  The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in connection with an individual who altered a Letter of Recommendation prior to submitting it to ERAS Support Services at ECFMG.
  
  Following review, the ECFMG Medical Education Credentials Committee determined the individual had engaged in irregular behavior and took action to permanently revoke the individual’s Standard ECFMG Certificate.


• Forging a Standard ECFMG Certificate
  
  The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in connection with an individual who submitted to a residency program a document that purported to be a Standard ECFMG Certificate. The individual involved had not met the requirements for ECFMG Certification, and no Standard ECFMG Certificate had ever been issued to him.
  
  Following review, the ECFMG Medical Education Credentials Committee determined the individual had engaged in irregular behavior and took action to bar the individual from admission to all ECFMG examinations and from ECFMG Certification.

The Fifth Pathway Program

The following information from the American Medical Association Council on Medical Education provides an overview of the Fifth Pathway Program.

AMERICAN STUDENTS IN FOREIGN MEDICAL SCHOOLS

The “Fifth Pathway” Statement

1. A pathway for entrance to approved programs of graduate medical education, other than those existing under previous policies, became available as of July 1, 1971 for students who have fulfilled the following conditions:


1. Have completed, in an accredited American college or university, undergraduate premedical work of the quality acceptable for matriculation in an accredited United States medical school, evaluated by measures such as college grade point average and scores on the Medical College Admission Test.
2. Have studied medicine at a medical school located outside the U.S., including Puerto Rico, and Canada that is listed in the International Medical Education Directory (IMED), published by the Foundation for Advancement of International Medical Education and Research.
3. Have completed all of the formal requirements for a diploma of the foreign medical school except internship and/or social service. Those who have completed all of the formal graduation requirements, including internship and/or social service, and are, consequently, eligible to apply for ECFMG certification, are not eligible for the Fifth Pathway.
2. Students who have completed the academic curriculum at a foreign medical school and who have fulfilled the above conditions may be offered the opportunity to substitute an academic year of supervised clinical training for the internship/social service required by the foreign medical school. The supervised training should consist of the clinical education provided in the third year of a U.S. medical school or in appropriate clinical subinternships. The supervised clinical training must be provided by faculty of a program in medical education accredited by the Liaison Committee on Medical Education and should be conducted in its affiliated hospitals, so as to assure that individuals who complete Fifth Pathway programs are reasonably comparable to the school’s regularly-graduated students. The medical school should insure that resources are adequate for the conduct of the Fifth Pathway program, without jeopardizing its other academic programs. Fifth Pathway education should be provided only with the written approval of the dean or other appropriate official of the medical school.
3. Students must pass Step 1 of the United States Medical Licensing Examination (USMLE) in order to be eligible for admission to a Fifth Pathway program.
4. Students must successfully complete clinical training, on the judgment of the medical school’s faculty based on a final evaluation comparable to that used to judge regularly-enrolled students. With the approval of the faculty, and upon passing Step 2 of the USMLE, Fifth Pathway students are eligible to enter the first year of approved graduate medical education, without completing the social service and/or internship required by the foreign country and without obtaining ECFMG certification.
5. Fifth Pathway certificates must be provided only with the approval of the dean or other medical school official and must be recorded with the registrar. The medical school must notify the American Medical Association that a student has successfully completed the Fifth Pathway program.
6. The Council on Medical Education recommends that all state medical licensing boards consider for licensure all candidates who have successfully completed a Fifth Pathway program on the same basis as they consider candidates who have received ECFMG certification.

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Policy statement of the American Medical Association Council on Medical Education (included in Report 2 I-01), adopted June 12, 1971 and modified May 23, 1973; March 22, 1975; September 7, 1979; June 11, 1981; March 2, 2001; November 30, 2001; and June 17, 2005.

Currently, three medical schools offer the Fifth Pathway in the United States:

• New York Medical College in Valhalla, New York. For more information, call (914) 594-4490 or visit www.nymc.edu.
• Ponce School of Medicine in Ponce, Puerto Rico. For more information, call (787) 844-3710 or visit www.psm.edu.
• Mount Sinai School of Medicine of New York University in New York, New York. For more information, call (212) 241-6696 or visit www.mssm.edu.

Fifth Pathway Website

The AMA maintains a website on the Fifth Pathway that answers many questions about the program, including:

• What is a Pathway?
• What is the Fifth Pathway?
• Who can qualify for a Fifth Pathway?
• How are Fifth Pathway students different from international medical graduates?
• How can I verify a physician’s Fifth Pathway credentials?
• Current Programs

The site is available at: www.ama-assn.org/ama/pub/category/9306.html.

Participants in Fifth Pathway programs who have not completed the internship and/or social service requirement for graduation at the non-U.S. medical school are not eligible for ECFMG Certification. However, these individuals may apply to ECFMG to take USMLE Step 1 and Step 2. The following additional requirements apply to Fifth Pathway participants who apply to ECFMG for examination.

Students Attending Medical Schools in Mexico

In order to apply to ECFMG for USMLE Step 1, Step 2 CK, or Step 2 CS, there is an additional requirement if you are a student officially enrolled in a medical school in Mexico and you intend to complete a Fifth Pathway program in lieu of: completing the internship and social service requirements, receiving the Titulo de Medico Cirujano, and fulfilling the medical education credential requirements for ECFMG Certification. If all of these conditions apply to you and you wish to apply to ECFMG for examination, you must notify ECFMG at the time of application that you intend to complete a Fifth Pathway program.

You must submit a letter:

• Stating that you intend to complete a Fifth Pathway program,
• Specifying which Fifth Pathway program (New York Medical College, the Ponce School of Medicine, or Mount Sinai School of Medicine) you plan to attend, and
• Confirming that you are aware of the eligibility requirements for admission to the Fifth Pathway program and that you have fulfilled these requirements, or have fulfilled the requirements but have not yet passed USMLE Step 1.

You must sign and date this letter. A letter from your medical school stating that you intend to complete a Fifth Pathway program will not be accepted.

Students Attending Other Medical Schools

Students attending medical schools in other countries should contact ECFMG for information on applying for examination as a Fifth Pathway candidate.

[Last update: 13 September 2007]

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Copyright © 2007 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
Portions reprinted, with permission, from the USMLE 2008 Bulletin of Information. Copyright © 2007 by the Federation of State Medical Boards of the United States, Inc., and the National Board of Medical Examiners® (NBME®).

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