Requirements for ECFMG Certification for 2022 Match

Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians

Who Should Apply

Pathway 6 is for applicants who do not meet the eligibility requirements for Pathway 1, 2, 3, 4, or 5 and/or have failed the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination® (USMLE®) one or more times.

To meet the requirements for Pathway 6, the applicant’s clinical skills must be evaluated by licensed physicians using ECFMG’s Mini-Clinical Evaluation Exercise (Mini-CEX) for Pathway 6.

Important Note: Applicants who already have satisfied the clinical and communication skills requirements for ECFMG Certification do not need to (and are not eligible to) pursue a Pathway to meet the requirements for ECFMG Certification or for participation in the 2022 Match. These individuals include:

  • IMGs who have a passing performance on Step 2 CS that is valid for ECFMG Certification (even if they previously failed Step 2 CS),
  • IMGs who are certified by ECFMG, and
  • IMGs with an approved 2021 Pathways application.

If you applied to a Pathway for the 2021 Match, please see Important Information for 2021 Pathway Applicants before applying to a Pathway for the 2022 Match.

Eligibility Requirements

Important Note: Applicants who failed Step 2 CS one or more times must apply to Pathway 6 in order to meet the clinical and communication skills requirements for ECFMG Certification, regardless of whether they meet the eligibility requirements for other Pathways.

In addition, to meet the requirements for Pathway 6:

In addition to the requirements listed above, the applicant must meet the requirements in General Eligibility for All Pathways and Assessment of Communication Skills, Including English Language Proficiency, as well as all other eligibility requirements for ECFMG Certification.

Criteria for Acceptable Physician Evaluators

To apply to Pathway 6, you will need to provide ECFMG with the names and e-mail addresses of licensed physicians who agree to observe and evaluate you during six distinct clinical encounters. Each physician may evaluate you on up to two encounters. This means that you will be required to identify a minimum of three and a maximum of six physicians in order to complete all six evaluations.

The physicians you select must:

You will be required to attest that each physician evaluator meets these criteria at the time you submit the physician’s information to ECFMG.

Criteria for Acceptable Clinical Encounters

Each of the six clinical encounters in which you are observed must:

In addition, please note that the encounter may be conducted in the language of the patient; however, the Mini-CEX evaluation must be submitted in English.

You must take all steps necessary to ensure that each clinical encounter is conducted in compliance with all applicable licensure, regulatory, and/or legal requirements. You will be required to extend absolute immunity to ECFMG and indemnify and hold harmless ECFMG for any of your actions, intentional or otherwise, that are a part of the clinical encounter and the Mini-CEX assessment process. You will be required to attest to this at the time you submit each physician’s information to ECFMG.

ECFMG Mini-CEX for Pathway 6

The Mini-CEX is a well-studied workplace-based assessment tool used to evaluate an individual’s clinical skills in a variety of clinical settings. Using ECFMG’s Mini-CEX for Pathway 6, your physician evaluators will assess your clinical skills during real, in-person patient encounters.

When completing the on-line Mini-CEX for Pathway 6, the physician evaluator will provide his or her name, physician license or registration number, and e-mail address, along with general information about the clinical encounter, including the date on which the encounter took place, the name of the health care facility at which the encounter took place, the setting of the encounter, the patient’s age, and the patient’s gender. The physician evaluator will then score your performance during the clinical encounter on each of four clinical skills components:

For each of the four components, the evaluator will score your performance on a scale of 1 to 9, with 1 being the lowest score and 9 being the highest score, based on the following anchors:

The Mini-CEX for Pathway 6 also includes descriptions of the skills expected at the level of an applicant who is a medical school graduate ready to enter postgraduate training/graduate medical education (GME). Any score below this level will require the evaluator to provide a reason for the score.

For a sample Mini-CEX form, see the PDF version of the ECFMG Mini-CEX for Pathway 6. Please note that this sample version is for reference only; it should not be used to complete the evaluation or be submitted to ECFMG. All Mini-CEX responses must be collected and scored electronically through ECFMG’s Clinical Skills Evaluation and Attestation Portal. Paper evaluations and evaluations sent via e-mail will not be accepted.

Scoring the Mini-CEX Evaluations

After ECFMG receives all six completed Mini-CEX evaluations for your application, ECFMG will determine your score in each of the four components evaluated (Medical Interviewing Skills, Physical Examination Skills, Professionalism/Communication Skills, and Clinical Reasoning & Judgment) by calculating the average score for each component across all six Mini-CEX evaluations.

You will meet ECFMG’s scoring requirements for the six Mini-CEX evaluations if:

You will not meet ECFMG’s scoring requirements for the six Mini-CEX evaluations if:

If you do not meet ECFMG’s scoring requirements for the six Mini-CEX evaluations, the evaluations will automatically be provided to the Pathway 6 Review Committee for review. The Pathway 6 Review Committee is comprised of physician reviewers from ECFMG|FAIMER and its Board of Trustees. The Committee will determine whether you have met ECFMG’s clinical skills requirements for Pathway 6 based both on the scores and the reasons for the scores provided by your physician evaluators. If the decision of the Committee is that you have not met the requirements, you will be able to request a recheck of your Mini-CEX scores; instructions will be provided to you if applicable.

Application Timing

If you meet the eligibility requirements for Pathway 6, you may apply now using the on-line Application for Pathways for ECFMG Certification for 2022 Match.

Your application must be submitted no later than December 15, 2021.

In order for you to participate in the 2022 Match, ECFMG must determine the outcome of your Pathway application; determine your overall eligibility for the 2022 Match, including verifying your passing performance on Step 1 and Step 2 CK; then report your eligibility status to the National Resident Matching Program® (NRMP®) by the NRMP Rank Order List Certification deadline. ECFMG will not determine the outcome of your Pathway application until all required supporting documentation has been received and approved. Therefore, the time needed to complete the processing of your application is contingent upon receipt of all supporting documentation, including all six Mini-CEX evaluations from your physician evaluators. All six completed Mini-CEX evaluations must be received by ECFMG no later than December 31, 2021. Please plan the timing of your application and clinical encounters accordingly.

Also, please note that you should not complete an in-person clinical encounter with a physician evaluator until after you submit your on-line application to Pathway 6 and after the physician evaluator has accepted your request for evaluation through the on-line application system. See Completing the Mini-CEX Encounters and Evaluations below for more information.

Application Instructions
  1. Confirm the eligibility of the three to six physicians who will observe and evaluate your clinical skills and obtain their approval to participate in the Mini-CEX process.
    • Confirm that each physician meets the Criteria for Acceptable Physician Evaluators (above).
    • Obtain each physician’s approval to evaluate your clinical skills using the Mini-CEX process.
    • Obtain each physician’s approval for you to provide his/her name and e-mail address to ECFMG.
  2. Access the Application for Pathways for ECFMG Certification for 2022 Match and determine general eligibility.
    • To begin the application, you will need to log in with your USMLE/ECFMG ID and ECFMG On-line Services password. Once you begin the application, you will have five days to complete and submit it. If the application is not submitted within five days, it will be deleted, and you will need to begin a new application if you wish to apply to a Pathway.
    • After you log in, the application will indicate whether you meet the eligibility requirements that pertain to all Pathways.
    • If you have failed Step 2 CS one or more times, the application will indicate that you will be required to apply to Pathway 6 and you will proceed directly to step 4 below.
  3. If you meet the general eligibility requirements for all the Pathways, you will proceed to questions regarding your eligibility for the specific Pathways.
    • You will begin by answering questions to determine your eligibility to apply to Pathway 1. If you do not meet the Pathway 1 eligibility requirements, you will proceed to provide information regarding your eligibility for Pathway 2.
    • If you do not meet the eligibility requirements for Pathway 1 or 2, the system will automatically determine your eligibility to apply to Pathway 3, 4, or 5, based on the information in your ECFMG record.
    • If the system indicates that you are not eligible for Pathway 3, 4, or 5, you will be required to apply to Pathway 6.
  4. Confirm that you have read and understand all requirements for Pathway 6. Before you submit your Pathway 6 application, you will be required to confirm that you have read all of the information on the Pathway 6 page on the ECFMG website, including Eligibility Requirements, Criteria for Acceptable Physician Evaluators, Criteria for Acceptable Clinical Encounters, and all Application Instructions, deadlines, and related information.
  5. Complete and submit the application. After providing the required information, you will be asked to certify your application, provide payment, and submit your application to ECFMG.
  6. Enter and manage information about your physician evaluators. After you submit your application, you will be able to enter the names and e-mail addresses of the physician evaluators for your six clinical encounters. See Managing Physician Evaluator Information and Tracking Encounters below for details.
  7. Be observed by your physician evaluators in six real, in-person clinical encounters. See Completing the Mini-CEX Encounters and Evaluations below for details.
  8. Ensure that your physician evaluators complete the on-line Mini-CEX evaluations through the ECFMG Clinical Skills Evaluation and Attestation Portal. Please note that it is your responsibility to ensure that your physician evaluators complete the Mini-CEX evaluations in support of your application; your application cannot be approved until all six completed Mini-CEX evaluations are received and accepted by ECFMG. All six Mini-CEX evaluations must be received by ECFMG no later than December 31, 2021.
Managing Physician Evaluator Information and Tracking Encounters

After you submit your application to Pathway 6, you can enter and manage information about your physician evaluators and track the statuses of your clinical encounters through the Application for Pathways for ECFMG Certification for 2022 Match. The Application will display a Clinical Encounters Dashboard that lists entries for each of your six encounters. From the dashboard, you will be able to:

In addition, please note the following regarding requests for evaluation:

Completing the Mini-CEX Encounters and Evaluations

When you add a physician evaluator for an encounter through the Application for Pathways for ECFMG Certification for 2022 Match, the physician will receive an e-mail from ECFMG indicating that you have requested a Mini-CEX evaluation. The e-mail also will provide the physician with instructions on how to access ECFMG’s on-line Clinical Skills Evaluation and Attestation Portal. The Clinical Skills Evaluation and Attestation Portal is where the physician can accept or reject your request and submit the Mini-CEX evaluation after the clinical encounter takes place. Access to this portal will require that the physician enter the same e-mail address that you entered when you added the physician’s information to the Clinical Encounters Dashboard in the Application for Pathways for ECFMG Certification for 2022 Match, so it is essential that you confirm the correct e-mail address to use with the physician before submitting it.

After logging into the Clinical Skills Evaluation and Attestation Portal, the physician can accept or reject your request.

Clinical encounters must not take place until after the physician evaluator accepts your request.

During the clinical encounter, the evaluator will observe you interacting with a patient. You must perform a medical interview and an appropriate physical examination of the patient. At the completion of the encounter, you should summarize the patient’s clinical findings in a brief (less than five minutes) presentation that includes an appropriate differential diagnosis and a plan for the next steps for diagnosis and treatment.

After observing your clinical interaction with the patient and your presentation, the physician evaluator must log in to the Clinical Skills Evaluation and Attestation Portal and complete and submit the Mini-CEX evaluation based on his/her observations of your clinical skills as demonstrated during the encounter. See ECFMG Mini-CEX for Pathway 6 and Scoring the Mini-CEX Evaluations above for details on how performance is evaluated and scored.

After the evaluator submits the Mini-CEX evaluation, the status for the encounter will be updated on the Clinical Encounters Dashboard in the Application for Pathways for ECFMG Certification for 2022 Match; however, the evaluation and scores will not be made available to you. In addition, the evaluator will be advised not to share the evaluation and scores with you.

All Mini-CEX encounters must be completed through the process outlined above, and all Mini-CEX evaluations must be completed through the Clinical Skills Evaluation and Attestation Portal. ECFMG will not accept Mini-CEX evaluations submitted outside of the Clinical Skills Evaluation and Attestation Portal in any way, including by e-mail.

Fees and Payment

The fee for applying to a Pathway is $900. Full payment is due when you submit your application. If the application is not submitted within five days of when you begin it, it will be deleted, and you will need to begin a new application if you wish to apply to a Pathway.

You must use a Visa, MasterCard, Discover, or American Express credit card with a security code; credit available in your ECFMG Financial Account cannot be used to pay for a Pathway application.

Fees related to your application are not refundable. If you submit a Pathway application and ECFMG determines that you are ineligible for the Pathway, your application will be rejected and the fee will not be refunded. In addition, if ECFMG does not receive all required documentation in support of your application, as well as any required verifications of submitted documentation from the issuing authority, your application will not be complete, and the application fee will not be refunded.

Application Processing Time

Once your application has been submitted, you can use the on-line Application for Pathways for ECFMG Certification for 2022 Match to check the status of your application. The following guidelines may be helpful:

The time needed to complete the processing of your application is contingent upon receipt of all six Mini-CEX evaluations.

The preceding information is current as of August 12, 2021 and is subject to change. Please visit the ECFMG website frequently for updates regarding these requirements.