ECFMG Certification Overview
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What is the purpose of ECFMG Certification?
ECFMG Certification is the standard for evaluating the qualifications of international medical graduates (IMGs) entering the U.S. health care system.
- The Accreditation Council for Graduate Medical Education (ACGME) requires IMGs who enter ACGME-accredited residency or fellowship programs to be certified by ECFMG.
- ECFMG Certification is one of the eligibility requirements for IMGs to take Step 3 of the three-step United States Medical Licensing Examination (USMLE).
- Medical licensing authorities in the United States require that IMGs be certified by ECFMG, among other requirements, to obtain an unrestricted license to practice medicine.
Who is an IMG?
For the purpose of ECFMG Certification, ECFMG defines IMGs as individuals who received their basic medical degree from a medical school located outside the United States*. The location of the medical school, not the citizenship of the individual, is what determines whether they are IMGs. This means that U.S. citizens who graduated from medical schools outside the United States are considered IMGs. Non-U.S. citizens who graduated from medical schools in the United States are not considered IMGs.
*Individuals who graduate from Canadian medical schools on or after July 1, 2025 are considered international medical graduates for the purpose of entry into graduate medical education (GME) programs in the United States. Individuals who graduated from a Canadian medical school prior to July 1, 2025, are not considered international medical graduates and are not eligible for ECFMG Certification. For more information, please refer to the Important Information for Students and Graduates of Canadian Medical Schools in the Certification section.
What are the requirements for ECFMG Certification?
To be eligible for certification by ECFMG, an IMG must meet the following requirements.
Medical School Requirements
The individual’s medical school must meet requirements established by ECFMG. Schools that meet all requirements will be listed in the World Directory of Medical Schools (World Directory) with an ECFMG Sponsor Note stating that the school meets eligibility requirements for its students and graduates to apply to ECFMG for ECFMG Certification. The ECFMG Sponsor Note also will include the graduation years for which the school meets these requirements. The ECFMG Sponsor Note is located on the “Sponsor Notes” tab of the medical school listing. If there is no ECFMG Sponsor Note on the Sponsor Notes tab of the medical school’s listing, its students and graduates are not eligible for ECFMG Certification. To confirm that a medical school meets ECFMG’s requirements, see How to Confirm that a Medical School Meets Eligibility Requirements for ECFMG Certification and access the World Directory at www.wdoms.org . For more information on the ECFMG Sponsor Note, see Information on Sponsor Notes in the World Directory of Medical Schools.
Application for ECFMG Certification
To be eligible for ECFMG Certification, international medical students/graduates must submit an Application for ECFMG Certification. The Application for ECFMG Certification confirms their intent to pursue ECFMG Certification and collects detailed information about their medical education, including provision of their medical education credentials. As part of completing the Application for ECFMG Certification, applicants will also confirm their understanding of the purpose of the ECFMG Certification program and the requirements for ECFMG Certification. The Application for ECFMG Certification is available through the MyIntealth Applicant Portal.
Examination Requirements
Medical Science Examination Requirement
To meet the medical science examination requirement for ECFMG Certification, applicants must pass Step 1 and Step 2 Clinical Knowledge (CK) of the USMLE. IMGs apply for USMLE through the Federation of State Medical Boards (FSMB), a co-sponsor of the USMLE program. See the USMLE website for more information and to apply.
Clinical Skills Requirement and Communication Skills Requirement
To meet the clinical skills requirement and the communication skills requirement for ECFMG Certification, IMGs must:
- Have satisfied the requirements of an ECFMG Pathway, which includes attaining a satisfactory score on the Occupational English Test (OET) Medicine, that is valid for ECFMG Certification, OR
- Have a passing performance on the former Step 2 CS component of USMLE that is valid for ECFMG Certification.
See the Pathways in the ECFMG Certification section of the ECFMG website for more information and to apply.
Important Note on Validity of Pathways: The Pathways are offered on a seasonal application cycle, and IMGs should consider the timing of their applications carefully. If you meet the clinical skills requirement and communication skills requirement for ECFMG Certification through the Pathways, your accepted Pathway is subject to expiration. The expiration date is based on the Pathways season for which the Pathways application was accepted. An accepted, unexpired Pathway is required to become ECFMG Certified. An accepted, unexpired Pathway also is required to participate in the NRMP Match. For detailed information on the Pathways, including expiration dates for each Pathways season, refer to the Pathways in the ECFMG Certification section of the ECFMG website.
ECFMG has established time limits and other rules for completing the examination requirements for ECFMG Certification. For detailed information, see Examination Requirements in the ECFMG Information Booklet.
Medical Education Credential Requirements
The individual’s graduation year must be included in the ECFMG Sponsor Note in the medical school's World Directory listing. See Medical School Requirements above. IMGs must have been awarded credit for at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) by a medical school that is listed in the World Directory with an ECFMG Sponsor Note stating it meets ECFMG eligibility requirements. 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.
IMGs must document the completion of all requirements for, and receipt of, the final medical diploma. See the Reference Guide for Medical Education Credentials for the exact title of the final medical diploma individuals must have earned (and must provide). ECFMG verifies every IMG’s medical school diploma with the appropriate officials of the medical school that issued the diploma and requests that the medical school provide the final medical school transcript. Verification by ECFMG with the issuing school may also be required for transcripts that are submitted to document transferred credits. For more information, see Medical Education Credentials in the ECFMG Information Booklet.
How do IMGs begin the certification process?
Both international medical students and graduates may begin the certification process. Individuals should begin the ECFMG Certification process by first confirming their medical schools meet ECFMG requirements. Schools that meet all requirements will be listed in the World Directory with an ECFMG Sponsor Note stating that the school meets eligibility requirements for its students and graduates to apply for ECFMG Certification. The ECFMG Sponsor Note also will include the graduation years for which the school meets these requirements. The ECFMG Sponsor Note is located on the “Sponsor Notes” tab of the medical school listing. If there is no ECFMG Sponsor Note on the Sponsor Notes tab of the medical school’s listing, its students and graduates are not eligible for ECFMG Certification. For more information on the ECFMG Sponsor Note, see Information on Sponsor Notes in the World Directory of Medical Schools. Students/graduates of schools that meet ECFMG requirements are eligible to apply to ECFMG for Certification and may do so via the MyIntealth Applicant Portal.
How long does it take to complete the certification process?
The time required to complete the certification process is different for each individual. Both international medical students and graduates may begin the certification process. However, since one of the requirements for ECFMG Certification is that the final medical diploma be verified by ECFMG with the issuing medical school, an IMG cannot complete the certification process until after graduation from medical school. The time required for some aspects of the certification process, such as the time required by a medical school to verify medical education credentials, is beyond the control of ECFMG.
All applicants pursuing ECFMG Certification must use the most current edition of the ECFMG Information Booklet available to them at the time of inquiry and must become familiar with and will be subject to the policies and procedures detailed therein. The ECFMG Information Booklet is available on the Publications page of this website.
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