Reminder: USMLE Attempt Limit Changing Soon

To protect the integrity of the United States Medical Licensing Examination® (USMLE®) program and more closely match the USMLE attempt limits imposed by state medical boards in the majority of states, effective July 1, 2021, the USMLE attempt limit policy will change, as previously announced. The change will reduce an examinee’s total number of allowable attempts from six (6) attempts to four (4) attempts per Step exam, including incomplete attempts.

The policy change is effective for applications submitted on or after July 1, 2021. After the implementation of this policy change, examinees who have attempted any USMLE Step (including Step 2 Clinical Skills) four (4) or more times and have not passed will be ineligible to apply for USMLE Steps.

Examinees with four (4) or five (5) attempts at an exam who meet all eligibility requirements outlined in the USMLE Bulletin of Information may submit application(s) for USMLE through June 30, 2021 at 11:59 pm, Eastern Time, under the current attempt limit of six (6).

To learn more about this change, please review the FAQs on the USMLE website. If you have questions about how this change impacts you, please email the Office of the USMLE Secretariat at

Update: MyECFMG Mobile App

ECFMG®|FAIMER® is no longer updating the MyECFMG mobile app, and it is no longer available for download in the App Store and for many individuals in Google Play. If you already have the MyECFMG mobile app, it may not function as intended with your mobile device or platform. If it is functioning for you, you may continue to use it. If you have used the MyECFMG mobile app recently to submit documentation to ECFMG, you do not need to resubmit that documentation.

To access certain account information and perform certain functions that may no longer be supported by the MyECFMG mobile app, please use the ECFMG website and ECFMG’s on-line services such as the On-line Applicant Status and Information System (OASIS) and Interactive Web Applications (IWA).

Applicants for ECFMG Certification who do not have the MyECFMG mobile app and who need to submit their Final Medical Diploma and related documents to ECFMG to meet the medical education credentials requirements for ECFMG Certification can use the free ECFMG Credentials Upload Tool or submit them by mail using information provided in the applicable edition of the ECFMG Information Booklet.



ERAS 2022 Program Information for IMGs Now Available

Information for international medical students/graduates (IMGs) on the Electronic Residency Application Service® (ERAS®) 2022 application season is now available. If you plan to apply for U.S. residency positions that begin in July 2022, please visit the following sections of the ECFMG website for important information.

Most U.S. residency programs participate in ERAS. If you apply to participating programs, you must use ERAS to do so.

At the ERAS Support Services section of the ECFMG website, you will be able to:

  • See an overview of the Application Process and Timeline.
  • View instructions on how to obtain an ERAS Token, which will enable you to register at the MyERAS website of the Association of American Medical Colleges (AAMC) and work on your residency applications.
  • Find instructions for submitting your supporting documents, such as letters of recommendation and transcripts.

ERAS Support Services will transmit your supporting documents to your ERAS application. All supporting documents must be submitted electronically. For more details, please refer to the “Upload Your Documents Now” e-mail that will be sent to you after you have registered at MyERAS.

Residency Tokens for the ERAS 2022 application season are expected to be available through ECFMG’s On-line Applicant Status and Information System (OASIS) beginning June 24, 2021. You can use a 2022 Token to register with AAMC’s MyERAS beginning June 24, 2021.

All IMGs Pursuing ECFMG Certification Must Meet Current Requirements

Effective April 15, 2021, all international medical graduates (IMGs) who were not certified by ECFMG as of that date must meet the current requirements for ECFMG Certification, regardless of what the requirements were at the time they initially applied to ECFMG. This means that ECFMG no longer accepts former examinations for the purpose of ECFMG Certification and individuals are no longer exempted from the current requirements for Certification. The following former exams are no longer accepted:

  • ECFMG Examination;
  • Federation Licensing Examination (FLEX);
  • Visa Qualifying Examination (VQE);
  • Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS);
  • NBME Part I and Part II; and
  • ECFMG Clinical Skills Assessment (CSA).

This change does not impact IMGs who already have been certified by ECFMG based on former exams. The Standard ECFMG Certificates of such individuals remain valid.

 Current Examination Requirements

  • To meet the medical science examination requirement for ECFMG Certification, applicants must pass Step 1 and Step 2 Clinical Knowledge (CK) of the United States Medical Licensing Examination® (USMLE®).
  • To meet the clinical and communication skills requirements for ECFMG Certification, applicants must:
    • Complete an ECFMG|FAIMER Pathway, OR
    • Have a passing performance on the former Step 2 Clinical Skills (CS) component of USMLE that is valid for ECFMG Certification.

 Time limits and other rules apply to the examination requirements for ECFMG Certification. Please refer to the ECFMG Information Booklet for more information.

ECFMG On-line Services Unavailable May 21-23

Due to scheduled maintenance, ECFMG’s on-line services are expected to be unavailable beginning at approximately 7:00 p.m. on Friday, May 21, 2021. Services are expected to be restored by 6:00 p.m. on Sunday, May 23, 2021. All times are calculated using Eastern Time in the United States.

During this maintenance period, you will be unable to access most ECFMG on-line services, including the following:

  • IWA—Interactive Web Applications
  • OASIS—On-line Applicant Status and Information System
  • Application for Pathways for ECFMG Certification for 2022 Match
  • EMSWP—ECFMG Medical School Web Portal, and its programs for medical schools and other institutions:
    • Status Verification
    • Credentials Verification
    • Performance Data
    • GEMxSM for Partner Institutions
  • CVS ON-LINE—Certification Verification Service On-line
  • EVNet—Exchange Visitor Network (for staff of U.S. training programs that host ECFMG-sponsored exchange visitor physicians)
  • EPICSM—Electronic Portfolio of International Credentials
    • Physician Portal
    • Report Portal
  • GEMx on-line services for students
  • MyECFMG mobile app

The World Directory of Medical Schools also will be unavailable during this maintenance period.

Thank you for your patience and cooperation as we work to maintain high-quality on-line services.

INPUT REQUESTED: Recommendations on the Transition to U.S. Graduate Medical Education

The Coalition for Physician Accountability, of which ECFMG|FAIMER is a member, has released its Initial Summary Report and Preliminary Recommendations of the Undergraduate Medical Education to Graduate Medical Education Review Committee (UGRC) and opened a 30-day public comment period, through May 26, seeking feedback on the report. The report offers 42 recommendations on how to improve the transition to U.S. graduate medical education for medical school graduates, teaching hospitals, and the patients they serve.

The mission of the Coalition is to advance health care and promote professional accountability by improving the quality, efficiency, and continuity of the education, training, and assessment of physicians. The Coalition’s members are the national organizations responsible for the oversight, education, and assessment of medical students and physicians throughout their medical careers.

ECFMG|FAIMER President and CEO William W. Pinsky, MD said he appreciated the important work of the Coalition and said the report includes important information for those entering graduate medical education, those involved in training the next generation of physicians, and the patients they serve.

“The report includes important information for house staff as well as patients,” Dr. Pinsky said. “There are issues specific to international medical graduates, both foreign nationals and U.S citizens. We are mindful of these specific issues and look forward to receiving your feedback.”

Before you begin the survey, we encourage you to review the supporting materials below to provide you with additional background information and context about the work of the UGRC to find solutions to identified challenges in the transition from undergraduate medical education (UME) to graduate medical education (GME).

1.) Initial Report and Preliminary Recommendations of the UGRC

2.) Glossary of Terms Used in UGRC Report, Recommendations and Survey

3.) Composite Ideal State of UME to GME Transition

To provide comments, please access the survey at The deadline to submit your feedback to the UGRC’s preliminary recommendations is May 26. If you have questions or need assistance, please e-mail

ECFMG|FAIMER Recognized for Most Outstanding Article

The Editorial Committee of the Journal of Medical Regulation, published by the Federation of State Medical Boards (FSMB), selected an ECFMG|FAIMER-authored article as the recipient of the 2021 Ray L. Casterline Award for Excellence in Writing. The award recognizes outstanding scholarly articles exploring issues of relevance to the state medical board community and the practice of medical regulation.

Christine D. Shiffer
Christine D. Shiffer

ECFMG|FAIMER Regulatory Affairs Manager Christine D. Shiffer was the primary author of the article titled Advancing the Quality of Medical Education Worldwide: ECFMG’s 2023 Medical School Accreditation Requirement. ECFMG|FAIMER President and CEO William W. Pinsky, MD, former Vice President for Research and Data Resources John Boulet, PhD, and former Senior Vice President for Business Development and Operations Lisa L. Cover co-authored the article. It was published in the December 2019 issue of the Journal of Medical Regulation. The award was presented on April 29 during the FSMB’s 2021 Annual Meeting.

The article explains the history of ECFMG Certification, the proliferation of medical schools worldwide, and the need to stimulate accreditation efforts and to improve the quality of medical education globally.  These efforts have led to ECFMG|FAIMER’s 2024 Medical School Accreditation Requirement.

“Christine is the primary author of the article. Accreditation of medical schools is important to the future of medical education globally, as well as a contributing factor to improving the delivery of quality health care,” Dr. Pinsky said. “Her straightforward approach to explain the history, necessity, and goals of the requirement really comes through in the article. She is very deserving of this writing honor.”

The Ray L. Casterline Award for Excellence in Writing is named for Ray L. Casterline, MD, who served ECFMG from 1973 through 1988 in a number of leadership roles, including Executive Director.

Update: Pathways for ECFMG Certification for 2022 Match

Detailed Information, On-line Application for Pathways 1-5 Now Available

The 2022 Pathways application process for Pathways 1-5 is now open. Qualified international medical graduates (IMGs) who need to meet the clinical and communication skills requirements for ECFMG® Certification and who intend to participate in the 2022 National Resident Matching Program® (NRMP®) Main Residency Match® (The Match®) can apply to a Pathway to meet these requirements for ECFMG Certification and the requirements for Match participation.

The information available on ECFMG’s website includes:

As announced previously, ECFMG|FAIMER has added a sixth Pathway for 2022. The application process for Pathway 6 is expected to open in July. Preliminary information on Pathway 6 is available now, and additional details and instructions for meeting the requirements for Pathway 6 will be provided as soon as they are available. Please monitor the ECFMG website for the steps that applicants can take before July to prepare for Pathway 6.

Step 1 Pass/Fail Score Reporting Implementation Date

United States Medical Licensing Examination® (USMLE®) Step 1 score reporting will transition to pass/fail outcomes only for administrations on or after January 26, 2022. Step 1 examinations administered before January 26 will include a three-digit numeric score.

Outcomes for Step 1 administrations occurring before January 26, 2022 will continue to include a three-digit score and pass/fail. Step 2 Clinical Knowledge and Step 3 examinations will continue to be reported as a three-digit score and pass/fail.

On February 12, 2020, the USMLE program announced it would change Step 1 score reporting to a pass/fail outcome no earlier than January 1, 2022. In taking this action, the USMLE’s co-sponsors—the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®)—considered the broad range of input received from the Invitational Conference on USMLE Scoring (InCUS), the subsequent InCUS report and its preliminary recommendations, and the extensive feedback and national conversation that preceded and followed the conference.

Additional information regarding the change to reporting Step 1 outcomes as pass/fail can be found here:

Recognition of Non-Standard Training for Exchange Visitor (J-1) Physicians to Transition to the ACGME

Today, the Educational Commission for Foreign Medical Graduates (ECFMG®), American Board of Medical Specialties (ABMS®), and Accreditation Council for Graduate Medical Education (ACGME®) announced a change in the process for recognition of non-standard training as it relates to the J-1 visa program administered by ECFMG. The term “non-standard training” refers to advanced clinical subspecialty disciplines or pathways for which there is no ACGME accreditation and/or ABMS Member Board certification available. Currently, all non-standard disciplines must be endorsed by an appropriate ABMS Member Board to be considered for J-1 sponsorship. The role of the ABMS Member Boards in providing this approval is detailed in federal regulation 22 CFR §62.27(e)(4)(i).

While the ABMS and its Member Boards have historically played a role in recognizing non-standard disciplines, ABMS initiated discussions several years ago with ECFMG about relinquishing that role. The rationale is that oversight of non-standard training does not fit with the mission of the ABMS and its Member Boards, which are responsible for certification of individuals; and, as such, the Member Boards are not structured to provide oversight of training programs and institutions. It was the consensus of the two organizations that the ACGME, as the primary national accreditor of graduate medical education programs and the institutions that sponsor them, is well suited to provide recognition of Sponsoring Institutions offering non-standard training opportunities to exchange visitor (J-1) physicians. At the request of the ECFMG and ABMS, the ACGME agreed to assume this responsibility. The ECFMG, ABMS, and ACGME jointly submitted a proposal to the United States Department of State (DOS) to substitute Sponsoring Institution “recognition” by the ACGME for the current ABMS endorsement role, with a transition period during which either organization’s recognition process may be honored based on criteria currently being developed. With publication of a Federal Register Notice on April 19, 2021, the DOS officially acknowledges the administrative change proposed by the ECFMG, ABMS, and ACGME.

Under the new model, the ACGME will offer recognition of Sponsoring Institutions that offer non-standard training programs for exchange visitor physicians. This recognition has been designed to ensure that institutions are providing appropriate oversight of the non-standard training program(s) they offer. The ACGME will not recognize individual non-standard training programs. A working group has been formed to develop Recognition Requirements and, upon ACGME Board approval of those Requirements, a new Recognition Committee will be formed to review and monitor institutions seeking to achieve and maintain this recognition.

Detailed information regarding the ACGME recognition process will be provided in the coming months, including notification when the proposed Recognition Requirements are posted on the ACGME website for a 45-day public comment period.

Questions regarding the release of the proposed Recognition Requirements should be directed to either Kathy Malloy, ACGME vice president, Accreditation Standards (312.755.5061 or or Tracy Wallowicz, assistant vice president, US Graduate Medical Education Services (215.823.2120 or

Questions regarding the recognition process should be directed to Paul Johnson, ACGME executive director, Institutional Accreditation (312.755.5005 or


William W. Pinsky, MD, FAAP, FACC
President and Chief Executive Officer, ECFMG

Richard E. Hawkins, MD
President and Chief Executive Officer, ABMS

Thomas J. Nasca, MD, MACP
President and Chief Executive Officer, ACGME