International medical graduates (IMGs) can use Pathways to meet certain requirements for ECFMG Certification and to participate in the National Resident Matching Program® (NRMP®) Main Residency Match® (The Match®). The Pathways evaluate IMGs’ clinical and communication skills—skills that are critically important to participate in U.S. graduate medical education (GME) and to provide supervised patient care. In order to become ECFMG certified, applicants must satisfy all other requirements for ECFMG Certification in addition to meeting Pathways requirements.
Important Information for 2021 and 2022 Pathways Applicants
Applications to 2022 Pathways
ECFMG is no longer accepting new Pathways applications for applicants who wish to participate in the 2022 Match. If you submitted a 2022 Pathways application, you can continue to check its status using the on-line application. ECFMG will continue to process 2022 Pathways applications leading up to the 2022 Match. ECFMG will not determine the outcome of a Pathways application until all required supporting documentation and/or verification(s) have been received. Applicants should refer to the detailed instructions for the Pathway to which they are applying in the Requirements for ECFMG Certification for 2022 Match section of the ECFMG website for information on required documentation.
Incomplete 2021 and 2022 Pathways Applications
All 2021 and 2022 Pathways applications that are incomplete by the time the 2023 Pathways application opens will be rejected. Applicants to the 2021 or 2022 Pathways whose application is rejected will be able to reapply to the 2023 Pathways when the application becomes available. The 2023 Pathways on-line application process is expected to open in the second quarter of 2022.
Information on Expiration of the ECFMG Certificate
ECFMG Certificates issued to applicants who satisfy the clinical and communication skills requirements for ECFMG Certification through a Pathway are subject to expiration. Once the applicant successfully completes the first year of U.S. GME training in a training program accredited by the Accreditation Council for Graduate Medical Education (ACGME), the ECFMG Certificate will no longer be subject to expiration. Information on validating the ECFMG Certificate indefinitely upon completion of the first year of ACGME-accredited training will be forthcoming.
If an applicant does not successfully complete the first year of ACGME-accredited training before the expiration date, the ECFMG Certificate will expire. Should the applicant wish to enter a GME program in the future, the applicant will be required to meet the clinical and communication skills requirements for ECFMG Certification in place at that time in order to revalidate the ECFMG Certificate. Information on how to revalidate an expired ECFMG Certificate will be forthcoming.
ECFMG Certificates issued to applicants who satisfy the clinical and communication skills requirements for ECFMG Certification through the 2021 or 2022 Pathways will be valid through December 31, 2024. If you were certified by ECFMG based on a 2021 or 2022 Pathway and your ECFMG Certificate lists an expiration date in 2021 or 2022, this expiration date will be extended through December 31, 2024. You will receive a direct communication from ECFMG when the expiration date has been updated, which should be shared with your prospective training programs.
Using the Pathways for the 2023 Match
Who Should Use the Pathways?
The Pathways for ECFMG Certification for the 2023 Match are intended for IMGs who need to meet the clinical and communication skills requirements for ECFMG Certification and who plan to participate in the 2023 Match (in March 2023).
The ability to apply to the 2023 Pathways is expected to become available in the second quarter of 2022. Please monitor the ECFMG website for information on availability of the on-line application.
As noted above, IMGs who applied to the 2021 or 2022 Pathways whose application was rejected will be able to reapply to the 2023 Pathways when the application becomes available.
What’s Changing for the 2023 Pathways?
As with the 2022 Pathways, six Pathways will be offered for the 2023 Pathways. Modifications to eligibility and requirements are detailed below.
Assessment of Communication Skills, Including English Language Proficiency
As with the 2022 Pathways, all IMGs who pursue one of the six 2023 Pathways will be required to achieve a satisfactory score on the Occupational English Test (OET) Medicine as part of their Pathways requirements. All Pathways applicants, regardless of citizenship or native language, must satisfy this requirement.
- Change to eligible testing dates: Applicants to the 2023 Pathways must have attained a satisfactory score on OET Medicine on or after January 1, 2021.
Pathway 1: Already Licensed to Practice Medicine in Another Country
As with the 2022 Pathways, Pathway 1 is for applicants who currently hold or have recently held a license/registration to practice medicine without supervision. Pathway 1 applicants will be required to demonstrate that they hold or have held an acceptable license/registration and that the license/registration has not been subject to disciplinary action.
- Change to eligible licensure dates: For the 2023 Pathways, applicants to Pathway 1 must currently hold, or have held, a full, unrestricted license to practice medicine issued at any time on or after January 1, 2018. The date of initial licensure/registration may be prior to January 1, 2018, but the license/registration still must have been valid on or after January 1, 2018.
Pathway 2: Already Passed an Objective Structured Clinical Examination (OSCE) for Medical Licensure Administered by an Acceptable Medical School
For the 2023 Pathways, Pathway 2 will be for applicants who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1), but who attend or have graduated from a medical school that administers an OSCE specifically required for medical licensure by the medical regulatory authority (MRA) in that country. The medical school must meet certain ECFMG requirements and the applicant must successfully complete the OSCE.
- Change to acceptable OSCEs: For the 2023 Pathways, ECFMG will no longer accept passing results on OSCEs that are not administered by an acceptable medical school. OSCEs administered by other entities will not be accepted.
- Change to eligible graduation date: For the 2023 Pathways, applicants to Pathway 2 must have a medical school graduation date on or after January 1, 2021.
Pathway 3: Medical School Accredited by Agency Recognized by World Federation for Medical Education (WFME)
Pathway 4: Medical School Accredited by Agency that Has Received a Determination of Comparability by National Committee on Foreign Medical Education and Accreditation (NCFMEA)
Pathway 5: Medical School Issues Degree Jointly with a U.S. Medical School Accredited by Liaison Committee on Medical Education (LCME)
As with the 2022 Pathways, Pathways 3, 4, and 5 are for students or recent graduates of medical schools that meet eligibility requirements established by ECFMG and who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1). An authorized official of the medical school must attest to the applicant’s clinical skills.
- Change to eligible graduation date: For the 2023 Pathways, applicants to Pathways 3, 4, and 5 must have a medical school graduation date on or after January 1, 2021.
Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians
As with the 2022 Pathways, 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 former USMLE Step 2 Clinical Skills (CS) one or more times. To meet the requirements for Pathway 6, the applicant’s clinical skills must be observed and evaluated by licensed physicians in six real, in-person clinical encounters using the ECFMG Mini-Clinical Evaluation Exercise (Mini-CEX) for Pathway 6.
- Change to number of applicants an individual physician evaluator may evaluate: For the 2023 Pathways, each physician evaluator will be able to submit evaluations for no more than 10 applicants.
- Changes to physician evaluator processes: For the 2023 Pathways, there will be some changes to the processes that physician evaluators must follow to complete Mini-CEX evaluations for Pathway 6 applicants; details on these changes will be published as they become available.
Pathways Application Fee
The fee to apply to the 2023 Pathways will be $925.
Expiration of the ECFMG Certificate
As with previous Pathways seasons, ECFMG Certificates issued to applicants who satisfy the clinical and communication skills requirements for ECFMG Certification through a 2023 Pathway will be subject to expiration. ECFMG Certificates issued to applicants based on the 2023 Pathways will be valid through December 31, 2024.