The 2026 Pathways for ECFMG Certification and Revalidation are for international medical graduates (IMGs) who need to meet the clinical skills requirement and the communication skills requirement for ECFMG Certification, or who need to revalidate a previously accepted Pathway that is expired or expiring. IMGs also must meet the clinical and communication skills requirements in order to participate in the 2026 National Resident Matching Program® (NRMP®) Main Residency Match® (The Match®), among other requirements.
The application for the 2026 Pathways for ECFMG Certification and Revalidation will open in August in conjunction with the launch of MyIntealth™, the new online environment for accessing services offered by Intealth and its divisions. Detailed information on the 2026 Pathways also will be made available at that time, including requirements, application instructions, and associated deadlines. An overview of what is changing for the 2026 Pathways and what you can do now to prepare for your application is provided below.
What’s Changing for the 2026 Pathways?
As with the 2025 Pathways, six Pathways will be offered to IMGs applying to the 2026 Pathways for ECFMG Certification. IMGs who need to revalidate a Pathway will be required to apply through Pathway 1 or Pathway 6, depending on their eligibility. Updates to eligibility and requirements are provided below.
Assessment of Communication Skills, Including English Language Proficiency
All applicants to the 2026 Pathways, including applicants for Revalidation, will be required to achieve a satisfactory score on the Occupational English Test (OET) Medicine, regardless of citizenship or native language.
- Change to eligible testing dates: Applicants to the 2026 Pathways must have attained a satisfactory score on OET Medicine on or after January 1, 2024.
Pathway 1: Already Licensed to Practice Medicine in Another Country
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 2026 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, 2021. The date of initial licensure/registration may be prior to January 1, 2021, but the license/registration still must have been valid on or after January 1, 2021.
Pathway 2: Already Passed an Objective Structured Clinical Examination (OSCE) for Medical Licensure Administered by an Acceptable Medical School
Pathway 2 is 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.
- No change to eligible graduation date: As with the 2025 Pathways, for the 2026 Pathways, applicants to Pathway 2 must have a medical school graduation date on or after January 1, 2023.
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)
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.
- No change to eligible graduation date: As with the 2025 Pathways, for the 2026 Pathways, applicants to Pathways 3, 4, and 5 must have a medical school graduation date on or after January 1, 2023.
Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians
Pathway 6 is for applicants who do not meet the eligibility requirements for Pathway 1, 2, 3, 4, or 5, and for applicants for Revalidation who do not meet the eligibility requirements for Pathway 1. 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.
- Changes to the Criteria for Acceptable Clinical Encounters: For the 2026 Pathways, there will be the following changes:
- Encounters must take place in a formal outpatient clinical setting and patients must be registered outpatients. Encounters with patients receiving care in an emergency room, separate dedicated urgent care facility, or those admitted to a hospital as an inpatient are not acceptable.
- Only encounters in which the patient is not the applicant’s relative are acceptable. For the purposes of the evaluation, “relative” is defined as a spouse, child, grandchild, parent, grandparent, sibling, uncle, aunt, nephew, niece, and/or cousin.
What You Can Do Now to Prepare
Book OET Medicine: If you are planning to apply to the 2026 Pathways for ECFMG Certification or for Revalidation, and you do not have a satisfactory score on OET Medicine that was attained on or after January 1, 2024, we encourage you to book OET Medicine now. If you are planning to participate in the 2026 NRMP Match, you should plan to take OET Medicine before the last scheduled test date in December 2025.
For Pathway 1 Applicants, Request Your Documents: We encourage applicants who are eligible for Pathway 1 to request their Certificate or Letter of Good Standing/Current Professional Status, or equivalent documentation, from their registration/licensing authority now. If the authority will send the documentation directly to ECFMG, request that they send it to [email protected]. Please note that this email address is for regulatory authorities only; email messages received at this address from applicants will not receive a response.
For Pathway 6 Applicants, Identify Your Physician Evaluators: We encourage applicants who are only eligible for Pathway 6 to review the Criteria for Acceptable Physician Evaluators now to identify physicians who meet the criteria and are willing to evaluate their clinical skills. Please note that you may not complete an in-person clinical encounter with a physician evaluator until after you submit your online application to Pathway 6 and after the physician evaluator has accepted your request for evaluation through the online application system. Physician evaluators will not be able to complete Mini-CEX evaluations for encounters that take place prior to when they accept the request for evaluation.
