Eligibility Requirements for Pathways Expanded, More IMGs May Be Eligible

ECFMG|FAIMER has expanded the eligibility requirements for certain pathways used to meet the Requirements for ECFMG Certification for 2021 Match, and additional international medical graduates (IMGs) may be eligible to apply to the pathways. Details on the expanded eligibility requirements and instructions are under development and will be posted to ECFMG’s website as soon as possible. We also are updating the on-line Application for Pathways for ECFMG Certification for 2021 Match to allow newly eligible applicants to apply. Please monitor the ECFMG website for the status of the updated information and on-line application.

We are providing this preliminary information now so that individuals who may be eligible under these expanded requirements can make decisions regarding their applications to residency programs for 2021. Program directors can begin downloading residency applications through the Electronic Residency Application Service (ERAS) on October 21.

If you want to apply to a pathway and believe you are eligible based on the expanded eligibility criteria outlined below, you are strongly encouraged to apply to ERAS now and to complete your ERAS application as soon as possible.

Eligibility requirements have been expanded for Pathways 1, 2, and 4, and the changes are highlighted below. Other eligibility requirements apply to specific pathways, and all applicants who apply to a pathway must meet all other requirements for ECFMG Certification.

Pathway 1:

The types of licenses that satisfy the requirements for Pathway 1 have been expanded. The following has been added as acceptable:

  • Applicant has held a license/registration to participate in postgraduate medical education (i.e., a provisional or training license/registration for postgraduate training) in any country at any time on or after January 1, 2015.
    • The license does not need to permit unsupervised practice.
    • A provisional or training license/registration for the purpose of participating in pregraduate clinical training does not meet the requirements for Pathway 1.

Pathway 2:

There is now an additional option for satisfying the requirements for Pathway 2. The new option is:

  • Applicant attends or has graduated from a medical school in a country where the medical regulatory authority requires an Objective Structured Clinical Examination (OSCE) for licensure of IMGs but does not mandate that same licensure requirement for graduates of domestic medical schools.
    • Students/graduates of medical schools in Malaysia will satisfy the requirements for this new option. These schools will be added to the list of schools eligible for Pathway 2 as soon as possible.

Pathway 4:

The requirements for Pathway 4 have been expanded to include the following:

  • Applicant attends or has graduated from a medical school that is accredited by an agency that has received a determination of comparability by the National Committee on Foreign Medical Education and Accreditation (NCFMEA).
    • Schools that are accredited by the following agencies meet the new requirements:
      • Czech Republic – National Accreditation Bureau for Higher Education
      • Dominican Republic – Ministry of Higher Education, Science and Technology
      • Hungary – Hungarian Accreditation Committee
      • Israel – Council for Higher Education
      • Poland – Polish Accreditation Committee
      • United Kingdom – General Medical Council
    • The schools that meet the new requirements will be added to the list of schools eligible for Pathway 4 as soon as possible. If you are unsure if your school is accredited by an agency listed above, please contact your school or the accrediting agency.

More information will be made available as soon as possible. Please monitor the ECFMG website for updates.

Temporary USMLE Step 3 Eligibility Requirements Are in Effect

Last month, the United States Medical Licensing Examination® (USMLE®) program announced temporary USMLE Step 3 eligibility requirements during the suspension of the USMLE Step 2 Clinical Skills (CS) examination. The temporary eligibility requirements, applicable to examinees who have not yet passed the Step 2 CS, are in effect within the Step 3 registration system starting Sept. 3, 2020 at 1 p.m. U.S. Central Time.

Examinees should read the full announcement on the USMLE website.

Application for Pathways for ECFMG Certification for 2021 Match Now Available

The on-line Application for Pathways for ECFMG Certification for 2021 Match is now available. Qualified international medical students/graduates (IMGs) who intend to participate in the 2021 Main Residency Match® and are unable to take Step 2 Clinical Skills (CS) of the United States Medical Licensing Examination® (USMLE®) due to the suspension of that exam may be able to meet the requirements for ECFMG Certification through one of five pathways.

Eligibility requirements and detailed instructions for applying to the pathways, including information on required documentation, application timing, fees, and a limited exceptions process, are available on the ECFMG website.

In order to ensure adequate time to address any technical issues that may arise with the new pathways application, please note that it may be unavailable between the hours of 7:00 p.m. and 10:00 p.m., U.S. Eastern Time, Monday through Friday, in the coming business days if updates are necessary.

Update on New Requirements for ECFMG Certification for 2021 Match

ECFMG®|FAIMER® has established five pathways that will allow qualified international medical graduates (IMGs) who have not passed Step 2 Clinical Skills (CS) of the United States Medical Licensing Examination® (USMLE®) to meet the requirements for ECFMG Certification. These pathways are available to eligible IMGs who plan to enter U.S. graduate medical education (GME) for the 2021-2022 academic year.

Since announcing the pathways in mid-June, ECFMG|FAIMER has been working aggressively to develop additional information and processes that will enable IMGs to use the pathways. In this announcement, we provide some important updates on these efforts:

Application for Pathways for ECFMG Certification for 2021 Match Available by End of August

This week, ECFMG|FAIMER announced that the on-line application process for the pathways will be available by the end of August. Detailed instructions for using the application will be published in approximately mid-August, allowing potential applicants to preview the process and make advance preparations.

As published by the Association of American Medical Colleges, during the 2021 application season for the Electronic Residency Application Service (ERAS®), residency programs may begin reviewing applications on October 21, 2020. This is approximately one month later than prior years. This delay, implemented as a result of the major issues facing applicants and training programs as they prepare for the 2021 residency application cycle, will allow IMG applicants additional time to meet pathway requirements.

Additional Resources

ECFMG|FAIMER has published a 20-minute webinar tailored to the needs of leaders in the U.S. GME community. The webinar provides additional details about the new requirements for ECFMG Certification for the 2021 Match and answers some frequently asked questions received from members of U.S. GME. The webinar is available from Resources in the Requirements for ECFMG Certification for 2021 Match section of the ECFMG website.

ECFMG|FAIMER also has published an expanded set of frequently asked questions about the Occupational English Test (OET) Medicine, the English language proficiency assessment that is required of all IMGs who pursue a pathway. ECFMG|FAIMER recently confirmed that IMGs pursuing a pathway must take OET Medicine by December 31, 2020 to help ensure enough time for ECFMG|FAIMER to determine applicant status and report that status to the National Resident Matching Program® by the NRMP® Rank Order List Certification deadline for the 2021 Match.

Preliminary Volume Indicators for IMGs in 2021 Match

ECFMG|FAIMER is the designated Dean’s Office for all IMGs who use ERAS to apply to first- and second-year (PGY-1 and PGY-2) residency positions in U.S. GME. To begin the ERAS application process, IMGs must obtain an ERAS Token from ECFMG|FAIMER. Through the end of July, ECFMG|FAIMER issued more than 11,400 ERAS 2021 Residency Tokens to IMGs, the same number when compared to last year at this time.

Pre-registration is available to IMGs who plan to take OET Medicine to satisfy the English language proficiency requirement associated with the pathways. As of this writing, more than 8,500 individuals have pre-registered to take OET Medicine.

Please continue to visit the ECFMG website, since additional resources and updates will be published as they become available.

Step 1 and Step 2 CK Content Distribution Changes

On May 15, the United States Medical Licensing Examination® (USMLE®) program announced that content distribution changes on Step 1 and Step 2 Clinical Knowledge (CK) would be delayed until at least September 2020 because of the impact COVID-19 (Coronavirus) has had on USMLE testing. Below is the current timetable for implementing these changes:

  • Beginning in October 2020, Step 1 will increase the number of items assessing communication skills.
  • Beginning in November 2020, Step 2 CK will increase the number of items assessing systems-based practice, patient safety, legal/ethical issues, and professionalism.

In mid-August, the USMLE program will provide updated practice materials and more information about the schedule for rollout of these changes, including the timeline for reporting scores. Examinees should monitor the USMLE website for the latest information.

COVID-19 Update for the USMLE Program

Delayed Change to USMLE Attempt Limit Policy

In February 2020, the United States Medical Licensing Examination® (USMLE®) program announced a reduction in the allowable number of exam attempts on each Step or Step Component from six to four that would go into effect no earlier than January 1, 2021. Due to the reduced testing capacity caused by COVID-19 (Coronavirus), the USMLE program is delaying the implementation of this policy change to no earlier than July 1, 2021.

Step 2 Clinical Skills (CS) Refunds

Last week, NBME and ECFMG sent e-mails to examinees who were registered to take Step 2 CS and were unable to test due to suspension of the exam. These e-mails included information about the refund process and timeline.


As the USMLE program continues its plans to expand USMLE testing, Prometric states that their testing capacity continues to increase as well. Since May 1, more than 21,000 USMLE examinees have tested. For examinees looking to secure a Prometric appointment, please continue to check the Prometric website for updated information, site openings/closings, and available appointments.

Examinees should continue to monitor the USMLE COVID-19 Resource Center, the USMLE website, and USMLE social media for updates.

ECFMG|FAIMER Supports Coalition Recommendations for Fellowship Applicants in 2020-2021

On June 16, the Coalition for Physician Accountability, of which ECFMG|FAIMER is a member, released its report titled Recommendations for Away Rotations and Interviews for Graduate Medical Education Fellowship Applicants During the 2020-2021 Academic Year. The report builds on the Coalition’s work to address aspects of the transition from medical school to residency during COVID-19 (Coronavirus).

ECFMG|FAIMER supports the Coalition’s recommendations for the sub-specialty community, which address away rotations, in-person interviews, and general communications. More information is available in the full report.

The Coalition exemplifies the collaboration required to create the best solutions for all stakeholders impacted by the pandemic. ECFMG|FAIMER looks forward to continuing to join with Coalition members and other partners to find those solutions.

USMLE Timeline for Step 1 Pass/Fail Score Reporting

The co-sponsors of the United States Medical Licensing Examination® (USMLE®)—the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME)―have recently received requests from examinees and student organizations to accelerate or delay the change to pass/fail score reporting for USMLE Step 1 in light of the uncertainties caused by the COVID-19 (Coronavirus) pandemic and social movements across the country. The USMLE program’s announcement of the Step 1 score reporting policy change, posted in February 2020, said the change in score reporting would be implemented no earlier than January 2022. After careful consideration of all the recent concerns that have been brought to the USMLE program’s attention, the USMLE program remains committed to the January 2022 timeline.

For more information, please read the full announcement on the USMLE website.

U.S. and International Prometric Test Centers Are Operating and International Medical Graduates Are Able to Schedule Appointments

Prometric has informed ECFMG that most international test centers are open with testing slots available for United States Medical Licensing Examination® (USMLE®) examinees. Testing centers in the following areas are planned to open as follows:

  • Next week: Bahrain, Canada, Egypt, Lebanon, and Pakistan
  • Mid to late June: Rest of Europe, Kuwait, Saudi Arabia, and the United Arab Emirates

There are some countries with governmental mandates preventing testing, including Qatar.

Prometric test centers in the U.S. are open in major markets. Due to the need to follow state and local regulations, some cancelations are still occurring. Testing center capacity is increasing overall as additional hours and days of the week are being added.

Please regularly check the scheduling system to check availability, as test centers are opening on a regular basis. In addition, refer to the Prometric Social Distancing Policies prior to taking the exam.

ECFMG|FAIMER Responds to Suspension of USMLE Step 2 CS Testing, Commits to Uninterrupted Pathway for IMGs to ECFMG Certification

The May 26 announcement by the United States Medical Licensing Examination® (USMLE®) program that it will suspend Step 2 Clinical Skills (CS) testing for an additional 12-18 months creates a major disruption to the education and assessment of all medical students and graduates who seek to train and practice in the United States. The impact of the USMLE program’s decision is significant and immediate for international medical students and graduates (IMGs) who have relied on Step 2 CS to meet the clinical skills requirement for ECFMG® Certification, to participate in the National Resident Matching Program (“the Match”), and to enter U.S. programs of graduate medical education (GME).

ECFMG|FAIMER is committed to the continued smooth operation of its certification program and the ability of qualified IMGs to pursue and participate in U.S. GME without interruption. We are engaged in the following activities in response to the suspension of Step 2 CS testing.

  • Identifying alternatives to Step 2 CS that can be available now to allow IMGs to meet the clinical skills requirement for ECFMG Certification and providing an update on these alternatives in the very immediate future;
  • Collaborating with organizations involved in the recruitment and training of medical school graduates in the United States to mitigate disruptions; and
  • Advocating forcefully for the interests of IMGs as plans develop for the continued training of physicians during the COVID-19 (Coronavirus) pandemic.

This commitment underscores the vital importance of ECFMG Certification, which has served the U.S. medical education and regulatory communities, IMGs, and the public for almost 70 years. ECFMG’s program of certification provides assurance that the IMGs who enter U.S. GME are ready to do so and ensures an adequate and qualified pool of IMG applicants—trainees who will join the next generation of physicians.

ECFMG Certification also provides the pathway for the best and brightest physicians from around the world to train in the United States. Across our nation, IMGs fill gaps in training and practice that otherwise would remain empty, thereby ensuring a sufficient number of physicians to care for our population. IMGs also bring important international perspectives and much-needed diversity to our physician workforce.

We are committed to ECFMG Certification as a core component of our mission to promote quality medical education and health care. We will continue to support and advocate for IMGs because we know that our nation’s ability to provide accessible, quality health care depends on the continued contributions of IMGs in both U.S. training and practice.

We recognize that many IMGs have questions and concerns, and we are mindful of the need to provide you with effective and prompt answers and solutions in support of your educational plans.

Please stay well and monitor the ECFMG website for updates in the coming weeks.