ECFMG|FAIMER, Other GME Leaders Collaborate on Toolkit for Transition to Residency

Transition in a Time of Disruption: Practical Guidance to Support the Move from Undergraduate Medical Education to Graduate Medical EducationECFMG|FAIMER President and CEO William W. Pinsky, MD recently joined forces with other national leaders in graduate medical education (GME) and medical school student leaders to develop a new toolkit of resources to support medical school graduates and U.S. GME programs in the transition to the first year of GME during the COVID-19 pandemic. The final product, titled Transition in a Time of Disruption: Practical Guidance to Support the Move from Undergraduate Medical Education to Graduate Medical Education, was announced Wednesday as a follow-up to last Friday’s Main Residency Match®.

The toolkit of resources is designed to support residents and their residency programs in delivering safe, high-quality patient care during the pandemic and beyond. In addition to ECFMG|FAIMER, the toolkit was developed by the American Association of Colleges of Osteopathic Medicine (AACOM), the Association of American Medical Colleges (AAMC), and the Accreditation Council for Graduate Medical Education (ACGME). FAIMER President Jeanette Mladenovic, MD, and Tracy Wallowicz, Assistant Vice President for U.S. Graduate Medical Education Services at ECFMG|FAIMER, joined Dr. Pinsky on the committee developing the toolkit.

“The COVID-19 global pandemic has disrupted almost all aspects of life and medical education has been no exception,” Dr. Pinsky said. “Supporting the well-being, professional development, and equitable treatment of incoming residents is critical as they begin their journey to the independent practice of medicine, especially during this time of disruption. These resources will help with that transition.”

This toolkit is divided into three sections:

  • Section I provides a framework and list of questions medical schools, residencies, and learners should review during this transition.
  • Section II provides a matrix of possible activities to help learners and residency programs implement a successful transition.
  • Section III provides a compendium of resources to support the transition for both learners and programs.

“The primary goal of the toolkit is to facilitate a successful and seamless transition from medical school to residency, and to create the necessary conditions to fully support young physicians’ early professional development during unprecedented times,” Dr. Pinsky said. “Investing in supporting all incoming physicians can help to facilitate their success throughout the entire residency.”

USMLE Policy Updates Following Step 2 CS Discontinuation

Step 3 Eligibility Requirements Reinstated; New Information Added to USMLE Transcripts; Attempt Limits Set at Four

The United States Medical Licensing Examination® (USMLE®) Composite Committee, the governing body of USMLE comprised of medical educators, regulators, and members of the public, recently met to determine how the discontinuation of the Step 2 Clinical Skills examination (Step 2 CS) will impact certain USMLE policies. The Composite Committee’s role is to ensure that the program fulfills its mission to support medical licensing authorities in the United States by providing them with meaningful information from assessments of physician competencies—including medical knowledge and skills—that are important to the provision of safe and effective patient care. The decisions surrounding these policies reflect that mission.

The policy decisions made regarding Step 3 eligibility requirements, reporting Step 2 CS results, and attempt limits are described below.

Step 3 Eligibility Requirements

During the Step 2 CS suspension, the USMLE program announced temporary Step 3 eligibility requirements. Since the Step 2 CS exam has been discontinued, these temporary requirements are no longer needed.

Step 3 eligibility requirements will conform with criteria established before Step 2 CS became part of the USMLE. The requirements, which can be found here, are:

  • Passing scores on Step 1 and Step 2 Clinical Knowledge (CK), and
  • An MD degree or DO degree from an LCME- or COCA-accredited U.S. or Canadian medical school, or
  • The equivalent of the MD degree from a medical school outside the U.S. and Canada that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, and obtain ECFMG Certification.
  • Meets all other eligibility criteria as listed in the USMLE Bulletin of Information.

Reporting Step 2 CS Results

As a medical licensing examination, the USMLE program has the responsibility to produce transcripts that report to state medical boards a complete exam history for each examinee. Accordingly, all Step 2 CS results will continue to be reported on the USMLE transcript.

To facilitate the interpretation of transcripts with either Step 2 CS fails or no Step 2 CS attempts, the following statement will be included on all transcripts:

“The USMLE Step 2 CS examination was suspended on March 16, 2020 and formally discontinued on January 26, 2021. Due to the exam’s discontinuation, examinees with a failing Step 2 CS outcome may not have had an opportunity to retest and remediate their performance. The USMLE defines successful completion of its examination sequence as passing Step 1, Step 2 CK, and Step 3.”

Attempt Limits

Beginning with applications submitted on or after July 1, 2021, examinees will be limited to four attempts per Step exam rather than the six allowed under the current policy. This policy decision is designed to protect the integrity of the exam and more closely match the attempt limits imposed by state medical boards for USMLE in the majority of states.

Once the change to the attempt limit policy is effective, examinees who have attempted a USMLE Step four or more times and have not passed will be ineligible for other USMLE Steps.

If you have any questions about these policies, please contact the USMLE program by using the form available here.

Want to Know More About the Decision to Discontinue Step 2 CS?

Listen to a New Podcast: In the March 4, 2021 episode of USMLE Connection, David Johnson, the Chief Assessment Officer at the Federation of State Medical Boards, and Chris Feddock, Executive Director for the Clinical Skills Evaluation Collaboration, discuss the discontinuation of the Step 2 CS exam, the reasons behind the decision, and next steps.

Match Day Adds 7,500+ International Medical Graduates to U.S. GME Programs

International Medical Graduate (IMG) Performance in the 2020 Main Residency Match
(Click to enlarge)

More than 7,500 international medical graduates (IMGs) obtained first-year residency positions in U.S. programs of graduate medical education (GME), an increase of 132 from last year, according to results of the 2021 Main Residency Match® announced Friday by the National Resident Matching Program® (NRMP®). The number of first-year residency positions offered in the 2021 Match increased by 928 (2.7%) to 35,194 over 2020.

The 7,508 IMGs who matched represent an overall IMG match rate of 57% in this highly competitive process. Of the IMGs who matched, 3,152 are U.S. citizens, a decrease of two, compared to last year. The number of positions obtained by foreign national IMGs is 4,356, an increase of 134 compared to last year. The match rates for U.S.-citizen and foreign national IMGs are 59.5% and 54.8%, respectively. An infographic on IMG performance in the 2021 Match can be found here.

The journey to the 2021 Match for IMGs was fraught with changes and challenges spurred by the COVID-19 pandemic, including worldwide disruptions to medical education and changes to the certification process for IMGs. Despite the challenges, William W. Pinsky, MD, President and CEO of the Educational Commission for Foreign Medical Graduates | Foundation for Advancement of International Medical Education and Research (ECFMG®|FAIMER®), said that he was pleased with the outcome of the Match for IMGs.

“ECFMG|FAIMER succeeded in ensuring an applicant pool of international medical graduates for the Match that was ample, diverse, and highly qualified, which is vital for the U.S. health care system,” Dr. Pinsky said. “IMGs play an important role in providing supervised patient care, contribute much needed diversity to our nation’s health care system, and help to address the nation’s growing physician shortage that is being exacerbated by the pandemic.”

ECFMG|FAIMER assesses the readiness of IMGs before they enter U.S. GME. The program for certifying IMGs is a rigorous process that includes passing components of the United States Medical Licensing Examination® (USMLE®), the same examinations required of U.S. medical school students and graduates, and demonstration of clinical and communication skills. As part of the certification process, ECFMG|FAIMER also verifies the authenticity of IMGs’ medical education credentials, including their medical diplomas, directly with the issuing medical schools. Only IMGs who are certified by ECFMG can enter accredited U.S. GME programs.

Beginning in March 2020, the pandemic forced the suspension and eventual permanent discontinuation of the Step 2 Clinical Skills (CS) component of USMLE, which had been used by IMGs to demonstrate the clinical and communication skills required for ECFMG Certification. ECFMG|FAIMER moved quickly to develop five pathways to allow qualified IMGs who had not passed Step 2 CS to meet the requirements for ECFMG Certification and participation in the 2021 Match. The pathways were critical to producing a robust IMG applicant pool for this Match. Approximately 6,000 IMGs who registered for the 2021 Match completed a pathway; this represents one-third of the total number of IMGs in the Match.

“Appropriate clinical and communication skills are essential for physicians who participate in U.S. graduate medical education,” Dr. Pinsky said. “The pathways ensure that the U.S. public and the U.S. GME community can continue to rely on ECFMG Certification as an indicator that IMGs are ready to enter U.S. GME and to provide supervised patient care.”

For the 2022 Match, ECFMG|FAIMER is expanding the pathways for IMGs to meet the requirements for ECFMG Certification. With the addition of a sixth pathway and changes to certain eligibility requirements, ECFMG|FAIMER expects that more IMGs will be eligible to pursue a pathway for the Match.

“The expansion of the pathways currently underway for the 2022 Match will ensure the continuity and integrity of ECFMG Certification and the vital service it provides to the U.S. public, the U.S. GME community, and to qualified IMGs who pursue training in our nation’s teaching hospitals,” Dr. Pinsky said.

Announcement Regarding Fee for Requests to Change Testing Regions for USMLE Step 1 and Step 2 CK

In March 2020, ECFMG|FAIMER elected to temporarily waive the fee associated with testing region changes for Step 1 and Step 2 Clinical Knowledge (CK) of the United States Medical Licensing Examination® (USMLE®) in order to give examinees flexibility in scheduling examinations during the COVID-19 (Coronavirus) pandemic. Since then, individuals and organizations have made significant adjustments in order to resume activities. Prometric indicates that it has resumed testing in more than 90 percent of its global test centers and operationalized COVID-19 safety protocols. As availability and administration of the COVID-19 vaccine increases around the world, ECFMG|FAIMER expects a corresponding decline in the direct impact of the pandemic and a reduction in examinee need for scheduling flexibility.

Effective April 1, 2021, ECFMG|FAIMER will reinstate the $85 fee to change testing regions for Step 1 and Step 2 CK. International medical students/graduates who are registered for Step 1 or Step 2 CK and are unable to take the exam in the testing region that they selected may request to change their testing region using Form 312. International test delivery surcharges also may apply. For more information, visit the ECFMG website.

ECFMG|FAIMER Is Planning Requirements for ECFMG Certification for 2022 Match

In a podcast released today, the United States Medical Licensing Examination® (USMLE®) program provided updates on the Step 2 Clinical Skills (CS) exam, which has been suspended since March 2020. The podcast does not provide, at this time, a specific time for launch of the modified exam.

ECFMG|FAIMER is partnering with the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB)—co-sponsors of USMLE—on this critical project and monitoring developments carefully. We continue to advocate for the interests and needs of international medical students and graduates (IMGs). Prior to the suspension, IMGs relied on Step 2 CS to meet the clinical skills requirement for ECFMG Certification, in order to participate in the National Resident Matching Program (“the Match”) 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 planning actively for the requirements for ECFMG Certification for the 2022 Match (March 2022) and will publish detailed information as soon as it is available.

For the 2021 Match (March 2021), thousands of IMGs are in the process of completing the  requirements for ECFMG Certification, including approximately 5,500 IMGs pursuing requirements for one of five pathways that ECFMG|FAIMER developed to allow IMGs who have not passed Step 2 CS to meet the clinical skills requirement for ECFMG Certification. More than 1,100 ECFMG Certificates have been issued to IMGs who have satisfied the clinical skills requirement for ECFMG Certification based on a pathway. These successful pathway applicants are in addition to the IMGs we continue to certify on an ongoing basis.

We recognize that many IMGs continue to have questions and concerns, and we are mindful of the need to provide you with additional information on the requirements for ECFMG Certification for the 2022 Match as soon as possible so that you can plan and prepare.

In the interim, ECFMG|FAIMER encourages IMGs to continue to pursue the other continuing requirements for ECFMG Certification, such as passing Step 1 and Step 2 Clinical Knowledge (CK), and to monitor the ECFMG website for updates.

IMGs Eligible for Pathways Under Expanded Requirements Can Apply Now

Details on the expanded eligibility requirements and instructions for Pathways 1, 2, and 4 are now available in the Requirements for ECFMG Certification for 2021 Match section of the ECFMG website. International medical graduates (IMGs) who believe they are eligible under the expanded requirements can apply using the on-line Application for Pathways for ECFMG Certification for 2021 Match.

For an overview of the changes to Pathways 1, 2, and 4, please see the previous announcement. Other eligibility requirements apply to specific pathways, and all applicants who apply to a pathway must meet all other requirements for ECFMG Certification.

If you are just beginning your pathways application based on the expanded eligibility criteria, you are strongly encouraged to apply to the Electronic Residency Application Service (ERAS) now and to complete your ERAS application as soon as possible.

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.