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.

ECFMG’s 2021 Information Booklet on ECFMG Certification and Application Materials Now Available

ECFMG’s 2021 Information Booklet on ECFMG Certification and the 2021 exam application materials for international medical students/graduates (IMGs) are now available on the ECFMG website. The ECFMG Information Booklet is the definitive source of information on ECFMG Certification and is required reading for applicants.

To meet the examination requirements for ECFMG Certification, IMGs have been required to pass Step 1, Step 2 Clinical Knowledge (CK), and Step 2 Clinical Skills (CS) of the United States Medical Licensing Examination® (USMLE®). The USMLE program has suspended administration of Step 2 CS until at least June 2021. ECFMG has established pathways that will allow qualified IMGs who have not passed Step 2 CS to meet the requirements for ECFMG Certification. These pathways are directed toward individuals who intend to apply to accredited graduate medical education programs in the United States for the 2021-2022 academic year. Information on the Requirements for ECFMG Certification for 2021 Match is available now on the ECFMG website.

Availability of 2021 Eligibility Periods for USMLE Step 1/Step 2 CK

Applicants can use the 2021 Information Booklet and 2021 exam application materials to apply for all available Step 1/Step 2 CK eligibility periods that end in 2021.

As announced previously by the USMLE program, all currently registered examinees who have a Step 1 or Step 2 CK scheduling permit with an unexpired eligibility period with an end date in 2020 will be extended through June 2021. ECFMG expects to complete these automatic extensions by the end of October.

Please monitor the ECFMG website, and follow ECFMG on Facebook and Twitter for updates and important information.

(published August 27; updated September 30)

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.

ECFMG|FAIMER Statement on Pathways Fees

ECFMG®|FAIMER® recently announced the fees for applying to the pathways for ECFMG Certification for the 2021 Match. Since publishing the fees, we have received questions and feedback on the fees and our process for determining them. We value this feedback and wish to share the following information.

ECFMG|FAIMER is committed to the continuity of the ECFMG Certification program and the vital service it provides to the U.S. public and GME community and to physicians around the world who wish to train in the United States. We also are committed to operating in the most efficient way possible while also ensuring that we fulfill our mission of promoting quality health care.

In establishing the pathways, ECFMG|FAIMER moved quickly and aggressively to build a new, comprehensive operational infrastructure, including a new technology platform. Although the fees associated with the pathways partially cover the cost of this investment and ongoing implementation, they do not offset 2020 and 2021 operating losses resulting from the suspension of USMLE Step 2 CS.

As part of the current requirements for ECFMG Certification, the pathways are designed mindfully and based on metrics in order to ensure that only qualified international medical graduates (IMGs) are eligible to enter U.S. graduate medical education (GME), where they provide supervised patient care. The pathway fees will enable evaluation of pathway applications by ECFMG|FAIMER staff with expertise in the world’s medical education, accreditation, and licensure systems. The fees also enable the primary-source verification of medical credentials, as well as evaluation of other documents submitted in support of pathways applications.

Like the fees collected by ECFMG|FAIMER for the former USMLE Step 2 CS exam, the pathways fees contribute to our broad support of IMGs who pursue ECFMG Certification and U.S. GME. This support includes:

  • Advocacy for IMGs and the vital role they play in U.S. GME and health care
  • Telephone and e-mail access to an Applicant Information Services team for customer service
  • Free resources to help IMGs orient to the U.S. residency application process and health care system, allowing them to be better prepared in applying to U.S. GME
  • Multi-lingual staff to help support our interaction with thousands of medical schools, regulatory agencies, and other institutions worldwide, which facilitates the credential verification process
  • Building and maintaining on-line systems that IMGs may use for on-line access to their accounts and transactions with ECFMG|FAIMER

In keeping with our nonprofit status and mission, we are committed to careful monitoring and control of the costs of operating our programs and services. Likewise, in determining fees for our services, we give careful consideration to the impact of fees on the diverse community of individuals we serve and their ability to access our services.

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.

ECFMG|FAIMER Research Finds Drop in Interest From Muslim-Majority Country Physicians

Applications for ECFMG Certification from citizens of Muslim-majority countries have decreased since 2016 which could exacerbate gaps in the U.S. physician workforce, according to an article co-authored by ECFMG|FAIMER executives and published July 6 in the JAMA Network Open, an on-line publication of the Journal of the American Medical Association.

The article, Prevalence of International Medical Graduates from Muslim-Majority Nations in the U.S. Physician Workforce from 2009 to 2019, was authored by John Boulet, PhD, Vice President for Research and Data Resources for ECFMG|FAIMER; William W. Pinsky, MD, President and CEO of ECFMG|FAIMER; and Robbert J. Duvivier, MD, PhD of the Parnassia Psychiatric Institute in The Hague, Netherlands.

According to the article, citizens from Muslim-majority nations made up 4.5 percent of the U.S. physician workforce in 2019. Applications for ECFMG Certification from citizens of these countries increased from 2009 to 2015 but decreased considerably from 2016 to 2018, especially for citizens of Pakistan, Egypt, Iran, and Saudi Arabia.

The article has generated significant coverage in the news media internationally, including articles in The Arab Weekly, Arabian Business, Free Malaysia Today, and The Daily Mail to name a few.

Requirements for ECFMG Certification for 2021 Match

To be certified by ECFMG, international medical graduates (IMGs) have been required to pass Step 1, Step 2 Clinical Knowledge (CK), and Step 2 Clinical Skills (CS) of the United States Medical Licensing Examination® (USMLE®). In response to the suspension of Step 2 CS for the next 12-18 months by the USMLE program, we have identified pathways that will allow qualified IMGs who have not passed Step 2 CS to meet the requirements for ECFMG Certification. These pathways allow ECFMG Certification to continue to perform its critical function of providing assurance to the public and U.S. graduate medical education (GME) programs that IMGs are ready to enter supervised training.

Please note: Applicants who have passed Step 2 CS and/or are certified by ECFMG do not need to be familiar with these new requirements and do not need to pursue these pathways.

The pathways are directed toward IMGs who intend to enter the 2021 Match. All other eligibility requirements for ECFMG Certification will remain in effect. An application process and instructions for the pathways are currently in development, with further details to be provided very soon. We are providing preliminary information now in order to direct individuals to begin their planning as they seek to enter U.S. GME programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) for the 2021-2022 academic year.

For additional information, visit Requirements for ECFMG Certification for 2021 Match on this website. Additional details will be published as they become available, and modifications to the information are possible. Please monitor this website for the latest information.

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.

ECFMG Medical School Accreditation Requirement Moved to 2024

ECFMG previously announced that, starting in 2023, applicants for ECFMG Certification will be required to be a student or graduate of a medical school that is appropriately accredited. More specifically, the medical school must be accredited by an agency recognized by the World Federation for Medical Education (WFME). To date, 21 accrediting agencies have received WFME recognition, with many others in process. We are energized by the commitment to quality improvement demonstrated in response to this initiative.

At the same time, we recognize that many countries have been forced to suspend or limit their accreditation efforts due to COVID-19 (Coronavirus). As such, we are moving the implementation of the requirement to 2024. We will announce an effective date as we approach 2024; we will also continue to reassess this timeline as needed.

Further information regarding this change will be provided in the coming weeks on our website at www.ecfmg.org/accreditation.

USMLE Update on Resuming Testing

Resuming United States Medical Licensing Examination (USMLE®) testing remains the USMLE program’s top priority. Below, please read several key updates.

Status of Prometric Testing
Testing resumed at select Prometric centers on Friday, May 1 in accordance with state and local social distancing guidelines. Although hundreds of examinees successfully tested, the overall examinee experience is not meeting expectations. The USMLE program continues to exert pressure on Prometric to rectify all issues in a timely manner. The USMLE program is working daily with Prometric and they have dedicated resources to both resume USMLE testing and address the quality of the examinee experience.

The USMLE program understands that when Prometric test centers reopened, some examinees with confirmed slots traveled to test centers only to find them closed, leading to increased confusion during an already difficult situation. The USMLE program has been disappointed with Prometric’s failure to fulfill its obligations to examinees and to the USMLE program. The USMLE program has emphasized to Prometric the importance of their obligations to examinees and the harm that their failures have caused.

Examinees who have suffered direct out-of-pocket monetary losses due to Prometric’s lack of communication or miscommunication regarding test center closures should submit a written claim directly to Prometric at prometric.com/contact-us.

In March 2020, in response to the suspension in testing, the USMLE program extended eligibility periods to December 2020 for all examinees who had a Step 1, Step 2 Clinical Knowledge (CK), or Step 3 scheduling permit with an unexpired eligibility period with an end date in 2020. To help alleviate some of the pressure examinees may be feeling, USMLE will further extend eligibility periods through June 2021.

  • Note: Eligibility period extensions will be processed approximately over the next eight to twelve weeks.

Alternate Delivery of USMLE Step 1, Step 2 CK, and Step 3
To resume testing, the USMLE program has already identified several options for proctored testing outside of Prometric centers. The USMLE program is expecting to begin testing at some medical school campuses this month. USMLE is committed to offering a broader distribution of testing at medical schools; it is working through technological challenges in order to do so. While this solution will not completely address the testing backlog, it will provide additional USMLE-specified slots within Prometric’s overall capacity, which is increasing. Schools are being considered based on geographic location and a willingness to serve as a regional testing site. Because the USMLE program is not able to scale this solution to all schools, it plans to deliver other solutions as well. The USMLE program will ramp-up testing as we institute new systems and processes.

The USMLE program continues to aggressively explore remote proctoring and expects to have progress to report on the timeline for that project in the next week.

Validity, Reliability, and Fairness
The USMLE program recognizes the burden that reduced testing capacity places on schools and examinees. As the USMLE program moves forward with solutions to alleviate this burden, it must also evaluate the fairness of any test administration method. The USMLE program needs to ensure that its test administration models allow all test takers to reliably and validly demonstrate their skills and maximize, to the extent possible, fairness, access, security, and reliability. Increasing capacity by deploying exam administrations to schools may create differential geographic access. Similarly, with respect to remote proctoring, the USMLE program recognizes that not all schools or individuals have equal access to high-speed internet, a computer that meets the technology requirements for remote proctoring, or dedicated space in which to take the test.

Given these issues of fairness and bias, the USMLE program will continue to work with organizations in the medical education and the medical regulatory community to identify temporary changes to policy and requirements such as relaxing requirements for promotion, graduation, or licensing decisions. The USMLE program is committed to continuing its focus on delivering safe testing and fair test results for examinees.

Step 2 CS
As announced previously, Step 2 Clinical Skills (CS) testing has been suspended due to the COVID-19 (coronavirus) pandemic, and the USMLE program is pursuing testing solutions to ensure the health and safety of examinees and test center staff. After careful consideration, the USMLE program has determined that it cannot resume the exam in its current format without unacceptable risk to examinees and staff.

Prior to COVID-19, the USMLE program was in the very early stages of exploring alternate formats and methods for delivery of the Step 2 CS exam, as part of overall efforts to enhance the USMLE. As a result of COVID-19, these plans have been accelerated and are focused on a testing solution that employs a telehealth model, where examinees and standardized patients would interact on-line, via a web browser. The USMLE program is aggressively assessing this solution, which will require significant redesign of the exam’s content and delivery. Expediting such changes to the exam format and delivery will help result in a safe and effective assessment for all involved.

At this time, Step 2 CS testing is expected to resume after July.

Please know that the USMLE program is doing everything it can to address the challenges of this new environment quickly, and that it will continue to provide you with updates on its progress.