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.

A Message from the Leaders of NBME and ECFMG|FAIMER

Dear International Medical School Educators, Students, and Graduates:

We recognize that the disruptions to USMLE testing present an extraordinary challenge for all of you. Finding a means to restore USMLE testing is a top organizational priority. Our goal is to collaborate with you as we determine how to assure rapid and safe resumption of testing across a variety of venues. We recognize the impact on both U.S. domestic students as well as those of you in our international community.

Status on Prometric Testing

We are receiving reports that several Prometric test centers are erroneously listed as open, and some examinees with confirmed slots were met with closed centers when Prometric resumed limited testing on May 1st. This has led to a confusing and difficult situation for examinees. We are deeply disturbed by the experience you may be having and are working to immediately find resolution to these issues.

Prometric CEO, Roy Simrell, is aware of our shared dissatisfaction with the current situation and the need for a clear and immediate plan to rectify the problems experienced by examinees. We have been, and continue to be, in daily contact with Prometric to represent the needs of the examinees and faculty to improve the execution of the safe resumption of testing and Prometric’s communication with examinees. We have emphasized the impact their actions have on this critical community and the need to ensure examinees are provided timely and reliable information.

We expect capacity constraints and challenges to continue. For this reason, we are working hard to design and deliver solutions even outside of Prometric test centers.

Alternate Delivery of USMLE Step 1, Step 2 CK, and Step 3

We have several efforts underway to resume testing and to address testing backlog and capacity constraints. We have incorporated the suggestions and ideas we have received from medical students, medical school faculty, state medical boards, and our international partners in this work, and will seek to partner even more closely as we move forward with implementation. We expect to have better insight on feasible alternatives and associated requirements within the next week. We will continue to provide at least weekly updates of our progress at usmle.org and ecfmg.org.

Step 2 CS

We are dedicated to finding a testing solution for Step 2 CS that assures the safety of examinees and standardized patients as our top priority. We have a dedicated team exploring innovative and disruptive solutions to resume Step 2 CS examinations. This includes options that alleviate the need to travel to examination centers. We expect to have more news next week.


Working together, we can respond to the challenges wrought by the COVID pandemic and ensure the continued excellence of America’s future physicians.

Peter J. Katsufrakis, M.D., M.B.A.
President and CEO, National Board of Medical Examiners
William W. Pinsky, M.D., FAAP, FACC
President and CEO, ECFMG|FAIMER
Chair, Board of Trustees, FAIMER
Professor (Hon.), University of Queensland

A Message to Applicants—ECFMG|FAIMER is Open and Processing Your Applications

We are pleased to confirm that ECFMG|FAIMER programs and services continue to operate. Our staff members are working to process your applications and service requests, and our representatives are answering phone and e-mail inquiries as quickly as possible.

Physicians who use our programs and services should continue to submit applications and other service requests as they would normally. This will help ensure sufficient processing time and your readiness for next steps, as they become available, in pursuing ECFMG Certification, J-1 visa sponsorship (if applicable), and U.S. graduate medical education (GME).

ECFMG Certification

ECFMG continues to process Applications for ECFMG Certification and applications for the United States Medical Licensing Examination® (USMLE®) step components required for Certification, and to verify medical education credentials.

  • USMLE Step 1 and Step 2 Clinical Knowledge (CK): Prometric test centers around the world are open or are beginning to reopen. We are aware that Prometric has provided inaccurate information about the status of some of its test centers, causing confusion and additional difficulties for some examinees. The leadership of the USMLE program and ECFMG are in daily contact with Prometric to ensure an immediate resolution to this situation. More >>
  • USMLE Step 2 Clinical Skills (CS): Work is underway to formalize a plan to resume USMLE Step 2 CS testing, and applicants with canceled testing appointments are receiving regular e-mail updates.
  • We continue to verify medical education credentials with international medical schools, although there are some pockets of service disruptions. To support institutions that are working remotely, ECFMG is leveraging electronic communications to stay connected, facilitate the verification process, and minimize disruption of services for our applicants.
  • Applicants seeking an ECFMG Certificate to begin U.S. GME programs in summer 2020 should expect their certificate to be issued in time to start their programs. ECFMG has been in contact with medical schools to ensure that individuals who meet ECFMG Certification requirements will be issued an ECFMG Certificate.

ECFMG Exchange Visitor (J-1 Visa) Sponsorship

ECFMG is actively processing applications for J-1 visa sponsorship for participation in U.S. GME programs that begin in summer 2020.

  • U.S. embassies and consulates worldwide have resumed processing of applications and visa appointments for medical professionals, including the J-1 Visa. More >>
  • The U.S. Department of State has provided additional flexibility regarding the Statement of Need letter for J-1 Visa sponsorship. More >>
  • President Trump’s Presidential Proclamation issued on April 22, 2020 does not affect physicians or their dependents who are on or applying for J-1 Visa sponsorship. More >>
  • Applicants who experience challenges during the application process should contact the Exchange Visitor Sponsorship Department at EVSP-support@ecfmg.org or +215-823-2121 for assistance.

Status on Prometric Testing – May 1, 2020

The USMLE program is aware that several Prometric test centers are erroneously listed as open, so some examinees with confirmed slots were met with closed centers when Prometric resumed limited testing on May 1st. This has led to increased confusion during an already difficult situation for examinees. The USMLE program is working to immediately find resolution to these issues.

The USMLE program has been and continues to be in daily contact with Prometric to represent the needs of the examinees and stakeholders to improve the safe resumption of testing and Prometric’s communication with examinees. On May 1, USMLE program senior leaders met with Prometric to share their dissatisfaction with the current situation and the need for a clear and immediate plan. The USMLE program emphasized the impact their actions have had on this critical community and the importance of providing examinees with timely and reliable information.

The USMLE program expects capacity constraints and challenges to continue. For this reason, as previously announced, the USMLE program is  working hard to accelerate alternate test delivery solutions.

For more information on the impacts of the COVID-19 pandemic on ECFMG|FAIMER programs and what we are doing in response, please visit our COVID-19 (Coronavirus) web page.

USMLE Exploring Alternate Test Delivery Options

Finding safe solutions to accommodate examinees’ testing needs has been the United States Medical Licensing Examination® (USMLE®) program’s main focus and highest priority over the past few months. Due to increasing uncertainty around having wider availability of in-person testing at Prometric test centers, the USMLE program has identified several alternate test delivery methods for Step 1, Step 2 CK, and Step 3 and has begun aggressively pursuing them.

Examinees should read the full announcement on the USMLE website.

For more information on the impacts of the COVID-19 pandemic on ECFMG|FAIMER programs and what we are doing in response, please visit our COVID-19 (Coronavirus) web page.