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.

Update on Pathways for ECFMG Certification for 2022 Match

As announced on January 26, 2021, ECFMG®|FAIMER® will offer expanded pathways for international medical graduates (IMGs) to meet the requirements for ECFMG Certification and to participate in the 2022 National Resident Matching Program® (NRMP®) Main Residency Match® (The Match®). On February 16, 2021, ECFMG|FAIMER published additional information on the 2022 pathways, including:

  • information on who should use the pathways;
  • general eligibility requirements for all pathways;
  • information on the individual pathways, including the new sixth pathway;
  • expected availability of the on-line application; and
  • important information for 2021 pathway applicants.

To access the updated information, visit Requirements for ECFMG Certification for 2022 Match.

Additional information, including detailed eligibility requirements and application instructions, will be published as it becomes available. Please monitor the ECFMG website for updates.

ECFMG|FAIMER Will Offer Expanded Pathways for 2022 Match

ECFMG®|FAIMER® will expand its pathways for international medical graduates (IMGs) to meet the requirements for ECFMG Certification and to participate in the 2022 National Resident Matching Program® (NRMP®) Main Residency Match® (The Match®). The pathways evaluate IMGs’ clinical and communication skills—skills that are critically important to participate in U.S. graduate medical education (GME) and to provide supervised patient care.

Until mid-March 2020, IMGs were required to pass Step 2 Clinical Skills (CS) of the United States Medical Licensing Examination® (USMLE®) to satisfy the clinical and communication skills requirements for ECFMG Certification. The USMLE program suspended Step 2 CS in March of last year due to the COVID-19 pandemic and subsequently indicated that it would take 12-18 months to bring back a modified Step 2 CS exam. In June 2020, ECFMG|FAIMER established five pathways to allow IMGs who had not passed Step 2 CS to meet ECFMG’s clinical and communication requirements and to participate in the 2021 Match (in March 2021). On January 26, 2021, the USMLE program announced that it had decided to discontinue the Step 2 CS exam.

In establishing the pathways, ECFMG|FAIMER has ensured that ECFMG Certification continues to perform the critical role for which the program was established more than 60 years ago—assessing the readiness of IMGs to enter U.S. GME. Clinical and communication skills are essential components of this readiness, and an evaluation of these skills always has been required for ECFMG Certification due to the variety in medical education systems at more than 3,000 medical schools around the world. 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.

The ECFMG|FAIMER pathways for the 2021 Match succeeded in producing an IMG applicant pool that is ample, diverse, and highly qualified. ECFMG expects to certify approximately 5,000 IMGs based on one of these pathways leading up to the July 1, 2021 start date for U.S. GME programs. Overall, more than 19,000 IMGs have applied to residency positions beginning in 2021 through the Electronic Residency Application Service® (ERAS®).

The expansion of the pathways currently underway for the 2022 Match ensures 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.

The pathways for IMGs planning to participate in the 2022 Match (in March 2022) will expand on the pathways that were established for the 2021 Match. The existing five pathways will continue to be offered with some modifications. ECFMG|FAIMER has identified an additional pathway for evaluation of clinical skills. As a result of the addition of this sixth pathway and changes to certain eligibility requirements, we expect more IMGs to be eligible to pursue a pathway for the 2022 Match. Detailed information on eligibility is not yet available; please monitor the ECFMG website since we expect to publish guidelines very soon.

Consistent with the requirements for the existing pathways, IMGs who pursue one of the six pathways for the 2022 Match will be required to pass the Occupational English Test (OET) Medicine to satisfy pathway requirements. OET Medicine is designed specifically for physicians, in consultation with physicians. The test assesses the health care-specific English language competency of physicians. It emphasizes the type of language physicians will need to communicate effectively in a clinical setting with peers and patients, including the ability to show empathy and to break down complex medical terminology and procedures into simpler language.

Who Should Use the Pathways?

The six pathways for the 2022 Match are intended for IMGs who need to meet the clinical and communication skills requirements for ECFMG Certification and who plan to participate in the 2022 Match (in March 2022).

IMGs who applied to a pathway for the 2021 Match and whose 2021 application was rejected can reapply to a pathway for the 2022 Match. Please see “Important Information for 2021 Pathways Applicants,” below.

The following individuals already have satisfied the clinical and communication skills requirements for ECFMG Certification and therefore do not need to pursue a pathway to meet these requirements or to participate in the 2022 Match:

  • IMGs who have a passing performance on Step 2 CS that is valid for ECFMG Certification,
  • IMGs who are certified by ECFMG, and
  • IMGs with an approved pathways 2021 application.

 Application to the pathways for the 2022 Match is not yet available. Please monitor the ECFMG website for information on the availability of the on-line application for the expanded pathways.

Important Information for 2021 Pathways Applicants

If your pathway application for the 2021 Match is approved and you do not enter U.S. GME in 2021, you will not be required to apply for a pathway for the 2022 Match. Your previously accepted pathway application will remain valid for the 2022 Match.

If you applied to a pathway for the 2021 Match and your application is rejected, you can pursue a pathway for the 2022 Match, provided you meet all eligibility requirements, but you will be required to reapply. Please monitor the ECFMG website for information on the timeline to reapply.

More Information on Pathways for 2022 Match

ECFMG|FAIMER is developing detailed information on eligibility and application procedures, including documentation requirements. ECFMG also is preparing the on-line pathways application to accept applications from IMGs who plan to participate in the 2022 Match. Please monitor the ECFMG website, since updates will be posted as they become available.

Please contact the USMLE Program with any questions on its decision to discontinue Step 2 CS and any other USMLE-related inquiries.

USMLE Program Discontinues Step 2 CS

The United States Medical Licensing Examination® (USMLE®) program announced today that it has discontinued work to relaunch a modified Step 2 Clinical Skills (CS) examination. In the spring of 2020, the USMLE program suspended Step 2 CS due to the COVID-19 pandemic and announced that it would take 12-18 months to bring back a modified Step 2 CS exam. In today’s announcement, the USMLE program indicated that it has no plans to bring back Step 2 CS and that it would use this change in direction to take additional time to partner with the medical education and medical board community to better develop innovative ways to assess the breadth of clinical skills in medicine. Please contact the USMLE Program with any questions on this decision and with any other USMLE-related inquiries.

Prior to the suspension of Step 2 CS, IMGs were required to pass this exam to meet the clinical and communication skills requirements for ECFMG Certification and to pursue U.S. graduate medical education (GME). Today, ECFMG®|FAIMER® announced that it is expanding its pathways that allow qualified IMGs to meet these requirements for ECFMG Certification and to continue to pursue U.S. GME. Detailed information is under development and will be posted on ECFMG’s website very soon. Please monitor the 2022 pathways web page on the ECFMG website for the latest information.

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.

Moving Forward: The Step 1 Pass/Fail Score Reporting Policy Change and Revitalization of Step 2 Clinical Skills Examination

The United States Medical Licensing Examination® (USMLE®) program recognizes that the upcoming score reporting change for Step 1 pass/fail (P/F) and the suspension of the Step 2 Clinical Skills (CS) examination have created new questions for medical students, faculty, and state board members. The USMLE program appreciates everyone’s patience and understanding as they work diligently on these two important issues.  As work progresses, the USMLE program is committed to providing monthly updates on these and other topics that are important to their stakeholders.

Step 1 P/F Score Reporting

The transition to Step 1 pass/fail score reporting is on track to be implemented in January 2022. Should this schedule change, the USMLE program will post an updated timeline. Specific dates and information will be made available in advance of the implementation date.

Information about the Step 1 P/F score reporting policy change can be found here.

Revitalization of Step 2 Clinical Skills Examination

As co-owners of the USMLE, the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB) collected valuable input over the summer from state medical boards, medical school faculty, and examinees about the prior Step 2 CS exam, including feedback on which skills are important to assess to inform medical licensure decisions. This feedback is greatly appreciated and will be essential in the development of a revitalized exam. An update on next steps and future developments will be shared by the end of November.

Information about the revitalization of Step 2 CS can be found here.

Examinees should monitor the USMLE website for the latest information.

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.

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.