Pathway 6 On-line Application Now Open

The on-line application for Pathway 6 is now open. Pathway 6 is for applicants who do not meet the eligibility requirements for Pathway 1, 2, 3, 4, or 5 and/or have failed the former Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination® (USMLE®). Pathway 6 requires an applicant’s clinical skills to be evaluated by licensed physicians through in-person clinical encounters.

Detailed information on Pathway 6, including criteria for acceptable clinical encounters, criteria for acceptable evaluators, and instructions for applicants, is available at Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians. Detailed information and instructions for physician evaluators are available at Information for Physician Evaluators for Pathway 6.

About the Pathways

The 2022 Pathways allow qualified IMGs who have not passed the former USMLE Step 2 CS exam to meet the clinical and communication skills requirements for ECFMG Certification and for participation in the National Resident Matching Program® (NRMP®) 2022 Main Residency Match® (The Match®).

ECFMG’s 2022 Information Booklet on ECFMG Certification and Application Materials Now Available

ECFMG’s 2022 Information Booklet on ECFMG Certification and the 2022 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 be eligible for ECFMG Certification, IMGs must satisfy a number of requirements, including the medical science examination requirement, the clinical skills requirement, and the communication skills requirement.

  • To meet the medical science examination requirement for ECFMG Certification, applicants must pass Step 1 and Step 2 Clinical Knowledge (CK) of the United States Medical Licensing Examination® (USMLE®).
  • To meet the clinical skills requirement and communication skills requirement for ECFMG Certification, applicants must:
    • Complete an ECFMG Pathway, which includes attaining a satisfactory score on the Occupational English Test (OET) Medicine, OR
    • Have earned a passing performance on the former Step 2 Clinical Skills (CS) component of USMLE that satisfies ECFMG requirements for ECFMG Certification.

Application Materials and USMLE Step 1/Step 2 CK Eligibility Periods

For USMLE Step 1 and Step 2 CK, applicants can use the 2022 materials to apply for all available eligibility periods ending in 2021 and all eligibility periods ending in 2022, beginning with the November 2021-January 2022 eligibility period.

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

(published July 28; updated August 11)

Detailed Information on Pathway 6 Now Available for Applicants and Physician Evaluators

Detailed information is now available on the ECFMG website for individuals planning to apply to Pathway 6 and for the physicians who will be evaluating their clinical skills. This new information includes step-by-step instructions for applicants and comprehensive information and instructions for physician evaluators. The on-line application process for Pathway 6 will open in August. Applicants should prepare now by reviewing this information carefully, identifying their physician evaluators if they have not already done so, and directing their physician evaluators to review the newly published information.

About the Pathways
The 2022 Pathways allow qualified international medical graduates who have not passed the former Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination® (USMLE®) to meet the clinical and communication skills requirements for ECFMG Certification and for participation in the National Resident Matching Program® (NRMP®) 2022 Main Residency Match® (The Match®). Pathway 6 is for applicants who do not meet the eligibility requirements for Pathway 1, 2, 3, 4, or 5 and/or have failed Step 2 CS one or more times. Pathway 6 requires an applicant’s clinical skills to be evaluated by licensed physicians through in-person clinical encounters.

OET@Home Available in August on Limited Basis

OET@Home, a version of the Occupational English Test (OET) Medicine that can be taken at home through remote proctoring, is available to certain Pathways applicants for test dates in August. OET@Home is available only to applicants who do not have a physical test venue (for paper-based or computer-based testing) in their country. Applicants with a test venue in their country should plan to take OET on paper or OET on computer at a physical test center to ensure that they test in time to meet Pathways requirements for participation in the National Resident Matching Program® (NRMP®) 2022 Main Residency Match® (The Match®). Please  visit Test Dates and Locations on the OET website to determine whether there is a test venue in your country.

Eligible applicants can book OET@Home now on the OET website. If you have questions regarding OET@Home, please contact OET.

About the Pathways

The 2022 Pathways allow qualified international medical graduates (IMGs) who have not passed the former Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination® (USMLE®) to meet the clinical and communication skills requirements for ECFMG Certification and for participation in the 2022 Match. A satisfactory score on OET Medicine is required for IMGs applying to a 2022 Pathway. To meet ECFMG’s requirements, applicants must attain a minimum score of 350 (Grade B) on each of the four measured sub-tests of OET Medicine (Listening, Reading, Writing, and Speaking) in one test administration. Applicants must take OET Medicine on or before the last scheduled test date in December 2021. See the ECFMG website for more information.

Additional Information on Pathway 6 Is Available

Prospective Pathway 6 Applicants Should Begin to Identify Evaluators Now

Additional information is now available on applying to Pathway 6, which requires an applicant’s clinical skills to be evaluated by licensed physicians through in-person clinical encounters. This new information includes criteria for both the physician evaluators and for the clinical encounters. If you plan to apply to Pathway 6, you should review this information and begin to identify your physician evaluators now. There also is new information on the availability of the on-line application for Pathway 6, now scheduled for August; application deadlines; and application processing times.

About the Pathways
The 2022 Pathways allow qualified international medical graduates who have not passed the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination® (USMLE®) to meet the clinical and communication skills requirements for ECFMG Certification and for participation in the National Resident Matching Program® (NRMP®) 2022 Main Residency Match® (The Match®). Pathway 6 is for applicants who do not meet the eligibility requirements for Pathway 1, 2, 3, 4, or 5 and/or have failed Step 2 CS one or more times.

Reminder: USMLE Attempt Limit Changing Soon

To protect the integrity of the United States Medical Licensing Examination® (USMLE®) program and more closely match the USMLE attempt limits imposed by state medical boards in the majority of states, effective July 1, 2021, the USMLE attempt limit policy will change, as previously announced. The change will reduce an examinee’s total number of allowable attempts from six (6) attempts to four (4) attempts per Step exam, including incomplete attempts.

The policy change is effective for applications submitted on or after July 1, 2021. After the implementation of this policy change, examinees who have attempted any USMLE Step (including Step 2 Clinical Skills) four (4) or more times and have not passed will be ineligible to apply for USMLE Steps.

Examinees with four (4) or five (5) attempts at an exam who meet all eligibility requirements outlined in the USMLE Bulletin of Information may submit application(s) for USMLE through June 30, 2021 at 11:59 pm, Eastern Time, under the current attempt limit of six (6).

To learn more about this change, please review the FAQs on the USMLE website. If you have questions about how this change impacts you, please email the Office of the USMLE Secretariat at USMLESec@nbme.org.

Update: Pathways for ECFMG Certification for 2022 Match

Detailed Information, On-line Application for Pathways 1-5 Now Available

The 2022 Pathways application process for Pathways 1-5 is now open. Qualified international medical graduates (IMGs) who need to meet the clinical and communication skills requirements for ECFMG® Certification and who intend to participate in the 2022 National Resident Matching Program® (NRMP®) Main Residency Match® (The Match®) can apply to a Pathway to meet these requirements for ECFMG Certification and the requirements for Match participation.

The information available on ECFMG’s website includes:

As announced previously, ECFMG|FAIMER has added a sixth Pathway for 2022. The application process for Pathway 6 is expected to open in July. Preliminary information on Pathway 6 is available now, and additional details and instructions for meeting the requirements for Pathway 6 will be provided as soon as they are available. Please monitor the ECFMG website for the steps that applicants can take before July to prepare for Pathway 6.

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.