Let’s start at the beginning. The ECFMG®, the Educational Commission for Foreign Medical Graduates (www.ecfmg.org), is a private, nonprofit organization, employing more than 800 people. Headquartered in Philadelphia, Pennsylvania, it was established in 1956 and issued the first Standard ECFMG Certificates two years later. Since then, it has certified more than 320,000 international medical graduates (IMGs).
The mission statement of the ECFMG begins with this: “The ECFMG promotes quality health care for the public by certifying international medical graduates for entry into U.S. graduate medical education…”
As an IMG, or a student working toward graduation with an interest in practicing in the U.S., it is important to familiarize yourself with the ECFMG Certificate and how to obtain it. It is required to qualify for residency and fellowship programs in the U.S. that are accredited by the Accreditation Council for Graduate Medical Education (www.acgme.org). The ACGME describes itself as, “a private, 501(c)(3), not-for-profit organization that sets standards for US graduate medical education (residency and fellowship) programs and the institutions that sponsor them, and renders accreditation decisions based on compliance with these standards.”
The ECFMG Certificate is also required before applying to take Step 3 of the United States Medical Licensing Examination® (https://www.usmle.org) in order to obtain an unrestricted license to practice medicine in the U.S. The USMLE is a joint program of the Federation of State Medical Boards (FSMB) and National Board of Medical Examiners® (NBME®).
The USMLE has typically been composed of Step 1, Step 2 – Clinical Skills (CS), Step 2 – Clinical Knowledge (CK), and Step 3. To accommodate COVID-19, there have been changes to the procedure, especially as relates to the current suspension of Step 2 – Clinical Skills (CS). We will discuss this important change later in this article and explain how to keep up-to-date with such changes as they occur.
An international medical graduate (IMG) is defined as, “a physician who received his/her basic medical degree from a medical school located outside the United States and Canada.” Note that it is the same whether you are a U.S. citizen or not—if you graduated from a school outside the U.S. and Canada you are an IMG; and similarly, regardless of your citizenship, if the medical school you graduated from is in the U.S. or Canada, you are not an IMG. You might find it encouraging to know that IMGs already make up almost 25% of the physicians in the U.S.
The answer to this question depends on whether you are a medical school student or a medical school graduate.
As a student, to be able to take the Step 1 and Step 2 Clinical Knowledge (CK), you must be officially enrolled in a medical school outside the United States and Canada with a listing in the World Directory of Medical Schools, often referred to as “World Directory” (https://www.wdoms.org). This indicates that the school meets the requirements for eligibility that enable its students and graduates to apply to the ECFMG for certification and examination both at the time of filing the examination application and on the day of the test. Further, there is a note by the ECFMG in the World Directory, on the Sponsor Notes tab, in which the “Graduation Years” for your medical school must be shown as “Current” at the time of both the application being filed and upon taking the test.
Your current enrollment status must be certified by an authorized official of your medical school, following the instructions provided upon filing the application for examination.
Further, upon completion of at least two years of your medical school curriculum, including the basic medical science component, by the beginning of your eligibility period for the examination, you become eligible for Step 1 and Step 2 CK. However, it is recommended to additionally complete the clinical clerkships and experience working directly with patients before taking Step 2 CK.
Eligibility for USMLE Step 1 and USMLE Step 2 CK requires graduation from a medical school outside the U.S. and Canada with a listing in the World Directory of Medical Schools, often referred to as “World Directory” (https://www.wdoms.org). This indicates that the school meets the requirements for eligibility that enable its students and graduates to apply to the ECFMG for certification and examination. Further, there is a note by the ECFMG in the World Directory, on the Sponsor Notes tab, in which the “Graduation Years” for your medical school must include your graduation year. Further, you must have received official credit for a minimum of four academic years toward completion of the medical curriculum by a medical school which, as mentioned above, is listed as meeting the ECFMG eligibility requirements in the World Directory.
Your status as a graduate must be certified by an authorized official of your medical school, following the instructions provided upon filing the application for examination.
In addition to graduation from a properly accredited medical school, certification typically has required IMGs to pass Step 1, Step 2 – Clinical Knowledge (CK), and Step 2 – Clinical Skills (CS) of the USMLE. Since Step 2 (CS) is currently suspended due to COVID-19 protocol, if you have not already passed Step 2 (CS), there are now pathways for allowing ECFMG Certification to continue, as detailed here for 2021: https://www.ecfmg.org/certification-requirements-2021-match/
Note that if you already have passed the USMLE Step 2 CS suitably for ECFMG Certification you are not eligible for and do not need to pursue the pathways to meet the requirements for ECFMG Certification.
Eligible IMGs can now apply for the pathways here: https://pathways.ecfmg.org
We will consider the case of Carolina Sanchez, a graduate from a medical school in Brazil. Carolina would like to apply for a Residency in the U.S. but is not sure what to do. Here is a step-by-step approach to acquire ECFMG Certification:
STEP 1: Carolina checks to see whether her medical school is properly accredited. It must meet requirements established by ECFMG. She confirms this by finding its listing in the World Directory of Medical Schools at www.wdoms.org. Note that starting in 2024 (it was originally 2023), she will be eligible to apply for ECFMG Certification if her school is accredited by an agency that is recognized by the World Federation for Medical Education (WFME). Carolina can find details and important updates at www.ecfmg.org/accreditation.
STEP 2:—Carolina did not yet have her USMLE/ECFMG Identification Number. To apply for one, she goes to the ECFMG site (https://www.ecfmg.org/#) and selects: On-line Services > IWA—Interactive Web Applications > “If you have never been issued a USMLE/ECFMG Identification Number and want to request one, click here.” This takes her to the initial instruction page, which she reads carefully so she can fill out the form exactly as required before she submits it. After a couple of weeks (which can vary) Carolina receives her Identification Number in an email, along with her password, which she can change.
STEP 3: Carolina goes back to the ECFMG site > IWA and logs in using her new Identification Number and password, and as a first-time user establishes her account and fills out a new application, this time for her ECFMG Certification. Again, she is careful to study and follow the instructions. Carolina makes payment and submits the online portion of her Application for ECFMG Certification.
STEP 4: After submitting payment and her Application for Certification, Carolina downloads Certification of Identification Form 186 (if she was still an undergrad student, it would be Form 183) and prints, completes, and has the form notarized via NotaryCam, as per the instructions provided. She then waits for the email confirmation that ECFMG has received the on-line part of her Application. This will also include a scheduling permit that will allow scheduling the exams.
STEP 5: Carolina applies and pays for each of the required USMLE Step exams using IWA as before, following the provided instructions. Once she receives ECFMG verification for each Step Application, which will include a scheduling permit, she schedules each on the Prometric site (https://www.prometric.com), as instructed. She must pass USMLE Step 1 and Step 2 – Clinical Knowledge (CK), and since she has not already passed Step 2 – Clinical Skills (CS) which is currently suspended due to COVID-19 protocol, she follows the instructions for the pathways as detailed here for 2021: https://www.ecfmg.org/certification-requirements-2021-match/. Throughout the USMLE Steps, Carolina follows her application status and payments on OASIS, on the ECFMG site.
STEP 6: While pursuing the USMLE Steps, Carolina waits to receive her final medical diploma from her medical school. Once it arrives, she scans it and emails it to ECFMG according to instructions. Once this has been verified, notification that her medical education credentials are complete and verified appears on OASIS.
STEP 7: Having satisfactorily passed USMLE Steps 1 and 2 (CK), having selected and pursued the proper pathway and satisfactorily completed the Occupational English Test (OET) Medicine, as instructed, Carolina waits to receive notification online that she has been ECFMG certified. The hard copy of her ECFMG Certificate is then mailed to her. Both final steps can be tracked on OASIS.
While your situation may differ from Carolina’s, the online instructions cover all the variables in detail, and by following them you should be readily able to obtain your ECFMG Certificate!
ECFMG Certification Fact Sheet: https://www.ecfmg.org/forms/certfact.pdf
USMLE Step 3 Eligibility Requirements During the Step 2 Clinical Skills Suspension:
Important Links to the various required and useful documents including and in addition to those mentioned above can be found at https://www.ecfmg.org/resources/publications.html#ib
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