ECFMG Certification Step by Step Process

Before doing anything else, confirm your medical school is eligible.

• Go to the World Directory of Medical Schools at www.wdoms.org
• Look up your medical school
• Click the “Sponsor Notes” tab
• Confirm there is an “ECFMG Sponsor Note” that includes your graduation year
• If there is no Sponsor Note, you are not eligible for ECFMG Certification — stop here

If you believe the absence of a Sponsor Note is an error, contact ECFMG directly at www.ecfmg.org or reach out to your medical school’s administration to ask whether the school has applied for or is in the process of obtaining the ECFMG Sponsor Note.

MyIntealth is the applicant portal where most of your ECFMG work happens.

• Go to the MyIntealth website
• Set up your account
• Complete identity verification (NotaryCam session)

The MyIntealth setup process has its own quirks — particularly around the ECFMG email and identity verification. For a step-by-step walkthrough, see Use Your ECFMG Email to Set Up MyIntealth: A Guide for IMGs.

• Log into the MyIntealth Applicant Portal
• Fill out the application with your medical education details
• Upload your medical education credentials (diploma, transcripts)

This application confirms your intent to pursue ECFMG Certification and is required before you can be recognized as eligible for the Step exams.

You must pass:

• USMLE Step 1 — Apply through the FSMB website
• USMLE Step 2 CK — Apply through the FSMB website

Step 1 became pass/fail in January 2022, which changed how programs read it in IMG applications. For what that shift means for your application strategy, see USMLE Step 1 Pass/Fail: The Impact on IMG Residency Applicants. Step 2 CK is numerically scored and is the primary metric residency programs use to compare applicants.

For a complete look at how IMGs approach the USMLE — eligibility, timing, scoring norms, and what scores match — see USMLE for International Medical Graduates: The Complete Guide. For a full breakdown of fees, including international surcharges and retake costs, see ECFMG Certification Cost: The Complete Fee Guide for IMGs.

The ECFMG Pathway is the formal replacement for the discontinued Step 2 CS exam. Every IMG who needs ECFMG Certification must complete a Pathway, unless they already hold a passing Step 2 CS result that is still valid for ECFMG Certification.

• Visit the Pathways section on the ECFMG website
• Review the six available Pathways and determine which one you are eligible for
• Apply for your chosen Pathway through the MyIntealth Applicant Portal
• Pathways are offered on a seasonal application cycle — pay close attention to application windows

The Pathway application fee is $925 and is non-refundable.

For detailed eligibility requirements for all six Pathways, the Mini-CEX requirements for Pathway 6, and the certificate expiration calendar, see ECFMG Pathways for IMGs: Which One Do You Qualify For?

As part of every ECFMG Pathway, you must achieve a satisfactory score on the Occupational English Test (OET) Medicine. This fulfills the communication skills requirement for ECFMG Certification.

• The OET has four sub-tests: Listening, Reading, Writing, Speaking
• A satisfactory score requires a minimum of 350 (Grade B) on each sub-test individually
• Passing three of four does not satisfy the requirement
• After taking the exam, you must explicitly authorize OET to release your scores to ECFMG through the OET portal — taking the exam is not enough on its own

This OET requirement applies to every Pathway applicant without exception — regardless of native language, citizenship, or the language of medical instruction. There are no waivers.

For preparation strategies, score release procedures, and what to do if you don’t pass on the first attempt, see OET Medicine for IMG Residency: What Every Applicant Needs to Know.

• ECFMG will contact your medical school directly to verify your final diploma
• ECFMG also requests that the medical school provide your final medical school transcript
• You must have completed at least 4 credit years at an eligible school
• This step can take time and is largely outside your control

Begin credential verification as early as possible. A medical school that takes six months to verify your transcript is not unusual, and that delay does not come out of ECFMG’s processing time — it comes out of your match cycle.

Once all requirements are verified and met, you will be issued ECFMG Certification.

You can then:

• Apply to U.S. residency programs through ERAS
• Take USMLE Step 3
• Pursue an unrestricted U.S. medical license after completing graduate medical training