On July 31, 2020, the Educational Commission for Foreign Medical School Graduates (ECFMG) provided an important update for International Medical Graduates (IMGs) who have not yet taken the Step 2-CS exam. They announced that starting August 31, their long-awaited instructions for how to pursue what is becoming known as “The Five Pathways,” which are some temporary alternative ways to get certified without Step 2-CS, will be available. Also under development is an online application process that incorporates the Five Pathways. This means that at least some IMG candidates will be able to start filling out their forms and proceed with obtaining the ECFMG Certification they need to be eligible to apply to residency programs in the US this year.* So, what are the Five Pathways? And what does this mean for IMGs? This article takes a look at how the ECFMG, which both acts as the US-based Dean’s Office for IMGs and ensures that they meet eligibility requirements to be trained in the US, is working to come up with temporary measures to mitigate the effects of this crisis period.
*Technically you do not need to be certified in order to apply. However, you will need to have the ECFMG certificate in hand by the time you start your program. Program requirements vary, and some programs prefer you to have the ECFMG certificate when you apply for residency or they will not give you an interview. Be sure to check your preferred program’s requirements and preferences when applying.
(Meanwhile, the USMLE made an announcement that eligibility criteria for the Step 3 exam will be available in early September. See below for more details or visit their website.)
Why did USMLE suspend the Step 2 – CS exams and how did that lead to the Five Pathways?
Back in March of this year, the US Medical Licensing Examination organization (USMLE), which is a Joint Program of the Federation of State Medical Boards of the United States, Inc., and the National Board of Medical Examiners®, was faced with an unfolding worldwide health crisis, so it opted to suspend the USMLE Step 2-CS exams for at least a year. The Clinical Skills exam involves direct interaction between medical graduates and patients, so there were understandable health concerns for all taking part in those assessments. This decision to suspend Step 2-CS for at least twelve months led to much uncertainty for those candidates who had not yet taken that exam or who were wanting to re-take it. After all, to be eligible to apply to a US-based residency program, the applicant must be certified by the ECFMG. And to be certified by the ECFMG, the applicant must have taken and passed the USMLE Step 2-CS exam (among other criteria). At the time, no one knew for sure what the implications would be for IMGs seeking residency in the 2021 Match season.
A few weeks after the USMLE announced its decision, the ECFMG made its own announcement by saying, “In response to the suspension of Step 2 CS 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.”
The announcement brought some hope for a way forward, but the ECFMG admitted that they were still working on the actual instructions, procedures, and forms that would need to accompany each pathway. That is why the announcement on July 31 that those items would be available to IMGs by August 31st was welcome news.
What is the OET and why was it chosen as a primary eligibility requirement regardless of a chosen pathway?
The Occupational English Test (OET) Medicine is a test developed in the UK and administered to medical personnel worldwide. In deliberating how to set temporary measures for IMGs in the 2021 season, ECFMG determined that “Applicants who pursue one of the pathways will be required to attain a satisfactory score on an English language proficiency assessment. All applicants, regardless of citizenship, will be required to satisfy this requirement. ECFMG will accept the Occupational English Test (OET) Medicine to satisfy the English language proficiency requirement.” Please see ECFMG’s English Language Proficiency Assessment page for more information.
What are the Five Pathways and how do I know whether I qualify for (any of) them?
First of all, there are certain eligibility requirements that must be met regardless of which pathway may be applicable to an individual. For example, all candidates must take and pass an English language proficiency exam; only those who have not already taken the Step 2-CS exam are eligible; only those who are applying in the 2021-2022 academic year can pursue the pathways, and so on. In sum, the pathways are temporary alternative ways to demonstrate eligibility in lieu of taking the Step 2-CS exam while the suspension is in effect.
Below is a chart of the information available on ECFMG’s website that includes the name of each pathway and its eligibility criteria. For information about the general eligibility criteria for all applicants regardless of pathway.
What if I do not qualify for any of the Five Pathways? Will there be other parameters put in place?
The ECFMG admits that these pathways will not be accessible by all IMGs. They have said that they are continuing to work on other measures to help a wider pool of IMG candidates through the certification for the application process. Whether those other measures will be defined in time for this year’s applicants is not yet known.
To determine whether you qualify for one or more of the pathways, you are encouraged to contact ECFMG directly. If you learn that none of the Five Pathways applies to you, then you are advised to check back regularly to the ECFMG website for updated information.
If I have already taken the Step 2-CS exam, do I need to know about the Five Pathways?
No. In fact, the ECFMG specifically notes that “Applicants who have a passing performance on USMLE Step 2 CS that is valid for ECFMG Certification and/or are certified by ECFMG are ineligible for the pathways.”
If you were planning to re-take the Step 2-CS exam, unfortunately, the USMLE will not allow you to do so. According to their website, “Due to the Step 2 CS suspension, a significant number of individuals applying for residency in the 2020-2021 cycle will not have a Step 2 CS result or an opportunity to retest after a Step 2 CS failure.” They further note that, “All Step 2 CS results from exam administrations prior to the suspension (March 2020) will be reported on [the individual’s] USMLE transcripts.
Do these Five Pathways represent a permanent change, or will the Step 2-CS come back at some point in the future?
For now, the Five Pathways developed by the ECFMG apply only to the 2021 Match season, and only to those who have not already taken the Step 2-CS exam. All other eligibility requirements set by the ECFMG remain in effect. Meanwhile, the USMLE has announced that the suspension of Step 2-CS is in effect at least until June 1, 2021. Both organizations continue to develop and update their information as the situation evolves.
If I change my mind and do not apply for residency this year, is the ECFMG Certification via one of the pathways permanent? Or will I need to re-certify next year?
According to their website: “ECFMG Certificates based on one of the clinical skills pathways will expire if the applicant does not enter an ACGME-accredited GME program for the 2021-2022 academic year. Once the applicant successfully completes the first year of ACGME-accredited training, the certificate is no longer subject to expiration.”
What about USMLE Step 3? Can I still prepare to take that exam during the Step 2-CK suspension?
On August 6th, the USMLE announced that temporary eligibility criteria for taking Step 3 will go into effect in early September. A specific date has not yet been set. For more information, the link to the announcement can be found here.
For more information, we highly recommend that you check out the highly detailed and specific list of Frequently Asked Questions that is periodically updated with the latest news and announcements.
Update on Pathways: Important Information for 2021 and 2022 Applicants; Using the Pathways for the 2023 Match
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