ECFMG 2022: Updated Pathways - IMGPrep

ECFMG 2022: Updated Pathways

May 7, 2021


ECFMG certification process for the 2022 Match: Updated Six Pathways

May 08, 2021


Educational Commission for Foreign Medical Graduates (ECFMG) Certification requires passing examinations in medical sciences, clinical skills, and communications skills. The USMLE discontinued the Step 2 Clinical Skills (CS) exam in 2020. In the 2021 Match, the ECFMG replaced the CS exam with five “Pathways” for International Medical Graduate Physicians (IMG). For the 2022 Match, the Pathways have now expanded to six pathways. Successful completion of the relevant Pathways helps ensure that IMG’s are ready to enter supervised training, enabling them to pursue ECFMG Certification and compete for U.S. Graduate Medical Education (GME).

One of the biggest challenges facing IMGs was the ECFMG’s decision to cancel the Step 2 Clinical Skills (CS) exam. For years, this exam was a prerequisite gateway for graduates of international medical schools to become ECFMG Certified. For more information, IMGPrep has prepared a good overview of the CS cancellation: USMLE Step 2 CS—Its Suspension and Re-Introduction: What you need to know 

On January 26th, 2021, the ECFMG announced the permanent discontinuation of this exam. (For additional information, see: ECFMG announcement). Instead, the ECFMG announced individualized pathways for ECFMG Certification.

Outlined below are the Pathways for the 2022 Match. The ECFMG initially introduced Pathways 1 through 5 in 2021, and these pathways have been retained, with some modifications, for the 2022 match. In addition, the ECFMG introduced an entirely new Pathway 6. ECFMG changed general eligibility requirements for all of the Pathways.

What if I already have ECFMG Certification?

Important Note: Applicants who already have satisfied the clinical and communication skills requirements for ECFMG Certification do not need to (and are not eligible to) pursue a Pathway to meet the requirements for ECFMG Certification for participation in the 2022 Match. These individuals include:

  • 1. IMGs who have a passing performance on Step 2 CS that is valid for ECFMG Certification (even if they previously failed Step 2 CS);
  • 2. IMGs who are certified by the ECFMG; and
  • 3. IMGs with an approved 2021 Pathways application.

An overview of the Pathways:

Pathway 1

A Pathway for an applicant who holds, or has recently held, a license/registration to practice medicine without supervision.

Example: Meet Sanaz. She is an IMG from Iran and a graduate of the Tehran University of Medical Science (TUMS). Sanaz had completed and met all the requirements to hold a license/registration to practice medicine in Iran. Sanaz qualifies to apply for Pathway 1.

Pathway 2

A Pathway for an applicant who has not yet obtained a license/registration to practice medicine without supervision (e.g., Pathway 1) but already passed an acceptable standardized clinical skills exam for medical licensure outside the United States.

ECFMG Pathway

Example: Narmeen is a graduate of Fatima Jinnah Medical University in Lahore, Pakistan. She completed the Objective Structured Clinical Examination (OSCE) required by Pakistan’s Medical Regulatory Authority (MRA) on January 2nd, 2018. Narmeen qualifies for Pathway 2.

Pathway 3

Pathway 3 applies when an agency recognized by the World Federation for Medical Education (WFME) accredits the medical school.

IMG Pathway

Example: Joseph is a final-year medical student at the Saint James University School of Medicine. The Accreditation Commission on Colleges of Medicine (ACCM) accredits the Saint James University School of Medicine. The WFME recognizes the ACCM. Joseph qualifies for Pathway 3.

Pathway 4

Pathway 4 applies when an agency that has received a Determination of Comparability by the National Committee on Foreign Medical Education and Accreditation (NCFMEA) accredits the Medical School.

IMG Pathway

Example: Rivka is a graduate of the Medical University of Warsaw Faculty of Medicine in Warsaw, Poland. Her school’s accrediting agency has received a Determination of Comparability by the National Committee on Foreign Medical Education and Accreditation (NCFMEA). Rivka qualifies for Pathway 4.

Pathway 5

Pathway 5 applies when the Medical School issues the degree jointly with a U.S. Medical School accredited by the Liaison Committee on Medical Education (LCME).

IMG Pathway

Example: Tan Eng is a final year student at the Duke-NUS Medical School in Singapore. This medical school issues its degree jointly with the Duke University School of Medicine. Tan Eng qualifies for Pathway 5.

Pathways 3, 4, and 5: Generally, these Pathways are for applicants who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1) and have not already passed an acceptable standardized clinical skills exam for medical licensure (Pathway 2). They must be a student or recent graduate of an ECFMG-eligible medical school. 

Pathway 6: Pathway 6 is for applicants who are not eligible for Pathway 1, 2, 3, 4, and 5 and have failed Step 2 CS one or more times. For Pathway 6, the applicant’s clinical skills must be assessed by licensed physicians using ECFMG’s Mini-Clinical Evaluation Exercise (Mini-CEX).

How long does it take to become ECFMG Certified?

Upon completion of all requirements of your pathway it should take approximately two weeks to be issued your ECFMG which will arrived in the mail via Fedex or Certified mail so be sure that the address listed in your ECFMG record is updated! Read More

How do I find out which ECFMG Pathway I qualify for? 

For Pathways 2-5, use the ECFMG search tool, which can be accessed here.

If you meet the eligibility criteria for Pathway 1-5, you may apply now using the online Application for Pathways for ECFMG Certification for the 2022 Match, accessible here

ECFMG Pathway Deadlines-2022 Match- Remember, you must submit your application no later than December 15th, 2021.

Another important step in qualifying to apply to the match is to select IMG friendly residency programs which meet your unique qualifications. IMGPrep is the leading consulting company for International Medical Graduates seeking a U.S. residency program. We offer the most reliable search engine for IMG friendly residency programs in 27 specialties. We provide a list of medical residency programs that match an applicant’s unique qualifications. The information about each program is more detailed than is otherwise available, and the lists have been updated for the 2021-2022 application season. For more information about our customizable Program Lists and accompanying services, please go to our website:

IMGPrep is a leading educational consulting firm dedicated to assisting IMGs in reaching their goals, dreams, and potential. Check out our other Articles and learn more about IMGPrep services at:

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