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Educational Commission for Foreign Medical Graduates
Educational Commission for Foreign Medical Graduates
Educational Commission for Foreign Medical Graduates
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According to the US Department of Education, the Educational Commission for Foreign Medical Graduates (ECFMG) is "the authorized credential evaluation and guidance agency for non-U.S. physicians and graduates of non-U.S. medical schools who seek to practice in the United States or apply for a U.S. medical residency program. It provides comprehensive information and resources on licensure, the U.S. Medical Licensure Examination (USMLE), residencies, and recognition."[1]

Key Information

Through its program of certification, the ECFMG assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).

ECFMG acts as the registration and score-reporting agency for the USMLE for foreign medical students/ graduates, or in short, it acts as the designated Dean's office for International Medical Graduates (IMGs) in contrast to the American Medical Graduates (AMGs).

Medical schools in Canada that award the M.D. are not assessed by ECFMG, because the Liaison Committee on Medical Education historically accredited M.D.-granting institutions in both the U.S. and Canada (today, Canada has its own accrediting body that generally follows U.S. standards). M.D. graduates of American and Canadian institutions are not considered IMGs in either country.

History

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ECFMG was founded in 1956, in response to the increase need for the evaluation of the readiness of international medical graduates entering the physician workforce during the 1950 expansion of US healthcare system. Its initial name was Evaluation Service for Foreign Medical Graduates (ESFMG).[2] Later that year, it was renamed Educational Council for Foreign Medical Graduates. In conjunction with NBME, it created what became known as the ECFMG certification which included examinations and assessments of English language proficiency.[citation needed] In 1974, it merged with the Commission on Foreign Medical Graduates and changed its name to its current name Educational Commission for Foreign Medical Graduates.[3]

Certification

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The main pathway for international medical graduates who wish to be licensed as a physician in the United States is to complete a U.S. residency hospital program. The general method to apply for residency programs is through the National Resident Matching Program (abbreviated NRMP, but also called "the Match"). To participate in the NRMP, an IMG is required to have an ECFMG certification[4] by the "rank order list certification deadline" time (usually in February of the year of the match).[5]

To acquire an ECFMG certification, the candidate must meet these requirements:[6]

  • Examination Requirement: Completion of USMLE Step 1 and USMLE Step 2 Clinical Knowledge
  • Meet the clinical and communication skills requirements (see section)[7]
  • Medical education credential requirements: A medical diploma of medical education taken at an institution registered in the World Directory of Medical Schools (WDOM). The official source to confirm that a medical school meets ECFMG's requirements, is the World Directory at www.wdoms.org. Schools that meet the requirements will have an ECFMG note stating this in the schools’ World Directory listing.

In comparison, regular graduates from medical schools in the United States need to complete USMLE Steps 1 and 2 as well, but can participate in the NRMP while still doing their final year of medical school before acquiring their medical diplomas.[8] In effect, taking regular administrative delays into account, and with residency programs starting around July, there is a gap of at least half a year for IMGs between graduation from medical school and beginning of a residency program.

Clinical and communication skills requirements

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The COVID-19 global pandemic has brought some changes to the ECFMG certification process. First as AAMC suspended temporarily and later eliminated the Step 2 CS examination,[9] ECFMG moved to a pathways model for verification of clinical skills.[10] IMGs who have already taken Step 2 CS may still use it to fulfill this requirement. All other IMGs will need:

  • Assessment of communication skills, including English language proficiency through the Occupational English Test Medicine exam
  • Meet the requirements for one of the pathways below:
Pathways for ECFMG certification (2022)
Pathway Description Notes
Pathway 1 Already Licensed to Practice Medicine in Another Country Intended for applicants who currently hold or have recently held a license/registration to practice medicine without supervision (unless they failed Step 2 CS)
Pathway 2 Already Passed a Standardized Clinical Skills Exam for Medical Licensure Intended for applicants who do not currently hold, or have not recently held, a license/registration to practice medicine without supervision (Pathway 1), but who successfully completed a secure, standardized clinical skills exam as a requirement for medical licensure or registration in a country other than the United States.
Pathway 3 Medical School Accredited by Agency Recognized by World Federation for Medical Education (WFME) Intended for applicants who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1) and who have not already passed an acceptable standardized clinical skills exam for medical licensure (Pathway 2). An applicant to Pathway 3, 4, or 5 must be a student or a recent graduate of a medical school that meets eligibility requirements established by ECFMG.
Pathway 4 Medical School Accredited by Agency that Has Received a Determination of Comparability by National Committee on Foreign Medical Education and Accreditation (NCFMEA) Intended for applicants who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1) and who have not already passed an acceptable standardized clinical skills exam for medical licensure (Pathway 2). These applicants must be students or recent graduates and must meet eligibility requirements established by ECFMG.
Pathway 5 Medical School Issues Degree Jointly with a U.S. Medical School Accredited by Liaison Committee on Medical Education (LCME) Intended for applicants who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1) and who have not already passed an acceptable standardized clinical skills exam for medical licensure (Pathway 2). These applicants must be students or recent graduates and must meet eligibility requirements established by ECFMG.
Pathway 6 Evaluation of Clinical Patient Encounters by Licensed Physicians Intended for applicants who do not meet the eligibility requirements for Pathway 1, 2, 3, 4, and 5 and/or have failed Step 2 CS one or more times. To meet the requirements for Pathway 6, the applicant's clinical skills must be evaluated by licensed physicians using ECFMG's Mini-Clinical Evaluation Exercise (Mini-CEX).

Certification expiration

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As of April 2021, ECFMG certifications obtained by fulfilling the clinical and communication skills requirements through a pathway will expire in 2022 if the applicant does not enter an ACGME-accredited training program in 2021 or 2022. If the applicant enters a training program they become permanent after one year of residency.[7]

Projects

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A pilot project was started in 2012 for an electronic verification system of medical credentials from international medical schools, with participation from approximately 20 international medical schools.[11] After completion of this pilot project, ECFMG now allows all medical schools to register for free.[12]

Expected to be implemented in late 2024, a notable development is anticipated in medical education application procedures. ECFMG Status Reports will be integrated into Electronic Residency Application Service (ERAS) submissions, offering vital information for institutions assessing applicants. These reports will specifically indicate whether the candidate's medical school meets the Recognized Accreditation Policy, determined by accreditation from agencies recognized by the World Federation for Medical Education or the National Committee on Foreign Medical Education and Accreditation. This enhancement aims to streamline the evaluation of medical school credentials, enhancing transparency and efficiency in the residency application process. However, IMGs will still be able to pursue ECFMG Certification even if their medical school doesn't meet the Recognized Accreditation Policy, as long as their school meets ECFMG's current requirements. [13] The accrediting agencies that are WFME recognized are:

Agencies with recognition status[14]
Agency Country Recognized until
Korean Institute of Medical Education and Evaluation (KIMEE) Republic of Korea September 2026
Accreditation Commission on Colleges of Medicine (ACCM) Selected Caribbean countries: Anguilla, Aruba, Cayman, Islands, Curaçao, Dominica, Saint Kitts and Nevis, Sint Maarten, St. Vincent & the Grenadines, University of Jordan Faculty of Medicine - Jordan December 2026
Japan Accreditation Council for Medical Education (JACME) Japan March 2027
Australian Medical Council (AMC) Australia and New Zealand January 2028
Independent Agency for Accreditation and Rating (IAAR) Kazakhstan, Kyrgyz Republic, Republic of Moldova, Russian Federation, Tajikistan, Ukraine, Romania, Belarus January 2028
Sudan Medical Council (SMC) Sudan June 2028
National Center for Educational Quality Enhancement (NCEQE) Georgia October 2028
Institute for Medical Education Accreditation (IMEAc) Thailand October 2028
Indonesian Accreditation Agency for Higher Education in Health (Lembaga Akreditasi Mandiri Perguruan Tinggi Kesehatan) (IAAHEH/LAM-PTKes) Indonesia October 2028
Accreditation Organisation of the Netherlands and Flanders (Nederlands-Vlaamse Accreditatieorganisatie) (NVAO) Netherlands and Flanders November 2028
Mexican Board for Accreditation of Medical Education (Consejo Mexicano para la Acreditación de la Educación Médica (COMAEM) Mexico, Costa Rica April 2029
National Authority for Quality Assurance and Accreditation of Education (NAQAAE) Egypt April 2029
System of Accreditation of Medical Schools/Sistema de Acreditação de Escolas Médicas (SAEME) Brazil April 2029
Taiwan Medical Accreditation Council (TMAC) Taiwan April 2029
Secretariat of the Council for Undergraduate Medical Education (SCUME) Iran June 2029
Commission for Academic Accreditation (CAA) United Arab Emirates June 2029
Cyprus Agency of Quality Assurance and Accreditation in Higher Education (CYQAA) Cyprus February 2030
Working Committee for the Accreditation of Medical Education, Ministry of Education (WCAME) China June 2030
Medical Council of Ireland (MCI) Ireland, Royal College of Surgeons in Ireland, Medical University of Bahrain - Bahrain June 2030
Accreditation and Quality Assurance Commission for Higher Education Institutions (AQACHEI) Jordan, Iraq, Palestine, and Syria September 2031
Quality Assurance Agency for Higher Education (AQU) Catalonia, Spain October 2031
Agency for Accreditation of Educational Programs and Organizations (AAEPO) Kyrgyzstan March 2032
Hungarian Accreditation Committee (MAB) Hungary March 2032
National Center for Academic Accreditations (NCAAA) Saudi Arabia April 2032
American Osteopathic Association, Commission on Osteopathic College Accreditation (AOA COCA) United States of America August 2032
Grenada Medical and Dental Council (GMDC) Grenada September 2032
National Agency for Quality Assessment and Accreditation of Spain (ANECA) Spain October 2032
Eurasian Centre for Accreditation and Quality Assurance in Higher Education and Health care (ECAQA) Kazakhstan and Uzbekistan October 2032
Education & Training Quality Authority (BQA) Bahrain November 2032
Sri Lanka Medical Council (SLMC) Sri Lanka March 2033
Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU) The Philippines April 2033
Malaysian Medical Council (MMC) Malaysia April 2033
Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM-HP) Countries of the Caribbean Community (CARICOM), Dominican Republic May 2033
Consejo Nacional de Acreditación (CNA) Colombia June 2033
The Association for Evaluation and Accreditation of Medical Education Programs (TEPDAD) Turkey, State of Palestine, Oman, Qatar, Kuwait, Lebanon

July 2033

Committee on Accreditation of Canadian Medical Schools (in cooperation with LCME) Canada March 2034
Liaison Committee on Medical Education (LCME) United States of America August 2034

Communication

[edit]

International medical schools can send Medical Student Performance Evaluations (MSPEs) and medical school transcripts on behalf of their students and graduates to ECFMG through digital documents by the ECFMG Medical School Web Portal (EMSWP)[15]

References

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[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Educational Commission for Foreign Medical Graduates

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from Grokipedia
The Educational Commission for Foreign Medical Graduates (ECFMG) is a nonprofit organization founded in 1956 and, since 2021, a division of Intealth, dedicated to promoting quality health care by evaluating and certifying the qualifications of international medical graduates (IMGs) seeking to enter the United States healthcare system. ECFMG certification serves as the standard for ensuring that IMGs meet the necessary educational and clinical standards for U.S. graduate medical education (GME) and medical licensure, requiring applicants to pass the United States Medical Licensing Examination (USMLE) Steps 1 and 2 Clinical Knowledge, verify their medical credentials, demonstrate English language proficiency, and satisfy clinical and communication skills requirements through ECFMG Pathways. In addition to certification, ECFMG provides essential services to support IMGs and the global medical education community, including sponsorship for J-1 exchange visitor visas—the only such designation by the U.S. Department of State for foreign national physicians participating in accredited U.S. clinical training programs—facilitating the entry of approximately 16,000 international physicians annually into American teaching hospitals as of 2024. The organization also administers the Electronic Portfolio of International Credentials (EPIC), a secure digital repository for verifying and storing medical documents worldwide, and offers resources for GME applications and policy development in health workforce training. Recent developments include the 2024 requirement for medical schools to meet recognized accreditation standards for IMG eligibility and the designation of Canadian medical graduates as IMGs effective July 1, 2025. With nearly 70 years of expertise, ECFMG has certified hundreds of thousands of IMGs, contributing significantly to addressing physician shortages and enhancing diversity in the U.S. medical workforce.

History

Founding and Early Years

The Evaluation Service for Foreign Medical Graduates (ESFMG) was founded in 1956 as a private, nonprofit organization, which was almost immediately renamed the Educational Council for Foreign Medical Graduates (ECFMG) to reflect its broader educational mission. This establishment addressed the growing need to evaluate the qualifications of international medical graduates (IMGs) seeking entry into U.S. graduate medical education programs amid increasing immigration of foreign-trained physicians. From its inception, ECFMG's primary responsibilities included verifying the authenticity of credentials, assessing candidates' medical knowledge through standardized examinations, and evaluating proficiency to ensure IMGs could communicate effectively in clinical settings. These evaluations aimed to standardize the screening process for IMGs, helping U.S. hospitals and licensing boards determine readiness for residency training. ECFMG administered its first examinations in March 1958, certifying the initial cohort of qualified IMGs and marking a pivotal step in formalizing credential assessment for foreign s. Within three years, ECFMG had emerged as the requisite standard for IMGs entering U.S. graduate medical education, influencing hospital appointment policies nationwide. Early on, ECFMG collaborated closely with the (NBME) to develop and administer these assessments, utilizing NBME's testing infrastructure and expertise in examination design.

Key Milestones and Organizational Changes

In 1974, the Educational Council for Foreign Medical Graduates (ECFMG) merged with the Commission on Foreign Medical Graduates (CFMG), and the combined organization was renamed the Educational Commission for Foreign Medical Graduates, retaining the ECFMG acronym. This merger significantly expanded its responsibilities to include sponsorship and monitoring of J-1 Exchange Visitor visas for international medical graduates pursuing graduate medical education in the United States. This merger integrated CFMG's visa-related functions into ECFMG's operations, enhancing oversight of international physicians' training programs and ensuring compliance with U.S. Department of State requirements. The year 2000 marked the establishment of the Foundation for Advancement of International Medical Education and Research (FAIMER) by ECFMG as a nonprofit entity dedicated to advancing global medical education through research, faculty development, and quality improvement initiatives. FAIMER's creation stemmed from ECFMG's longstanding commitment to elevating international standards in health professions education, enabling targeted programs like leadership fellowships and accreditation support worldwide. ECFMG commemorated its 50th anniversary in 2006, reflecting on five decades of contributions to international medical education by certifying 287,382 physicians as of 2005 and fostering collaborations with bodies like the National Board of Medical Examiners (NBME). The milestone celebrations, including an invitational conference on the impact of international medical graduates, underscored ECFMG's role in standardizing qualifications and promoting equitable access to U.S. graduate medical training. In 2021, ECFMG and FAIMER unveiled Intealth as an integrated organizational identity to streamline their combined missions in certification, education, and global health workforce development. This restructuring followed years of operational alignment, positioning Intealth to address evolving needs in international medical regulation and accreditation under a unified framework. By 2023, Intealth transitioned into a standalone private nonprofit 501(c)(3) corporation, with ECFMG and FAIMER operating as its core divisions to support enhanced efficiency and expanded services in health professions education. This evolution built on prior integration efforts, allowing for greater autonomy while maintaining the organizations' focus on and . The permanent discontinuation of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam in January 2021 prompted ECFMG to formalize and expand its Pathways program, introduced provisionally in 2020, to verify international medical graduates' clinical and communication skills through alternative, accredited assessments. These pathways ensured continued certification eligibility without the Step 2 CS, adapting to pandemic-related disruptions while upholding rigorous standards for entry into U.S. residency programs.

Mission and Operations

Purpose and Role in Medical Education

The Educational Commission for Foreign Medical Graduates (ECFMG) serves a critical mission in promoting quality by advancing worldwide to improve health care delivery for all populations. As a , ECFMG focuses on assessing the qualifications of international medical graduates (IMGs) who seek to enter U.S. graduate medical education (GME) programs and pursue licensure, thereby ensuring that these professionals meet rigorous standards comparable to those of U.S. medical graduates. This evaluation process helps safeguard and maintain high standards in the U.S. system while facilitating the integration of skilled physicians from diverse global backgrounds. ECFMG's role as the established standard for IMG certification dates back to its founding in 1956, when it began developing examinations and credential reviews to verify that IMGs possess the necessary medical knowledge, clinical skills, and English proficiency for U.S. residency training. By providing this benchmark, ECFMG ensures equivalence between international and domestic medical training, allowing certified IMGs to access GME opportunities that are essential for U.S. medical licensure. Over nearly seven decades, this certification has become a prerequisite recognized by major U.S. medical bodies, such as the American Medical Association, for IMGs engaging in patient care roles. Through its efforts, ECFMG has certified hundreds of thousands of IMGs since 1956, contributing significantly to the U.S. physician workforce, where IMGs now comprise approximately 23% of active physicians as of 2025. Beyond U.S.-focused assessment, ECFMG advances global medical education standards by offering primary-source credential verification services, such as the Electronic Portfolio of International Credentials (EPIC), which enables physicians and institutions worldwide to securely validate medical qualifications. These initiatives foster international collaboration, enhance the mobility of health professionals, and support ongoing improvements in medical training quality across borders.

Organizational Structure and Affiliations

The Educational Commission for Foreign Medical Graduates (ECFMG) operates as a private nonprofit division of Intealth, an integrated organization established in 2021 and transitioned to a standalone entity in 2023, with governance provided by a Board of Trustees that oversees its operations and strategic direction. As of 2025, the board is chaired by Peter Buckley, MD, and includes 15 trustees, two resident trustees, and the president and CEO as a management trustee, comprising experts in , , and administration to ensure alignment with global health standards. Within Intealth, ECFMG focuses on the certification of international medical graduates, while the Foundation for Advancement of International Medical Education and Research (FAIMER) handles programs aimed at enhancing global health professions education and accreditation support. This divisional structure enables synergistic efforts, with ECFMG emphasizing credential evaluation and FAIMER providing research, fellowships, and data resources for educators and policymakers worldwide. ECFMG maintains key affiliations to support its certification processes, including collaboration with the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB) for the administration of the United States Medical Licensing Examination (USMLE), with a mid-2025 transition centralizing services such that international medical graduates use FSMB for Steps 1, 2 Clinical Knowledge, and 3. It also partners with the World Federation for Medical Education (WFME) on accreditation recognition, requiring medical schools to be accredited by WFME-recognized agencies for ECFMG eligibility, and operates the World Directory of Medical Schools in conjunction with FAIMER. Additionally, ECFMG aligns with the American Medical Association (AMA) on policies for international medical education and with FSMB on licensure pathways for internationally trained physicians. Headquartered in , , ECFMG employs a leadership team including Kara Oleyn, JD, and supports through online portals such as MyIntealth for applicant services and credential management. This structure facilitates its role in evaluating qualifications for approximately 23% of the U.S. physician workforce derived from international medical graduates.

Certification Process

Eligibility and General Requirements

To be eligible for ECFMG Certification, international medical graduates (IMGs) must first graduate from a medical school that meets specific criteria outlined by the Educational Commission for Foreign Medical Graduates (ECFMG). The school must be listed in the World Directory of Medical Schools (WDMS) and include an ECFMG sponsor note confirming eligibility for the graduate's year of graduation. Additionally, applicants must have been awarded credit for at least four academic years (or equivalent) of medical education at an eligible institution, ensuring a comprehensive curriculum typically spanning basic sciences and clinical training. This requirement verifies that the education aligns with standards necessary for further assessment in the United States medical licensing process. Credential verification is a foundational step in the eligibility process, requiring IMGs to submit their final medical diploma and, if applicable, transcripts directly to ECFMG for . ECFMG then verifies these documents with the issuing officials to confirm authenticity and alignment with the WDMS listing. This process ensures the integrity of the applicant's educational background before proceeding to examinations. Credential verification through the Electronic Portfolio of International Credentials (EPIC) costs $200, comprising $100 for the final medical diploma and $100 for the final medical school transcript. Once verified, applicants can advance to fulfilling the core certification requirements. The overall requirements for ECFMG Certification include passing the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK), as well as meeting the clinical and communication skills standards through one of the approved ECFMG Pathways (or a valid prior performance on the former Step 2 Clinical Skills examination). All examination-related components must be completed within a seven-year period, starting from the date the first qualifying examination is passed and ending exactly seven years later; performances outside this window generally become invalid, though limited reexamination opportunities may apply under specific rules. The application process begins through the MyIntealth Applicant Portal, where candidates create an account, undergo identity verification, submit required documentation, and track their application status (such as Accepted, Pending, or Under Review) in real time. The application for ECFMG Certification incurs a fee of $560, with additional potential costs for rescheduling fees, eligibility extensions, and retakes.

Examination Components

The United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) are the core examination components required for international medical graduates (IMGs) seeking ECFMG certification. These exams evaluate foundational medical knowledge and are prerequisites for demonstrating readiness for residency training in the United States. is a computer-based, multiple-choice examination that assesses whether examinees understand and can apply key concepts in the basic sciences fundamental to medical practice, including subjects such as , biochemistry, , , , and . The exam consists of up to 280 questions organized into seven 60-minute blocks, administered over an 8-hour testing session that includes breaks. Since January 26, 2022, Step 1 results have been reported solely as pass or fail, with the passing standard determined by the USMLE Management Committee based on periodic reviews of examinee performance and other data; the previous numeric threshold was 196 prior to the pass/fail transition. USMLE Step 2 CK is also a computer-based, multiple-choice exam that evaluates the ability to apply medical knowledge, skills, and principles of clinical science essential for the provision of patient care under supervision, spanning topics from disease prevention and health promotion to diagnosis, management, and treatment across organ systems. It features up to 318 questions divided into eight 60-minute blocks, delivered in a 9-hour testing session with scheduled breaks. The passing standard for Step 2 CK, set by the USMLE Management Committee, increased to 218 for exams taken on or after July 1, 2025, from the prior level of 214. The USMLE program is jointly sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), which oversee development, administration, and scoring. For IMGs pursuing ECFMG certification, applications for Step 1 and Step 2 CK are processed through ECFMG via the MyIntealth portal, with exams available year-round at secure Prometric test centers worldwide, except in sanctioned countries. Scores are valid indefinitely for certification purposes once passing results are achieved. Historically, ECFMG certification also required the USMLE Step 2 Clinical Skills (CS) exam to assess clinical and communication abilities, but this component was permanently discontinued by the USMLE program in January 2021 due to challenges including the COVID-19 pandemic, with alternative pathways introduced to fulfill those requirements.

Pathways for Clinical and Communication Skills

Following the discontinuation of the USMLE Step 2 Clinical Skills (CS) examination in January 2021, the Educational Commission for Foreign Medical Graduates (ECFMG) introduced six pathways in 2021 to enable international medical graduates (IMGs) who had not previously passed Step 2 CS to meet the clinical and communication skills requirements for ECFMG Certification. These pathways, applicable to IMGs seeking eligibility for the National Resident Matching Program (NRMP) Main Residency Match, require applicants to have already passed USMLE Step 1 and Step 2 Clinical Knowledge (CK) exams, in addition to fulfilling one clinical pathway and the communication skills assessment. To be eligible for a given Match year, IMGs must submit their pathway application and supporting documentation, including Occupational English Test (OET) Medicine scores, by January 31 of that year. The application to a Pathway incurs a fee of $925. For the 2026 NRMP Match, OET Medicine must be taken by December 2025 with scores received by ECFMG by January 31, 2026; the application opens in August 2025. Pathway 1 allows IMGs who hold or have held a license to practice medicine independently (without supervision) in another country to demonstrate clinical skills. The license must be unrestricted, issued by a medical regulatory authority, and valid on or after January 1, 2021, with no disciplinary actions; provisional licenses qualify if they permit unsupervised practice. ECFMG verifies the license through primary-source documentation, such as a certificate of good standing submitted directly by the issuing authority. Pathway 2 is designed for IMGs who have passed an Objective Structured Clinical Examination (OSCE) required for medical licensure in their home country or region. The OSCE must have been administered by an acceptable medical school accredited by the relevant medical regulatory authority, with the requirement established before 2020, and the applicant must have graduated on or after January 1, 2023. This pathway applies to schools in regions without coverage by World Federation for Medical Education (WFME) or National Committee on Foreign Medical Education and Accreditation (NCFMEA) recognized agencies, and the school provides an attestation confirming the OSCE passage. Pathways 3, 4, and 5 focus on IMGs graduating from medical schools meeting specific accreditation standards that ensure robust clinical training, as attested by the school. Pathway 3 requires graduation on or after January 1, 2023, from a school accredited by an agency recognized by WFME, which sets global standards for medical education quality. Pathway 4 is for graduates from schools accredited by an agency deemed comparable to the U.S. Liaison Committee on Medical Education (LCME) by the NCFMEA, a U.S. Department of Education committee. Pathway 5 applies to those receiving a medical degree issued jointly with a U.S. LCME-accredited school, confirming equivalent clinical preparation. For all three, the medical school must complete ECFMG's Clinical Skills Attestation, verifying the applicant's readiness for unsupervised patient care. Pathway 6 provides an evaluation-based option for IMGs ineligible for Pathways 1 through 5 or those who previously failed Step 2 CS. It involves six in-person clinical encounters in primary care outpatient settings (such as internal or family medicine), assessed using ECFMG's Mini-Clinical Evaluation Exercise (Mini-CEX) form. Each encounter must be observed and evaluated by a different licensed physician with at least five years of unsupervised practice experience, focusing on skills in medical interviewing, physical examination, professionalism and communication, and clinical reasoning; the average score across encounters must be acceptable in all components. Evaluators submit assessments electronically via ECFMG's portal, with no compensation allowed from the applicant. The communication skills requirement for all pathways is met by achieving satisfactory scores on the OET Medicine, a profession-specific English language proficiency test for physicians. Applicants must obtain a minimum score equivalent to Grade B (350 for Listening, Reading, and Speaking sub-tests; 300 for Writing) on all four sub-tests in a single administration, with no exemptions regardless of native language. Scores must be from a test taken on or after January 1, 2024 for the 2026 Pathways, and released directly to ECFMG using the applicant's USMLE/ECFMG Identification Number during registration. If any sub-test score is below the minimum, the full OET Medicine must be retaken, with no limit on attempts.

Certificate Validity and Expiration

The ECFMG Certificate is issued to international medical graduates upon successful completion of all requirements, including the relevant Pathway for assessing clinical and communication skills. For certificates based on a Pathway, the standard validity period aligns with the expiration date of the accepted Pathway, typically December 31 of the second year following the Pathway's approval year (e.g., 2025 Pathways expire December 31, 2027), unless revalidated or permanently validated. Revalidation of an ECFMG Certificate is required annually for those with expiring or expired Pathways to maintain eligibility for key processes, such as applying for USMLE Step 3 or participating in residency programs. International medical graduates can apply for revalidation online through the ECFMG's MyInBox portal using the designated Pathways Revalidation application, which must be submitted before the Pathway's expiration to avoid lapses in certification status. This process is particularly relevant for applicants from earlier Pathway cycles, such as those approved in 2023, whose Pathways expire on December 31, 2025, without revalidation. The 2025 Pathways Revalidation application closed on May 31, 2025. Permanent validation removes the expiration from an ECFMG Certificate, making it valid indefinitely in ECFMG records. This status is achieved by completing at least 12 months of clinical education or training in an Accreditation Council for Graduate Medical Education (ACGME)-accredited program while sponsored on a J-1 visa through the ECFMG Exchange Visitor Sponsorship Program, or by obtaining an unrestricted medical license in a U.S. state, territory, or the District of Columbia. For J-1 visa holders, ECFMG automatically updates the certificate upon verification of the training completion; non-J-1 holders in training or license holders must submit a specific request form to ECFMG for verification and confirmation. An expired ECFMG Certificate significantly impacts an international medical graduate's professional opportunities, as it renders the holder ineligible to apply for or take USMLE Step 3 and disqualifies participation in the National Resident Matching Program (NRMP) Main Residency Match or entry into ACGME-accredited graduate medical education programs. To regain eligibility, the certificate must be revalidated or permanently validated prior to application submission, ensuring the Pathway remains current on testing dates and during the Match cycle.

Programs and Services

Visa Sponsorship and Exchange Visitor Program

The Educational Commission for Foreign Medical Graduates (ECFMG), now operating under Intealth, administers the Exchange Visitor Sponsorship Program (EVSP), which serves as the sole sponsor for J-1 visas for international medical graduates (IMGs) pursuing graduate medical education (GME) in accredited U.S. programs. Designated by the U.S. Department of State as a BridgeUSA sponsor since 1974, EVSP facilitates the entry of foreign national physicians into clinical training to enhance their medical skills while ensuring compliance with exchange visitor regulations. This program is essential for IMGs who must obtain ECFMG Certification as a prerequisite for sponsorship, enabling them to participate in ACGME-accredited residencies and fellowships. To qualify for J-1 sponsorship under EVSP, applicants must secure acceptance into an accredited GME program, provide a Statement of Need from their country's Ministry of Health confirming the training's to needs, and demonstrate to return after training. A key requirement is adherence to the two-year -country physical presence rule under Section 212(e) of the Immigration and Nationality Act, mandating that J-1 physicians return to their country of nationality or last legal residence for at least two years following program completion to share acquired knowledge; waivers are available through U.S. government processes for cases involving no objection from the country, exceptional hardship, or persecution fears. ECFMG verifies eligibility, issues the Form DS-2019 to authorize the visa, and coordinates with training program liaisons at host institutions to ensure all documentation aligns with federal regulations. EVSP's administration encompasses comprehensive support, including mandatory online orientation modules such as "The Spirit and Intent of the Exchange Visitor Program for Physicians," which educate participants on program expectations, cultural adaptation, and ethical obligations. Ongoing compliance monitoring involves verifying full-time program participation, health insurance coverage, and annual reporting to the Student and Exchange Visitor Information System (SEVIS); any deviations, such as unauthorized employment or program changes, can result in sponsorship termination and visa revocation. Sponsorship is limited to seven years total for postgraduate training, with restrictions on repeat or remedial training to no more than 12 months. The program supports a significant scale of international medical training, sponsoring more than 15,900 active J-1 physicians across U.S. teaching hospitals as of August 2025, with thousands of new and continuing sponsorships issued annually to address workforce needs in specialties like and . To promote well-being and integration, EVSP integrates resources such as the Journeys in Medicine blog, which features personal stories from J-1 physicians, hosts webinars on and cultural transitions, and offers grants for well-being projects tailored to exchange visitors. These initiatives underscore EVSP's role in fostering a supportive environment for IMGs contributing to U.S. delivery.

Credential Verification and Support Services

The Educational Commission for Foreign Medical Graduates (ECFMG) provides essential credential verification services to ensure the authenticity of international medical graduates' (IMGs') qualifications, facilitating their participation in U.S. graduate medical education and licensure processes. These services include primary-source verification of medical diplomas, transcripts, and certification status, conducted directly with issuing institutions to maintain high standards of integrity. Since 1986, ECFMG has verified credentials for all applicants seeking certification, comparing submitted documents against samples in its Medical Credentials Reference Library and communicating with medical schools in up to 10 languages as needed. ECFMG's verification of credentials requires IMGs to submit copies of their final and final transcript (plus any transcripts) through the MyIntealth portal. The organization then requests primary-source confirmation directly from the issuing , accepting only responses sent by authorized officials via secure methods such as official letterhead or encrypted email. This process is mandatory for ECFMG eligibility and incurs a fee of $200, comprising $100 for the and $100 for the transcript; additional charges of $52 per page apply for English translations arranged by ECFMG if documents are not in English. While timelines vary based on institutional , ECFMG monitors status updates in the MyIntealth portal and follows up on to expedite completion. The Certification Verification Service (CVS) offers primary-source confirmation of an IMG's ECFMG certification status to authorized entities, such as state medical boards, residency programs, hospitals, and employers. Recognized by bodies like The Joint Commission as an equivalent to direct school verification for foreign graduates and by the National Committee for Quality Assurance (NCQA) for IMGs licensed in the U.S. after 1986, CVS requires organizations to obtain the physician's signed authorization and submit requests via MyIntealth using the IMG's ID and birth date. Confirmations are typically delivered within two weeks, with reports costing $66 for state medical boards and other licensing authorities; for Electronic Residency Application Service (ERAS) applications, status reports are transmitted electronically without additional delay. IMGs may request their own status reports solely for licensing purposes, supporting seamless credential management. Through the of International Credentials (EPIC), ECFMG enables secure, lifelong storage and sharing of verified medical credentials, benefiting both physicians and global organizations. Physicians establish an EPIC Portfolio in MyIntealth for $30 after a one-time $100 account setup (including identity ), then upload credentials for primary-source verification at $100 per item—waived if previously verified for ECFMG certification. Once verified, credentials are stored electronically, and physicians can generate free initial EPIC Reports for sharing via secure links (valid for 90 days for one-time recipients or 18 months for partner organizations), with subsequent reports at $50 each. Optional courier of $15 (U.S.) or $30 (international) apply for verification requests; the process typically reviews prior verifications within 10 business days, allowing IMGs to build portable portfolios for advancement. ECFMG supports IMGs in the Electronic Residency Application Service (ERAS) by acting as their designated Dean's office, streamlining applications to U.S. residency programs managed by the Association of American Medical Colleges. This includes issuing season-specific ERAS Tokens for $165 via MyIntealth (available starting June 25 for the 2026 season), collecting supporting documents like ECFMG Certification Status Reports, and uploading them directly to MyERAS for program review. Applications become viewable by programs on September 24 following submission, with recommendations to submit medical school performance evaluations and transcripts by September 16 to meet deadlines; this service ensures verified credentials integrate efficiently into the residency matching process through the National Resident Matching Program.

Educational Initiatives and Grants

The Educational Commission for Foreign Medical Graduates (ECFMG), as a division of Intealth, supports global medical education through its FAIMER division, which provides leadership and faculty development programs for international health professions educators. FAIMER's flagship offerings include the International FAIMER Institute, a two-year fellowship focused on advancing educational methodologies, curriculum design, and leadership skills in medical training. Additionally, FAIMER operates regional institutes, such as the Eastern Africa FAIMER Regional Institute (EAFRI), which deliver part-time fellowships tailored to local needs, emphasizing competency-based education and community-oriented health professions training. These programs have fostered a network of over 2,000 fellows worldwide, contributing to reforms in medical education in more than 50 countries by enhancing teaching quality and accreditation standards. ECFMG's well-being initiatives include annual grants administered through Intealth, awarding up to $5,000 each to J-1 physician-led projects that address mental health, cultural adaptation, and professional integration for international medical graduates (IMGs). Launched in 2023, the program has funded innovative efforts such as wellness workshops and peer support systems at U.S. institutions, and plans to award three grants in 2025 to projects tackling isolation and transition challenges among foreign national physicians. For instance, a 2024 grant supported the "IMG Taskforce" at Children’s National Hospital, which established mentorship pairings and resource guides to improve IMG retention and satisfaction during training. These grants, partially funded by the U.S. Department of State, prioritize scalable interventions that enhance overall physician well-being and patient care outcomes. Complementing these efforts, Journeys in Medicine is an ECFMG blog initiative that builds community by sharing personal stories from current and former J-1 physicians and their host institutions, highlighting experiences in cross-cultural adaptation and clinical growth. The platform encourages submissions to create a supportive network, offering practical insights on navigating U.S. medical training and reducing feelings of isolation among IMGs. IMG empowerment initiatives, funded through Intealth grants, include events, mentorship programs, and adaptation workshops designed to foster leadership and inclusion for IMGs. A notable example is the 2023 "Alone We Survive, Together We Thrive" project at Cincinnati Children’s Hospital, which received a $5,000 grant to organize cultural outings, buddy systems, and DEI committee representation, resulting in improved community ties and reduced adaptation barriers for J-1 trainees. These initiatives emphasize collaborative environments to empower IMGs in their professional journeys.

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