Medical schools outside the United States and Canada vary in educational standards, curriculum, and evaluation methods. The Educational Commission for Foreign Medical Graduates (ECFMG), through its program of certification, assesses whether physicians graduating from these schools are ready to enter programs of graduate medical education in the United States.
This Fact Sheet is intended to provide international medical school students and graduates (IMGs) interested in graduate medical education in the United States with basic information on ECFMG Certification, as well as next steps and additional resources for those who are ready to begin the certification process.
The definitive resource on ECFMG Certification is the ECFMG Information Booklet. The definitive resource on the United States Medical Licensing Examination® (USMLE®) is the USMLE Bulletin of Information. Before applying for examination and certification, you must read the applicable editions of these publications. In the event that information in this Fact Sheet differs from the corresponding information in the ECFMG Information Booklet / USMLE Bulletin of Information, the latter publications will contain the most current and accurate information.
The purpose of ECFMG Certification is to assess the readiness of IMGs to enter U.S. residency and fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). If you wish to enter such a program, you must be certified by ECFMG before you can start the program. ECFMG Certification is also required before applying to take Step 3 of the United States Medical Licensing Examination (USMLE). In the United States, to obtain a license to practice medicine, physicians must apply directly to the jurisdiction where they plan to practice medicine. Licensing jurisdictions in the United States require that IMGs applying for unrestricted licensure be certified by ECFMG.
To be certified by ECFMG, you must satisfy ECFMG’s medical education credential requirements. You must also pass a series of exams. Applicants who satisfy all requirements are issued ECFMG’s Standard ECFMG Certificate.
Eligibility & Requirements
To apply for ECFMG Certification, you must be an international medical student or graduate. This means that your medical school is located outside the United States and Canada. U.S. citizens who graduate from such schools are considered IMGs and are eligible to apply for ECFMG Certification. Non-U.S. citizens who graduate from schools in the United States and Canada are not considered IMGs and are not eligible for ECFMG Certification.
Additionally, your medical school must be listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER®). If you are a medical school graduate, your graduation year must be included in your school’s IMED listing. If you are a student, the “Graduation Years” in IMED for your medical school must be listed as “Current.” You can access IMED on the ECFMG website.
- To be eligible for certification, you must graduate from a medical school that meets the requirements described above, and fulfill the following additional medical education credential requirements
• You must have had at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) at a medical school listed inIMED.
There are restrictions on credits transferred to the medical school that awards your medical degree that can be used to meet this requirement.
• You must document the completion of all requirements for, and receipt of, the final medical diploma. ECFMG will verify your medical school diploma with the appropriate officials of the medical school that issued the diploma and request that the medical school provide your final medical school transcript. Verification by ECFMG with the issuing school may also be required for transcripts that you submit to document transferred credits. Your credentials are not considered complete until ECFMG receives verification directly from the issuing school(s) and accepts this verification.
Applicants for ECFMG Certification must also satisfy the following examination requirements:
• Medical Science Examination. USMLE Step 1 and Step 2 Clinical Knowledge (CK) are the exams currently administered that satisfy this requirement. Applicants register for these exams with ECFMG and take these exams worldwide at test centers of Prometric™. ECFMG also accepts certain former medical science exams to fulfill this requirement. Refer to the ECFMG Information Booklet for more information.
• Clinical Skills Requirement. USMLE Step 2 Clinical Skills (CS) is the exam currently administered that satisfies this requirement. Applicants register for Step 2 CS with ECFMG and take the exam at one of several regional clinical skills evaluation centers in the United States. Applicants who have both passed the former ECFMG Clinical Skills Assessment (CSA®) and achieved a score acceptable to ECFMG on an English language proficiency test (such as the Test of English as a Foreign Language™ [TOEFL®] or the former ECFMG English Test) can use these passing performances to fulfill this requirement. Refer to the ECFMG Information Booklet for more information.
Step 1, Step 2 CK, and Step 2 CS are the same exams taken by graduates of U.S. and Canadian medical schools. Detailed information on the USMLE is available on theUSMLE website.
Refer to the ECFMG website for information on exam eligibility, fees, application, scheduling, test centers, preparation, and orientation and practice materials.
Applying for ECFMG Certification
The certification process begins when you apply to ECFMG for a USMLE/ECFMG Identification Number. You must have your number before you can apply for examination. Before applying for examination, you must also read the applicable editions (those that pertain to the eligibility period in which you take the exam) of the ECFMG Information Booklet and the USMLE Bulletin of Information. Both publications are available on this website. To apply for the required exams, use ECFMG’s Interactive Web Application (IWA), available on this website. Detailed instructions accompany the application.
Both medical school students and graduates can begin the certification process. You can apply for the required exams as soon as you meet the exam eligibility requirements. All of the required exams are offered continuously throughout the year. However, since one of the requirements for ECFMG Certification is verification of your final medical diploma with your medical school, you cannot complete the certification process until you graduate and receive the diploma.
There is no time limit for completing the certification process. However, there are specific time requirements for completing the exams for ECFMG Certification and medical licensure. These requirements are described in the ECFMG Information Booklet and USMLE Bulletin of Information, respectively.
The academic year for U.S. graduate medical education programs typically begins in July. You must be certified by ECFMG before your program’s start date, although you can apply to programs before becoming certified. In planning the timing of your exam application and scheduling, you should also consider deadlines imposed by the programs to which you plan to apply and the National Resident Matching Program. See Applying to Graduate Medical Education Programs below.
Applying to Graduate Medical Education Programs
The Graduate Medical Education Directory, published by the American Medical Association (AMA), is recognized as the official list of ACGME-accredited graduate medical education programs. For each medical specialty, the Directory provides general and special requirements and specific information on each program in that specialty. You can order the Directory on the AMA website. Application deadlines vary among programs. You should contact programs directly for information on their deadlines.
Most programs require applicants to submit their applications using the Electronic Residency Application Service (ERAS®). ERAS was developed by the Association of American Medical Colleges (AAMC) to transmit residency applications via the Internet. ECFMG coordinates the ERAS application process for IMGs. ERAS information for IMGs is available on this website. Programs that do not participate in ERAS require applicants to use paper application materials. You should contact programs directly for their requirements.
The National Resident Matching Program (NRMP), also known as “the Match,” matches applicants with available residency positions in the programs to which they have applied. If you wish to participate, you must register with the NRMP. Refer to the NRMP website for requirements and deadlines, as well as information on the numbers of IMGs who have obtained residency positions through the Match in recent years.
Obtaining a Visa
IMGs who are neither citizens nor lawful permanent residents of the United States must obtain an appropriate visa to participate in U.S. graduate medical education programs. A common visa employed for this purpose is the J-1 visa. ECFMG is authorized by the U.S. Department of State to sponsor foreign national physicians for the J-1 visa. Information on eligibility and deadlines is available from ECFMG’s Exchange Visitor Sponsorship Program. Additional information is available from the U.S. Department of State Exchange Visitor Program. General information on the entry of foreign nationals to the United States is available from U.S. Citizenship and Immigration Services and theU.S. Department of Homeland Security.
The ECFMG website provides access to important updates, application materials, and publications, including:
ECFMG Information Booklet, including the Reference Guide for Medical Education Credentials
USMLE Bulletin of Information
International Medical Education Directory
Interactive Web Application (IWA)
The ECFMG Reporter – ECFMG’s free e-mail newsletter for IMGs interested in ECFMG Certification. Subscribe
ECFMG Fact Card – summary annual data on IMGs pursuing ECFMG Certification
Applying to Graduate Medical Education Programs
Graduate Medical Education Directory
AAMC ERAS website
ERAS Support Services at ECFMG
ECFMG-ERAS News – ECFMG’s free e-mail newsletter for IMGs participating in ERAS. Subscribe
National Resident Matching Program
ECFMG Exchange Visitor Sponsorship Program
ECFMG® J-1 Visa Sponsorship Fact Sheet
U.S. Department of State Exchange Visitor Program
U.S. Citizenship and Immigration Services
U.S. Department of Homeland Security
ECFMG representatives are available to answer your questions by
e-mail at firstname.lastname@example.org, or
phone at (215) 386-5900 from 9:00 a.m. to 5:00 p.m., Eastern Time in the United States, Monday through Friday.
ECFMG is a private, nonprofit organization committed to promoting excellence in international medical education. ECFMG’s aims and missions include providing information to IMGs regarding entry into graduate medical education and health care systems in the United States, evaluating the qualifications of IMGs, and providing international access to testing and evaluation programs.
ECFMG’s organizational members are:
American Board of Medical Specialties
American Medical Association
Association of American Medical Colleges
Association for Hospital Medical Education
Federation of State Medical Boards of the United States, Inc.
National Medical Association