Understanding ECFMG Certification: The Ultimate Guide

Earning a US Residency for an IMG requires obtaining the ECFMG Certificate. As an international medical graduate (IMG), there are many applications and certifications to complete to move on to the next stages in the process. To begin the journey of practicing medicine in the United States, the Educational Commission for Foreign Medical Graduates (ECFMG) Certificate is required to continue on to your residency or fellowship as well as qualify for Step 3 of the Medical Licensing Examination (USMLE). This the IMGPrep 2024 guide for becoming ECFMG certified.

What Is the ECFMG Certificate?

The ECFMG Certificate is the qualifying entity which allows medical students from other countries to Match for residencies and fellowships and practice medicine in the United States. There is a lengthy application process which has multiple steps and fees and must be timed appropriately to match up with the time-sensitive Pathways applications. Once you are certified and complete your residency or fellowship in the US, you are considered ECFMG certified for life.

Who Can Qualify to Become ECFMG Certified?

IMGs who attended medical schools which qualify for ECFMG certification are eligible. You can verify that your medical school is eligible for ECFMG through the World Directory and checking under the “Sponsor Notes”.

What Are the Requirements for the ECFMG Certificate?

There are several steps before you can even begin the ECFMG Certification process. Closely review the following steps and determine where you are at or what else you need as you begin your ECFMG Certification.

1. Medical School Requirements
2. Application for Certification
3. Exam Requirements
4. Medical Education Requirements

Medical School Requirements

To be eligible for the ECFMG Certification and to be able to practice medicine in the United States, you must have graduated from a medical school that meets the standards set in place by the ECFMG. You can check your school’s eligibility by going to the World Directory of Medical Schools website: Find your school and check the “Sponsor Notes”.

Application for ECFMG Certification

ECFMG applicants must submit an Application for Certification. The application itself reinforces the applicant’s intent for obtaining the certification as well as further encourages an understanding of the certification’s purpose. There is an online application as well as the Certification of Identification Form (Form 186) to complete for consideration. You can apply here.

Examination Requirements

Applicants for the ECFMG Certification must complete the medical science examination portion which requires successful completion of Step 1 and Step 2 of the Clinical Knowledge (CK) part of the USMLE. The clinical and communication skills requirements must also be successfully completed.

1. An ECFMG Pathway must be completed by either earning a passing score on the OET; or
2. The applicant must have passed the old Step 2 CS portion of the USMLE.
   1. For any components of the USMLE, the applicant will have 7 years to fulfill the remainder of the steps before any scores and accompanying applications become invalid.

Medical Education Requirements

In addition to your school being eligible for ECFMG Certification, you must have also graduated within the given timeframe according to the ECFMG standards (listed in the World Directory’s “Notes” section of the school page). You must have completed at least four years at the school; there are different and more restrictive requirements for accumulating transfer credits.

All of the applicant's medical school, credits, and diploma information must be accurately tracked and completed. Consult this reference sheet to determine the final medical transcript and diploma information needed.

Once all of the aforementioned requirements have been met, the applicant is considered to be eligible for the ECFMG Certification and thus begin the process. 

What Are the Pathways?

The Pathways are what IMGs can use to successfully complete the clinical and communication skills requirement for the ECFMG Certification. You will need to apply for Pathways to be able to participate in the 2024 National Resident Matching Program® (NRMP®).

Due to the time-sensitive nature of the Pathways, you must coordinate your application with your ECFMG Certification application and relevant deadlines with respect to The Match deadline for the year.

Once you determine your eligibility and the timing aligns, you can apply here. You will also need to consider the timing of any supplemental testing or documentation you may need. For example, to fulfill the communications skills requirement, you must pass the OET before you are able to complete the Pathways application, which can potentially impede your eligibility for the year’s Match session.

What Is the OET?

As a part of the Communication Skills requirement of the ECFMG certification, you must pass the Occupational English Test (OET). This test is not a typical English language proficiency test but rather is designed for physicians by physicians. Wherever your country of origin or native language, you must pass this test to remain eligible for the ECFMG certification.

The test is made up of four sections: listening, reading, writing, and speaking.

How Do I Register for the OET?

To register for the OET, you must create an account and register for the exam on the OET website. There, you will find test locations, exam dates, preparation materials, and additional resources. The steps for registration are as follows:

1. Go to OET.com and select “Book a Test” at the top right corner of the page.
2. Enter your location on the next page. This should be the physical location that you plan on taking the exam. There are three ways you can take the exam: In person on paper, on a computer at a testing site, and at home. A list of options will populate identifying location and type of test.
3. Select “Book Now” for the option that best suits you and follow the prompts to complete registration.
4. Pay the exam fee after you complete registration.

What Are the Fees for ECFMG Certification?

There are many fees associated with becoming ECFMG certified. The following table includes the basics of what you will need to pay. There are additional fees for services like international testing, translation, transcripts, and more; review the complete list here to determine what else you will need to pay for.

Does the ECFMG Certificate Expire?

Once you apply and get approved for your ECFMG Certification, you will have about two years to successfully enter your ACGME-accredited training program. If you do not enter or complete your first training year before the expiration date–you will be notified of this date when you receive your certification–your certification will become invalid and you must reapply, including paying the fees again. To closely follow news and updates for the ECFMG Certification, visit the website.

Need Help Finding IMG Friendly Residency Programs?

Since our establishment in 2005, IMGPrep has been devoted to helping international medical graduates (IMGs) seeking a medical residency in the United States. Each IMG residency applicant works one-on-one with an IMGPrep specialist who reviews their unique credentials and recommends steps to showcase their strengths and overcome any deficiencies.

Our experts provide complete guidance about how to earn a medical residency in the USA through a custom individual plan to help maximize the chances of an IMG residency match. Once an applicant passes the exam, finding and applying for IMG friendly residency programs is essential to their success. Learn more about program options in this list.