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ECFMG CERTIFICATION
The Educational Commission for Foreign Medical Graduates (ECFMG), through its program of certification, assesses whether international medical graduates are ready to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).
ECFMG and its sponsoring organizations define an international medical graduate as a physician who received his / her basic medical degree or qualification from a medical school located outside of the United States and Canada**. To be eligible for ECFMG certification, the physician's medical school and graduation year must be listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER®). To verify that a particular medical school and graduation year are listed, access IMED on this website.
Citizens of the United States who have completed their medical education in schools outside of the United States and Canada are considered international medical graduates; non-U.S. citizens who have graduated from medical schools in the United States and Canada are not considered international medical graduates.
ECFMG certification assures directors of ACGME-accredited residency and fellowship programs, and the people of the United States, that international medical graduates have met minimum standards of eligibility required to enter such programs. ECFMG certification does not, however, guarantee that these graduates will be accepted into programs since the number of applicants frequently exceeds the number of available positions.
ECFMG certification is one of the eligibility requirements to take Step 3 of the three-step United States Medical Licensing Examination (USMLE). Most states in the United States also require ECFMG certification, among other requirements, to obtain a license to practice medicine.
Requirements for ECFMG Certification
To be eligible for certification by ECFMG, international medical graduates must meet the following requirements:
1. Pass the basic medical and clinical science components of the medical science examination within a seven-year period. Step 1 (basic medical) and Step 2 (clinical) of the United States Medical Licensing Examination are the exams currently administered that meet this requirement. See Medical Science Examination and Formerly-Administered Medical Science Examinations Acceptable for ECFMG Certification.
Important Note: This policy applies only to ECFMG certification. The USMLE program has made specific recommendations to state medical licensing authorities regarding the time to complete all three Steps and the number of attempts allowed to pass each Step. If you are taking the Steps for the purpose of licensure, refer to Time Limit and Number of Attempts Allowed to Complete All Steps, Formerly Administered Examinations, and Retakes on page 5 of USMLE Bulletin of Information for more information. You should also contact the medical licensing authority of the jurisdiction where you plan to apply for licensure or the Federation of State Medical Boards, since licensure requirements vary among jurisdictions.
2. Pass the English language proficiency test. Applicants can satisfy this requirement by achieving a score acceptable to ECFMG on the Test of English as a Foreign Language (TOEFL) and requesting that ECFMG accept the TOEFL score in fulfillment of this requirement. A passing performance on the former ECFMG English Test is also accepted by ECFMG to meet the English language proficiency requirement for ECFMG certification. Passing performance on either test is valid for two years from the date passed for the purpose of entry into graduate medical education. See English Language Proficiency Test.
3. Pass the Clinical Skills Assessment (CSA). The CSA is a one-day exam that requires examinees to demonstrate clinical proficiency, spoken English language proficiency and appropriate interpersonal skills. To be registered for the CSA, applicants must have passed USMLE Step 1 and satisfied the English language proficiency requirement. Passing performance on the CSA is valid for three years from the date passed for the purpose of entry into graduate medical education. See Clinical Skills Assessment.
Medical Education Credential Requirements
The physician's medical school and graduation year must be listed in the International Medical Education Directory (IMED). International medical graduates must have had at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) in attendance at a medical school that is listed in IMED. Applicants for ECFMG certification must document the completion of all requirements for, and receipt of, the final medical diploma. ECFMG requires all applicants for certification to submit the final medical diploma. ECFMG sends all medical diplomas to appropriate officials of the medical schools that issued the documents for verification. You will not fulfill the medical education credential requirements for ECFMG certification until ECFMG receives verification of your medical diploma directly from the medical school. See Medical Education Credentials.
The International Medical Education Directory is available on this website. The Directory is maintained by the Foundation for Advancement of International Medical Education and Research (FAIMER), a non-profit foundation of ECFMG. The Directory contains information supplied by countries about their medical schools. FAIMER is not an accrediting agency.
Important Note: Submitting altered or falsified documents to ECFMG may be sufficient cause for ECFMG to bar you from the exam, to terminate your participation in the exam, to withhold and / or invalidate the results of your exam, to withhold a certificate, revoke a certificate or to take other appropriate action. ECFMG may also report instances of altered or falsified documents to the USMLE Committee on Irregular Behavior, state medical licensing authorities and directors of graduate medical education programs or to any other organization or individual who, in the judgment of ECFMG, has a legitimate interest in such information.
In all cases when the ECFMG Committee on Medical Education Credentials, the CSA Committee on Irregular Behavior or the USMLE Committee on Irregular Behavior has taken an action with respect to an examinee, an annotation will be included in the ECFMG Status Report and ECFMG Certification Verification Service (CVS) Report.
Representative Examples of Irregular Behavior
Summary of ECFMG Certification Requirements
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Examination Requirements Pass:
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Medical Education Credential Requirements
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ECFMG issues the Standard ECFMG Certificate to applicants who meet all of the examination and medical education credential requirements. Applicants must also pay any outstanding charges on their ECFMG financial accounts before their certificates are issued. Standard ECFMG Certificates are sent approximately two weeks after all of these requirements have been met. Currently, ECFMG sends the Standard ECFMG Certificate to the applicant's address of record by Federal Express.
The Standard ECFMG Certificate includes:
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Applicants may use the Standard ECFMG Certificate to enter an accredited program of graduate medical education as long as the program's start date is before both of the valid through dates (English test and Clinical Skills Assessment) on the Standard ECFMG Certificate.
Revalidation of the Certificate for Entering Graduate Medical Education
Two of the exam dates on the Standard ECFMG Certificate are subject to expiration for the purpose of entering graduate medical education programs. The English test date is valid for two years from the most recent date of passing performance. The Clinical Skills Assessment date is valid for three years from the most recent date of passing performance.
If the English test date on your Standard ECFMG Certificate has expired, you must take the TOEFL exam and achieve a score acceptable to ECFMG before you can enter a program of graduate medical education. If the CSA date on your Standard ECFMG Certificate has expired, you must pass another CSA before you can enter a program of graduate medical education. Once you meet these exam requirements, ECFMG will mail your revalidation sticker for the appropriate exam. You must attach the revalidation sticker to your Standard ECFMG Certificate, following the instructions that accompany the sticker. Each revalidation sticker is unique and includes the same Identification Number that is on your Standard ECFMG Certificate.
If your English test and / or CSA dates expire before your Standard ECFMG Certificate is issued, you may revalidate these dates, as described above, prior to becoming certified by ECFMG. In this event, the English test / CSA valid through dates on your Standard ECFMG Certificate will reflect your most recent passing performances on these exams.
Permanent Validation of the Certificate Following Entry into Graduate Medical Education
After you enter an ACGME-accredited program of graduate medical education in the U.S., you can request permanent validation of your Standard ECFMG Certificate. This means that the English test and CSA dates are no longer subject to expiration. To receive the appropriate valid indefinitely sticker for the certificate, you and an authorized official of your training institution must complete the Request for Permanent Validation of Standard ECFMG Certificate (Form 246) and send it to ECFMG. Form 246 is available on this website. ECFMG also sends Form 246 to all applicants with their Standard ECFMG Certificates.
After ECFMG receives and verifies the information contained on the form, a sticker indicating valid indefinitely status will be mailed to you. You must attach the sticker to your Standard ECFMG Certificate, following the instructions that accompany the sticker. Each sticker is unique and includes the same Identification Number that is on your Standard ECFMG Certificate.
Confirmation of ECFMG Certification Status - ECFMG's Certification Verification Service
ECFMG's Certification Verification Service provides primary-source confirmation of the ECFMG certification status of international medical graduates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has determined that an accredited health organization will satisfy the Joint Commission requirement for primary-source verification of medical school completion for international medical graduates if it confirms directly with ECFMG that an applicant possesses a valid Standard ECFMG Certificate.
ECFMG will confirm your certification status when a request is received in writing from a medical licensing authority, residency program director, hospital or other organization that, in the judgment of ECFMG, has a legitimate interest in such information. For status reports sent to medical licensing authorities, the request can also be sent to ECFMG by you. Requesting organizations must normally secure and retain your signed authorization to obtain certification information. Please note that there may be a fee for this service.
Requests for confirmation must contain your name, date of birth, USMLE / ECFMG Identification Number, and name and address of the organization to which the confirmation should be sent. You may obtain the appropriate request form from this website. Confirmations are mailed to the requesting organization within approximately two weeks. Confirmations are not sent to applicants directly.
If you apply to residency programs through ERAS, ECFMG will send an electronic ECFMG status report automatically, at the time that your application is processed, to all of the programs to which you applied. If your ECFMG certification status changes during the ERAS application process, ECFMG will send an updated status report automatically to all programs to which you applied.
** The United States and Canada refer to the geographic locations where citizens are issued passports by the governments of either the United States or Canada.
Copyright © 2002-2003 by the Educational Commission for Foreign Medical Graduates. All rights reserved.
Portions reprinted, with permission, from the USMLE 2003 Bulletin of Information. Copyright © 2002 by the Federation of State Medical Boards of the United States, Inc., and the National Board of Medical Examiners® (NBME®).