• About This Publication
• General Information
• Description Of The CSA
• Test Regulations
• Registration And Scheduling
• Common Questions
• Glossary And Common Abbreviations
• References

CSA Candidate Orientation Manual: PDF Format - for printing/downloading (1.0 MB)

ECFMG Home > Publications > CSA Candidate Orientation Manual > Common Questions

Common Questions

1. What are the eligibility requirements for the CSA?
To be registered for the CSA, you must have passed USMLE Step 1 (or its equivalent) and satisfied the English language proficiency requirement for ECFMG certification.

If you are a medical school student, you must be officially enrolled in a medical school located outside of the United States and Canada that is listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER^®), both at the time that you apply and at the time you take the CSA. You must also be within twelve months of completing the full didactic curriculum at the time you take the CSA.

If you have graduated, you must be a graduate of a medical school located outside of the United States and Canada that is listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER^®). Your graduation year must be included in the school's IMED listing. You 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.

You can access IMED on the ECFMG Home Page.

Applicants who, as of June 30, 1998, had met all ECFMG certification requirements in effect through this date are not required, but are permitted, to take the CSA.

2. Is USMLE Step 3 a certification requirement and a prerequisite to the CSA?
No. Passing USMLE Step 3 is not a prerequisite for the CSA or ECFMG certification. The individual U.S. medical licensing authorities, not ECFMG, administer USMLE Step 3 as part of their licensing examination requirements. Questions regarding Step 3 should be addressed to the Federation of State Medical Boards (FSMB).

3. How do I apply for the CSA?
You can apply for the CSA on-line using ECFMG's Interactive Web Application (IWA) on the ECFMG Home Page. You can also complete a paper application (Form 706) and send it to ECFMG by mail (or courier service). Form 706 is available on the Publicatons Page of this website, and from ECFMG, upon request.

Once your completed application and payment are received at ECFMG, and you are determined to be eligible, ECFMG will mail your notification of registration, which includes information on scheduling your CSA. You must schedule the CSA within four months of, and must take the CSA within one year of, the date indicated on your notification of registration. If you do not meet these deadlines, you will be required to submit a new application and fee to take the CSA.

After you schedule your assessment, ECFMG will mail an admission permit confirming the date, time and location of your assessment. You must present this admission permit when you arrive at the CSA Center.

4. What is the application deadline for the CSA?
Since the CSA is offered throughout the year, there is no application deadline. However, in planning the timing of your application and scheduling your assessment date, you should consider deadlines imposed by the National Resident Matching Program and GME programs.

5. What is the fee for the CSA?
The CSA fee is $1,200 (U.S. dollars/Fee subject to change). Payment of the CSA fee is due at the time of application.

6. How often is CSA administered?
Daily, depending on demand, except for major U.S. holidays.

7. Where is CSA administered?
ECFMG administers the CSA at the following locations:

Information on the location of your assessment will be available during the CSA scheduling process.

8. How long do CSA administrations last?
The duration of the CSA, including orientation, testing, and breaks, is approximately eight hours.

9. Will I be required to diagnose and treat real patients?
No. The CSA consists of encounters with standardized patients (SPs), lay persons trained to accurately and consistently portray patients. The SPs will respond to your questions with answers appropriate to the case and, upon physical examination, will demonstrate appropriate physical findings. You will be expected to proceed through each encounter with an SP as you would with a real patient, but you should not do treatment of any kind.

10. Is a proctor present during the encounters with SPs?
No. However, all encounters are videotaped for research and quality control purposes. In addition, all encounters can be observed in real time by both video and one-way mirror.

11. Following an encounter with an SP, am I required to present the case history, diagnosis, management plan, or other material related to the encounter, in writing or orally?
You are required to compose a written record of each patient encounter.

12. What are the qualifications of the SPs who document the clinical skills and evaluate the doctor-patient communication of candidates?
The SPs are lay people who undergo extensive training and evaluation prior to participation in the CSA.

13. How many SP encounters do I need to pass in order to pass the CSA?
Passing performance on the CSA is not based on passing a specific number of encounters, but rather overall performance on the CSA components.

14. How soon after the CSA are results available?
Reports of performance on the CSA are mailed to candidates typically within six to eight weeks of the assessment date.

15. Do scores consist of a PASS/FAIL designation or numeric value?
A report of performance on the CSA consists of a pass/fail designation.

16. If I fail the CSA, how can I retake it?
If you have not passed the CSA, you may continue to take the CSA until you pass it. Once you pass the CSA, you may only retake it to revalidate your CSA valid through date (see Question 18).

For each attempt on the CSA, you must submit an application and assessment fee. Additionally, there are specific, minimum waiting periods between CSA attempts. Please note that these waiting periods will change for examinees who fail the CSA on or after February 1, 2003. These reexamination policies apply to applicants taking the CSA for ECFMG certification and to individuals taking CSA to revalidate their CSA valid through dates. For complete information, refer to the Announcements Page of this website and to the appropriate edition of the ECFMG Information Booklet.

If you fail the CSA, your score report will provide information on the areas in which you did not meet CSA standards. If you fail the CSA, you should consider obtaining more formal training in these areas before retaking the CSA.

17. Do I need to pass the CSA to participate in the NRMP Match?
To participate in the Match, you must have passed all examinations necessary for ECFMG certification. Therefore, if you are required to pass the CSA for ECFMG certification, you must pass the CSA to participate in the Match.

18. If the CSA date on my Standard ECFMG Certificate has expired, do I have to pass the CSA again before entering an ACGME-accredited program of graduate medical education?
For the purpose of entering accredited GME programs, the CSA date indicated on the Standard ECFMG Certificate is valid for three years from the most recent date of passing performance on the CSA. If the CSA date has expired, you must revalidate the CSA date before you can enter such a program. To revalidate the CSA date for an additional three year period, you must pass a subsequent CSA. Once you enter an accredited GME program in the U.S., you can request permanent validation of the Standard ECFMG Certificate. Permanent validation means that the CSA valid through date (and the English test valid through date) is no longer subject to expiration.

19. If I am certified by ECFMG but have not taken the CSA, will I be at a disadvantage in obtaining a residency position compared to applicants who have passed the CSA?
The criteria for selecting applicants for residency positions are determined by individual graduate medical education programs. The number of applicants frequently exceeds the number of residency programs available. Historically, programs select from the pool of applicants those individuals who have met the requirements that are current at the time of selection. However, this does not necessarily mean that applicants who were certified under a previous set of requirements will not be selected for residency positions at such programs.