ECFMG Explained

ECFMG is an acronym, which stands for Educational Commission for Foreign medical graduates. It is a certification, which assesses all International Medical Graduates (IMG) whether or not they are ready to enter any residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME), upon completion of which they shall be working as a licensed medical doctor in the United States. ECFMG certification is also a prerequisite for International Medical Graduates (IMG) to appear for Step 3 of United States Medical Licensing Examination (USMLE). It does not however, give any guarantee that upon completion of this certification, the candidate will be accepted into a residency program. With each year passing, more and more IMG are applying for residency programs in the Unites states in comparison to the available positions in residency programs.

Who is an International Medical Graduate (IMG)?

ECFMG and its organizational members define an international medical graduate as a physician who received his/her basic medical degree or qualification from a medical school located outside the United States and Canada. Citizens of the United States who have completed their medical education in schools outside 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.

  • Requirements for an ECFMG certification

There are broadly 3 types of requirements for ECFMG certifications:

  1. Application for ECFMG certification – The application requires the applicants have to provide the following eligibility requirements– Name, contact information and graduation certification from the medical college (The medical college should be listed in the World Directory of Medical Schools). In case the medical school is not listed in the World directory, the candidate is not eligible to apply for the certification.
  2. Examination requirement – In order for the candidate to appear for the certification exam, he needs to fulfill the following two conditions:
  • He should have successfully completed Step 1 and Step 2 (Clinical Knowledge) exams of USMLE
  • He should have also successfully completed the Step 2 (Clinical skills) exam of USMLE.


For candidates, who clear the Step 2 (clinical skill) USMLE exam, their result is not subject to expiration for the purpose of entering U.S. programs of graduate medical education. However, there are certain time limits that the candidate has to adhere to with subject to using the passing results of the USMLE steps.

  • ECFMG policy states that once a IMG has successfully completed a step or a component of a step, the candidate has 7 years to successfully pass all of the other steps and steps component for getting an ECFMG certification.
  • The state medical licensing authorities require the IMG to complete all USMLE steps (inclusion step 3) within seven years for a candidate to achieve a license.
  • Candidates who have appeared for the Clinical Skills Assessment (CSA) are required to pass only Step 1 & Step 2 (CK) within 7 years of each other for ECFMG certification.
  • If a candidate has passed any step before June 14, 2004, they are required to pass Step 1 and Step 2 CK within 7 years to get the ECFMG certification.
  1. Medical Education Credential Requirements 

The physician’s medical school must be listed in the World Directory as meeting eligibility requirements for its students and graduates to apply to ECFMG for ECFMG Certification and examination. For those medical schools that meet ECFMG eligibility requirements, there will be an ECFMG note on the Sponsor Notes tab of the schools’ World Directory listing. If there is no ECFMG note on medical school’s Sponsor Notes tab, then the candidate is not eligible to apply to ECFMG for ECFMG Certification or examination.

What does a Standard ECFMG certificate contain?

  • The name of the Candidate.
  • The USMLE/ECFMG identification number of the candidate.
  • The dates when the examination requirement are met
  • The date when the certificate was issued.

Eligibility for the exam

  • For Medical School Students – For a candidate to be eligible for Step 1, Step 2 CK and Step 2 CS, he/she should be enrolled in a medical school located outside of US and Canada that is listed in the World Directory both at the time of submitting the application for the exam and on the date of appearing for the exam.
  • For Medical School Graduates – For a candidate to be eligible for Step 1, Step 2 CK and Step 2 CS, he/she should be enrolled in a medical school located outside of US and Canada that is listed in the World Directory. The graduation year of the candidate should be mentioned on the Sponsor note tab of the medical school World Dictionary. ECFMG also seeks validation from a authorized official of the candidate’s medical school that the candidate is a graduate of that medical school.
  • If the candidate’s eligibility for the exam changes after application is submitted, the candidate has to inform ECFMG immediately.
Posted in IMG