Foreign medical graduates educational commission for foreign medical graduates



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Example: An international medical graduate passed Step 1 on April 1, 2008, and passed Step 2 CK on

May 1, 2009. She had through April 1, 2015 (seven years from her Step 1 passing performance) to pass

Step 2 CS, satisfying the remaining exam requirements for ECFMG Certification. She did not pass Step 2

CS by April 1, 2015, so her passing performance on Step 1 is no longer valid for ECFMG Certification. Her

earliest USMLE passing performance that is valid for ECFMG Certification is now the Step 2 CK passing

performance on May 1, 2009. She now has through May 1, 2016 (seven years from her Step 2 CK passing

performance) to pass Step 1 and Step 2 CS, satisfying the remaining exam requirements for ECFMG

Certification. If she does not pass Step 1 and Step 2 CS by May 1, 2016, her passing performance on Step

2 CK will no longer be valid for ECFMG Certification.

There are exceptions to this policy:

This seven-year limit does not apply to the former ECFMG CSA because the CSA was not a USMLE Step or

Step Component. International medical students/graduates who satisfied the clinical skills requirement for

ECFMG Certification by passing the CSA are required to pass only Step 1 and Step 2 CK within seven years of

each other for ECFMG Certification. For these individuals, the seven-year period begins on the exam date of

the first USMLE Step or Step Component passed, regardless of when the CSA was passed.

If your earliest USMLE passing performance that is valid for ECFMG Certification took place before June 14,

2004, you are required to pass only Step 1 and Step 2 CK within seven years of each other for ECFMG

Certification; if required for ECFMG Certification, Step 2 CS can be passed outside the seven-year period.



Example: An international medical graduate passed Step 1 on May 25, 2004, passed Step 2 CK on

August 10, 2007, and passed Step 2 CS on February 15, 2012. This applicant was required to pass Step

2 CK by May 25, 2011 (within seven years from her Step 1 passing performance on May 25, 2004), a

requirement she has satisfied. While this applicant was also required to pass Step 2 CS to meet the exam

requirements for ECFMG Certification, she was not required to pass Step 2 CS by May 25, 2011, since

her earliest USMLE passing performance that is valid for ECFMG Certification (the May 25, 2004 Step 1

passing performance) took place before June 14, 2004.

If you have passed a Step or Step Component but this passing performance is no longer valid for ECFMG

Page 24


Certification, you may request an exception to retake the previously passed exam that is no longer valid. The USMLE

program limits to six the total number of times an examinee can take the same Step or Step Component. See



Reexamination and Reapplication

 in The United States Medical Licensing Examination (USMLE).



Important Notes: Time limits to complete the USMLE for the purpose of U.S. medical licensure are

established by state medical licensing authorities and may require completion of all Steps or Step

Components (including Step 3, which is not required for ECFMG Certification) within seven years.

Information regarding specific state requirements can be obtained on the 

FSMB website

.

Applicants who retake a previously passed Step or Step Component to comply with a time limit should



understand the implications of a failing retake performance on their Step 3 eligibility. See Retaking

Previously Passed Steps in the 

USMLE Bulletin of Information

.

Last updated: September 9, 2015



Copyright © 2015 by the Educational Commission for Foreign Medical Graduates. All rights reserved.

Page 25


Eligibility for Examination

Medical School Students | 

Medical School Graduates

 | 


Reverification of Eligibility

 | 


Fifth Pathway Participants

The eligibility requirements for examination differ depending on whether you are a medical school student or a

medical school graduate.

Medical School Students

To be eligible for Step 1, Step 2 CK, and Step 2 CS, you must be officially enrolled in a medical school located

outside the United States and Canada that is listed in the 



World Directory

 as meeting eligibility requirements for its

students and graduates to apply to ECFMG for ECFMG Certification and examination, both at the time that you apply

for examination and on your test day. In addition, the “Graduation Years” in the ECFMG note on the Sponsor Notes tab

for your medical school's World Directory listing must be “Current” at the time you apply and on your test day. An

authorized official of your medical school must certify your current enrollment status; instructions will be provided at

the time of application for examination.

As soon as you graduate and receive your medical diploma, you must send two photocopies of your medical diploma

and one full-face, passport-sized, color photograph to ECFMG. See 

Final Medical Diploma

 in Medical Education



Credentials. The photograph that you send must be current; it must have been taken within six months of the date

that you send it. A photocopy of a photograph is not acceptable.



In addition to being currently enrolled as described above, to be eligible for Step 1, Step 2 CK, and Step 2 CS,

you must have completed at least two years of medical school. This eligibility requirement means that you must have

completed the basic medical science component of the medical school curriculum by the beginning of your eligibility

period.


Although you may apply for and take the examinations after completing the basic medical science component of your

medical school curriculum, it is recommended that you complete your core clinical clerkships, including actual patient

contact, before taking Step 2 CK and Step 2 CS.

If you have passed the former ECFMG CSA, you are not eligible to take Step 2 CS, except under certain, well-defined

circumstances. Eligible circumstances include: taking Step 2 CS to permanently validate an expired CSA examination

date for the purpose of entering U.S. GME (See 



Validity of Examinations for Entry into Graduate Medical Education

 in


ECFMG Certification); taking Step 2 CS because your most recent performance on a clinical skills exam (CSA or Step

2 CS) is a failing performance (See Retaking Previously Passed Steps in the 

USMLE Bulletin of Information

); and


retaking Step 2 CS to meet a time limit [See 

Reexamination and Reapplication

 in The United States Medical Licensing



Examination (USMLE)].

Important Notes: If your eligibility for an exam changes after you apply but before you take the exam, you

are required to inform ECFMG immediately in writing of this change in your status. Such notification must

be sent to ECFMG’s Applicant Information Services. Use the contact information for General Inquiries on

the 


Contact ECFMG

 page of the ECFMG website. Failure to inform ECFMG that you may no longer be

eligible to take the examination may result in a finding of irregular behavior and a permanent annotation on

your score reports and transcripts. See 



ECFMG Policies and Procedures Regarding Irregular Behavior

.

Such changes in your eligibility status include, but are not limited to, the following:



Medical school students who transfer to another medical school after submitting an application for

examination must inform ECFMG immediately in writing of this transfer.

Medical school students who have been dismissed or withdraw(n) from medical school are not eligible for

USMLE, even if they are appealing the school's decision or otherwise contesting their status. Medical

school students who have been dismissed or withdraw(n) from medical school must inform ECFMG

immediately in writing of their dismissal or withdrawal.

Medical school students who take a leave of absence should consult with their medical schools about

whether they will be considered officially enrolled in medical school during leave. Your medical school may

consider a student on leave of absence to be withdrawn from medical school. Medical school students who

are not officially enrolled in medical school are not eligible to apply for or take USMLE. Applicants who take

Page 26


a leave of absence after submitting an application for examination to ECFMG must inform ECFMG

immediately in writing of this leave.

If you take a Step or Step Component for which you are not eligible, results for that exam may not be

reported or, if previously reported, may be canceled.

Last updated: September 9, 2015

Copyright © 2015 by the Educational Commission for Foreign Medical Graduates. All rights reserved.

Page 27


Eligibility for Examination

Medical School Students

 | Medical School Graduates | 

Reverification of Eligibility

 | 

Fifth Pathway Participants



The eligibility requirements for examination differ depending on whether you are a medical school student or a

medical school graduate.



Medical School Graduates

To be eligible for Step 1, Step 2 CK, and Step 2 CS, you must be a graduate of a medical school located outside the

United States and Canada that is listed in the 



World Directory

 as meeting eligibility requirements for its students and

graduates to apply to ECFMG for ECFMG Certification and examination. Your graduation year must be included in the

"Graduation Years" listed in the ECFMG note on the Sponsor Notes tab for your medical school’s World Directory

listing. You must have been awarded credit for at least four credit years (academic years for which credit has been

given toward completion of the medical curriculum) by a medical school that is listed in the World Directory as meeting

ECFMG eligibility requirements. An authorized official of your medical school must certify your status as a graduate of

the school; instructions will be provided at the time of application for examination.



Two photocopies of your medical diploma must be submitted at the time of exam application if your diploma has not

been sent to ECFMG previously. See the 



Reference Guide for Medical Education Credentials

 on the ECFMG website

for the exact title of the final medical diploma you must provide. One full-face, passport-sized, color photograph must

accompany the photocopies of your diploma. The photograph must be current; it must have been taken within six

months of the date that your exam application is sent to ECFMG. A photocopy of a photograph is not acceptable. If

you have graduated and met all requirements for your medical diploma but your medical diploma has not yet been

issued, a current, full-face, passport-sized, color photograph and a letter signed by an authorized official of your

medical school must be submitted with your exam application. The letter you submit must be the original document

and must be written on your medical school’s letterhead. The letter must include the following statement:

This is to confirm that [applicant name] has graduated and completed all requirements to receive

the [degree title] degree from [medical school/university name]. The degree will be issued [month

and year].

You must then send the photocopies of your medical diploma to ECFMG as soon as your diploma is issued. See



Medical Education Credentials

.

All documents that are not in English must be accompanied by an official English translation that meets ECFMG’s



translation requirements. See 

English Translations

 in Medical Education Credentials.

If you have passed the former ECFMG CSA, you are not eligible to take Step 2 CS, except under certain, well-defined

circumstances. Eligible circumstances include: taking Step 2 CS to permanently validate an expired CSA examination

date for the purpose of entering U.S. GME (See 

Validity of Examinations for Entry into Graduate Medical Education

 in


ECFMG Certification); taking Step 2 CS because your most recent performance on a clinical skills exam (CSA or Step

2 CS) is a failing performance (See Retaking Previously Passed Steps in the 

USMLE Bulletin of Information

); and


retaking Step 2 CS to meet a time limit [See 

Reexamination and Reapplication

 in The United States Medical Licensing



Examination (USMLE)].

Important Notes: If your eligibility for an exam changes after you apply but before you take the exam, you

are required to inform ECFMG immediately in writing of this change in your status. Such notification must

be sent to ECFMG’s Applicant Information Services. Use the contact information for General Inquiries on

the 


Contact ECFMG

 page of the ECFMG website. Failure to inform ECFMG that you may no longer be

eligible to take the examination may result in a finding of irregular behavior and a permanent annotation on

your score reports and transcripts. See 



ECFMG Policies and Procedures Regarding Irregular Behavior

.

If you take a Step or Step Component for which you are not eligible, results for that exam may not be



reported or, if previously reported, may be canceled.

If you have already been granted a license by a U.S. medical licensing authority based on previous

Page 28


licensure examinations, such as the Federation Licensing Examination (FLEX) or the NBME certifying

examinations, you are not eligible to take the USMLE.

Last updated: September 9, 2015

Copyright © 2015 by the Educational Commission for Foreign Medical Graduates. All rights reserved.

Page 29


Eligibility for Examination

Medical School Students

 | 

Medical School Graduates



 | Reverification of Eligibility | 

Fifth Pathway Participants



Reverification of Eligibility

ECFMG reserves the right to reverify your eligibility for examination at any time during the application and registration

process. If your medical school informs ECFMG that your status has changed, and ECFMG determines you are no

longer eligible for examination, your registration will be canceled. If you have failed to inform ECFMG of this change in

your status, it may result in a finding of irregular behavior.

For medical school students, ECFMG may reverify your status as a student officially enrolled in medical school. When

a medical school does not participate in 

ECFMG Medical School Web Portal (EMSWP)

 Status Verification, ECFMG’s

reverification of the status of the school’s students may include ECFMG sending a written request for reverification by

postal mail to the medical school. If reverification is requested by ECFMG, ECFMG may cancel your registration or

withhold your score report until ECFMG has received reverification of your status directly from the medical school. If

your registration is canceled, you may be required to reapply.

For medical school graduates, ECFMG may reverify your medical education credentials with the issuing medical

school. If such reverification is requested by ECFMG, you will be registered for examination only after ECFMG has

received reverification of your credentials directly from the medical school. If reverification is requested by ECFMG

after you have been registered for examination, ECFMG may cancel your registration or withhold your score report

until ECFMG has received reverification of your medical education credentials directly from the issuing school. If your

registration is canceled, you may be required to reapply.

Last updated: September 9, 2015

Copyright © 2015 by the Educational Commission for Foreign Medical Graduates. All rights reserved.

Page 30


Eligibility for Examination

Medical School Students

 | 

Medical School Graduates



 | 

Reverification of Eligibility

 | Fifth Pathway Participants

Fifth Pathway Participants

The Fifth Pathway, created by the 

American Medical Association (AMA)

 in 1971, has allowed certain students who

attended four years at an international medical school to complete their supervised clinical work at a U.S. medical

school; to become eligible for entry to U.S. residency training; and ultimately to obtain a license to practice in the

United States. The AMA’s Council on Medical Education no longer supports the Fifth Pathway as a mechanism for

eligibility to enter the first year of ACGME-accredited graduate medical education programs. The last Fifth Pathway

program class supported was the class that began in January 2009 and ended in December 2009.

Individuals who pursued the Fifth Pathway completed the four-year didactic curriculum at the international medical

school, but they did not complete the internship and/or social service requirement for the final medical diploma.

Instead, they completed a Fifth Pathway program, which was one year of supervised clinical work at a U.S. medical

school. Since they did not complete the internship and/or social service requirement, they did not receive the final

medical diploma and, therefore, are not eligible for ECFMG Certification. However, these individuals may apply to

ECFMG for examination, provided that they hold a Fifth Pathway certificate issued on or before December 31, 2009.

Important Note: Individuals who hold valid Fifth Pathway certificates issued through December 31, 2009,

and are otherwise eligible, may use their Fifth Pathway certificates to meet Step 3 eligibility requirements

for applications submitted through December 31, 2016. Effective January 1, 2017, the USMLE Program will

no longer accept Fifth Pathway certificates for the purpose of meeting Step 3 eligibility requirements.

Individuals holding Fifth Pathway certificates that are not accepted by the USMLE Program for purposes of

meeting Step 3 eligibility must obtain ECFMG Certification in order to meet Step 3 eligibility requirements.

Last updated: September 9, 2015

Copyright © 2015 by the Educational Commission for Foreign Medical Graduates. All rights reserved.

Page 31


The United States Medical Licensing Examination (USMLE)

About USMLE | 

Registration and Test Delivery Entities

 | 


Applying for Examination

 | 


Scheduling the Examination

 |

Preparing for Examination



 | 

Taking the Examination

 | 

USMLE Program and Irregular Behavior



 | 

Examination Results

 |

Reexamination and Reapplication



About USMLE

The USMLE is a three-step examination for medical licensure in the United States. The USMLE provides a common

system to evaluate applicants for medical licensure. The USMLE is sponsored by the 

Federation of State Medical

Boards (FSMB)

 and the 

National Board of Medical Examiners (NBME)

. The USMLE is governed by a committee

consisting of representatives of FSMB, NBME, ECFMG, and the American public. If you apply for examination, you are

required to read the 

USMLE Bulletin of Information

 for detailed information on the USMLE.

Important Note: The Composite Committee, which establishes policies for the USMLE program, initiated

the Comprehensive Review of USMLE (CRU) in 2004. This multiyear review has led to a series of

modifications to test content representation, to changes in a number of existing test formats, and to

developmental efforts intended to expand the types of competencies addressed by USMLE. Information on

the status of changes to USMLE resulting from the CRU process is posted to the 

USMLE website

.

As changes to the examinations are implemented, the practice materials available on the USMLE website



may be updated to reflect these changes. If you plan to take USMLE examinations, you should monitor the

USMLE


 and 

ECFMG


 websites for the latest information on changes to the examinations.

Last updated: September 9, 2015

Copyright © 2015 by the Educational Commission for Foreign Medical Graduates. All rights reserved.

Page 32


The United States Medical Licensing Examination (USMLE)

About USMLE

 | Registration and Test Delivery Entities | 

Applying for Examination

 | 

Scheduling the Examination



 |

Preparing for Examination

 | 

Taking the Examination



 | 

USMLE Program and Irregular Behavior

 | 

Examination Results



 |

Reexamination and Reapplication



Registration and Test Delivery Entities

Step 1 and Step 2

ECFMG serves as the registration entity for international medical students/graduates taking Step 1 and Step 2 (CK

and CS). This means that ECFMG processes your exam application and payment, verifies your eligibility, and notifies

you of the outcome of your application. The NBME serves as the registration entity for students/graduates of U.S. and

Canadian medical school programs accredited by the 

Liaison Committee on Medical Education (LCME)

 and U.S.

medical schools accredited by the 

American Osteopathic Association (AOA)

.

For eligible international medical students/graduates applying for Step 1/Step 2 CK, ECFMG forwards registration



information to NBME, and NBME issues the exam scheduling permits. ECFMG notifies these applicants when their

scheduling permits are available and provides them with secure, web-based access to the scheduling permits.

Scheduling and test centers for USMLE Step 1 and Step 2 CK are provided by 

Prometric

. Prometric serves as the test

delivery entity for all examinees taking Step 1/Step 2 CK. Step 1 and Step 2 CK are delivered at Prometric test centers

worldwide. ECFMG is not responsible for errors or problems that may occur in issuing Step 1/Step 2 CK scheduling

permits or in delivering these exams. These functions are the responsibility of NBME and/or Prometric.

For eligible international medical students/graduates applying for Step 2 CS, ECFMG issues the exam scheduling

permits; sends notification to applicants when the scheduling permits are available; and provides them with secure,

web-based access to the scheduling permits. The Clinical Skills Evaluation Collaboration (CSEC), a collaboration of

ECFMG and NBME, is responsible for delivery of the Step 2 CS exam. Step 2 CS is delivered to all examinees at

regional CSEC Centers in the United States.

For all applicants, NBME is responsible for determining the results of USMLE exams and for issuing the score reports.

ECFMG notifies international medical students/graduates when their Step 1, Step 2 CK, and Step 2 CS score reports

are available and provides them with secure, web-based access to the score reports.



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