Medical schools outside the United States and Canada vary in educational standards, curricula, and evaluation

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Medical schools outside the United States and Canada vary in educational standards, curricula, and evaluation 

methods. The Educational Commission for Foreign Medical Graduates (ECFMG), through its program of certification, 

assesses whether physicians graduating from these schools are ready to enter programs of graduate medical 

education in the United States.

This Fact Sheet is intended to provide international medical school students and graduates (IMGs) interested in 

graduate medical education in the United States with basic information on ECFMG Certification, as well as next steps 

and additional resources for those who are ready to begin the certification process.

The definitive resource on ECFMG Certification is the ECFMG Information Booklet. The definitive resource on the United 

States Medical Licensing Examination® (USMLE®) is the USMLE Bulletin of Information. Before applying for examination

you must read the applicable editions of these publications. In the event that information in this Fact Sheet differs 

from the corresponding information in the ECFMG Information Booklet/USMLE Bulletin of Information, the latter 

publications will contain the most current and accurate information.

ECFMG Certification

The purpose of ECFMG Certification is to assess whether IMGs are ready to enter U.S. residency and fellowship 

programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). If you wish 

to enter such a program, ACGME requires you to be certified by ECFMG before you can start the program. ECFMG 

Certification is also required before applying to take Step 3 of the USMLE. In the United States, to obtain a license to 

practice medicine, physicians must apply directly to the jurisdiction where they plan to practice medicine. Licensing 

jurisdictions in the United States require that IMGs applying for unrestricted licensure be certified by ECFMG.

Requirements for ECFMG Certification

To be eligible for certification by ECFMG, international medical graduates must meet the following requirements.

Application for ECFMG Certification

IMGs must submit an Application for ECFMG Certification before they can apply to ECFMG for examination. The 

Application for ECFMG Certification consists of questions that require applicants to confirm their identity, contact 

information, and graduation from or enrollment in a medical school that is listed in the World Directory of Medical 

Schools (World Directory) as meeting eligibility requirements for its students and graduates to apply to ECFMG for 

ECFMG Certification and examination. As part of the application, IMGs must also confirm their understanding of 

the purpose of ECFMG Certification and release certain legal claims. See Application for ECFMG Certification in the 

ECFMG Information Booklet. 

Examination Requirements

The examination requirements for ECFMG Certification include passing Step 1 and Step 2 of the USMLE. The  

Step 2 exam has two separately administered components, the Clinical Knowledge (CK) component and the 

Clinical Skills (CS) component.




To meet the examination requirements for ECFMG Certification, applicants must:

1. Satisfy the medical science examination requirement. Step 1 and Step 2 CK of the USMLE are the exams 

currently administered that satisfy this requirement.  

2. Satisfy the clinical skills requirement. Step 2 CS of the USMLE is the exam currently administered that 

satisfies this requirement.  

Step 1, Step 2 CK, and Step 2 CS are the same exams taken by graduates of U.S. and Canadian medical schools. 

Detailed information on USMLE is available on the USMLE website at

ECFMG has established time limits for completing the examinations required for ECFMG Certification. Refer to 

the ECFMG website and the ECFMG Information Booklet for information on time limits, exam eligibility, fees, 

application, scheduling, test centers, and practice materials.

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. The World Directory is 

available at 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 your medical school’s Sponsor Notes tab, you are not eligible to apply to ECFMG for ECFMG Certification or 

examination. Additionally, the physician’s graduation year must be included in the ECFMG note on the Sponsor 

Notes tab of the school’s World Directory listing. International medical graduates 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. 

There are restrictions on credits transferred to the medical school that awards an applicant’s medical degree that 

can be used to meet this requirement. 

Applicants must document the completion of all requirements for, and receipt of, the final medical diploma. 

ECFMG verifies every applicant’s medical school diploma with the appropriate officials of the medical school that 

issued the diploma and requests that the medical school provide the final medical school transcript. Verification 

by ECFMG with the issuing school may also be required for transcripts that are submitted to document 

transferred credits. See Medical Education Credentials in the ECFMG Information Booklet.

ECFMG issues the Standard ECFMG Certificate to applicants who meet all of the requirements for certification. 

The Certification Process

The certification process begins when you apply to ECFMG for a USMLE/ECFMG Identification Number. Once you 

obtain this number, you can use it to complete the Application for ECFMG Certification. Once your Application for 

ECFMG Certification has been submitted, you may apply for examination. 

Before applying for examination, you must also read the applicable editions (those that pertain to the eligibility 

period in which you take the exam) of the ECFMG Information Booklet and the USMLE Bulletin of Information. Both 

publications are available in the Resources section of the ECFMG website at To apply for the required 

exams, use ECFMG’s Interactive Web Applications (IWA), available in the On-line Services section of the ECFMG 

website. Detailed instructions accompany the application.

Both medical school students and graduates can begin the certification process. You can apply for the required exams 

as soon as you meet the exam eligibility requirements. All of the required exams are offered continuously throughout 

the year. However, since one of the requirements for ECFMG Certification is verification of your final medical diploma 

with your medical school, you cannot complete the certification process until you graduate and receive the diploma.

There is no time limit for completing the certification process. However, there are specific time requirements for 

completing the exams for ECFMG Certification and medical licensure. These requirements are described in the ECFMG 

Information Booklet and USMLE Bulletin of Information, respectively. 

The academic year for U.S. graduate medical education programs typically begins in July.  You must be certified by 

ECFMG before your program’s start date, although you can apply to programs before becoming certified. In planning 

the timing of your exam application and scheduling, you should also consider deadlines imposed by the programs to 

which you plan to apply and the National Resident Matching Program® (NRMP®). See Applying to Graduate Medical 

Education Programs below. 

Applying to Graduate Medical Education Programs

Basic information about all ACGME-accredited programs is available on the ACGME website at FREIDA 

Online®, published by the American Medical Association (AMA), provides access to information on more than 10,000 

residency and fellowship programs. You can access FREIDA Online on the AMA website at 

Application deadlines vary among programs. You should contact programs directly for information on their deadlines.

Most programs require applicants to submit their applications using the Electronic Residency Application Service 

(ERAS®), which was developed by the Association of American Medical Colleges (AAMC). ECFMG coordinates the ERAS 

application process for IMGs. ERAS information for IMGs is available at Programs that do not 

participate in ERAS require applicants to use paper application materials. You should contact programs directly for 

their requirements.

NRMP, also known as “the Match,” matches applicants with available residency positions in the programs to which they 

have applied. If you wish to participate, you must register with the NRMP. Refer to the NRMP website at for requirements and deadlines, as well as information on the numbers of IMGs who have obtained 

residency positions through the Match in recent years.

Obtaining a Visa

IMGs who are neither citizens nor lawful permanent residents of the United States must obtain an appropriate visa 

to participate in U.S. graduate medical education programs. A common visa employed for this purpose is the J-1 visa. 

ECFMG is authorized by the U.S. Department of State to sponsor foreign national physicians for the J-1 visa. All initial 

applicants for ECFMG J-1 sponsorship are advised that sponsorship eligibility should not be presumed and cannot 

be determined until a complete review of an individual’s U.S. visa history has been conducted. The U.S. Department 

of State has expressed concern about individuals with a history of “transiting non-immigrant visa types” and has 

advised ECFMG against sponsoring individuals who previously held J status and switched to an alternate visa 

classification or J category before applying to ECFMG. Therefore, any history of multiple changes in visa classification 

and/or movement between multiple J categories may negate sponsorship eligibility. More information on eligibility 

and deadlines is available from ECFMG’s Exchange Visitor Sponsorship Program at 

Additional information is available from the U.S. Department of State Exchange Visitor Program website at General information on the entry of foreign nationals to the United States is available from U.S. 

Citizenship and Immigration Services at and the U.S. Department of Homeland Security at


ECFMG Certification

Visit the ECFMG website at for access to important updates, application materials, and publications, 


•    ECFMG Information Booklet

•  Reference Guide for Medical Education Credentials

•    USMLE Bulletin of Information

•    World Directory of Medical Schools

•    Interactive Web Applications (IWA)

•    The ECFMG® Reporter – ECFMG’s free e-mail newsletter for IMGs interested in ECFMG Certification. 

      Subscribe at 

•    ECFMG® Fact Card – summary annual data on IMGs pursuing ECFMG Certification

Applying to Graduate Medical Education Programs

•    Accredited Programs and Sponsoring Institutions –

•    FREIDA Online –

•    AAMC ERAS website –

•    ERAS Support Services at ECFMG –

•    National Resident Matching Program –


•    ECFMG Exchange Visitor Sponsorship Program –

•    ECFMG® J-1 Visa Sponsorship Fact Sheet

•    U.S. Department of State Exchange Visitor Program –

•    U.S. Citizenship and Immigration Services –

•    U.S. Department of Homeland Security –

Additional Information

ECFMG representatives are available to answer your questions by

•    e-mail at, or

•    phone at (215) 386-5900 from 9:00 a.m. to 5:00 p.m., Eastern Time in the United States, Monday through Friday.


ECFMG is a private, nonprofit organization committed to promoting excellence in medical education. ECFMG’s aims 

and missions include providing information to IMGs regarding entry into graduate medical education and health care 

systems in the United States, evaluating the qualifications of IMGs, and providing international access to testing and 

evaluation programs.

ECFMG’s organizational members are:

American Board of Medical Specialties

American Medical Association

Association of American Medical Colleges

Association for Hospital Medical Education

Federation of State Medical Boards

National Medical Association

3624 Market Street

Philadelphia, PA 19104-2685 USA


Published November 2002

Last updated August 24, 2016

Copyright© 2002-2004, 2007-2012, 2014-2016 by the Educational Commission for 

Foreign Medical Graduates. All rights reserved. The term ECFMG® is registered in 

the U.S. Patent and Trademark Office.

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