Requirements for 2025 Pathways for ECFMG Certification (2024)

• Overview
• Who Should Use the Pathways?
• Assessment of Communication Skills, Including English Language Proficiency
• General Eligibility for All Pathways
• The Pathways
• Applying to the Pathways
• Information on Expiration of the ECFMG Certificate
• Impact of Pathways on the Time Limit for Completing Examination Requirements

Overview

To be eligible for ECFMG Certification, international medical graduates (IMGs) must satisfy a number of requirements, including the following examination requirements:

• Medical Science Examination Requirement. Currently, IMGs must pass Step 1 and Step 2 Clinical Knowledge (CK) of the United States Medical Licensing Examination^® (USMLE^®) to satisfy this requirement.
• Clinical Skills Requirement and Communication Skills Requirement. Currently, IMGs must complete a Pathway to satisfy these requirements.

Who Should Use the Pathways?

The 2025 Pathways for ECFMG Certification (2025 Pathways) are intended for IMGs who need to meet the clinical skills requirement and the communication skills requirement for ECFMG Certification. These requirements are among the examination requirements that IMGs must meet in order to participate in the 2025 NRMP Main Residency Match^® (The Match^®).

If you previously applied to a Pathway or familiarized yourself with prior Pathways requirements, you should review the 2025 Pathways information carefully to ensure an understanding of 2025 Pathways eligibility and requirements.

If you were certified by ECFMG based on a Pathway, your certificate is subject to expiration. See Information on Expiration of the ECFMG Certificate for additional information. If you do not expect to meet the requirements to have your ECFMG Certificate made valid indefinitely before your certificate expires, please monitor this website for forthcoming information on revalidating your ECFMG Certificate. We expect to have a process for revalidation in place by the end of this year.

Assessment of Communication Skills, Including English Language Proficiency

As part of the Pathways, applicants are required to attain a satisfactory score on the Occupational English Test (OET) Medicine to satisfy the communication skills requirement for ECFMG Certification. All Pathways applicants, regardless of native language, language of instruction at medical school, or citizenship, must satisfy this requirement in addition to meeting the requirements of a specific Pathway. There will be no exceptions.

See the Assessment of Communication Skills, Including English Language Proficiency page for more information.

Important Note: Obtaining a satisfactory score on OET Medicine is only one of the requirements for completing a Pathway. Applicants also must submit an on-line application for the appropriate Pathway. See Applying to the Pathways below.

General Eligibility for All Pathways

Applicants who are eligible to pursue ECFMG Certification based on one of the Pathways include those who:

• Have not already met the clinical and communication skills requirements for ECFMG Certification.
• Are not barred by ECFMG from pursuing ECFMG Certification.
• Have submitted an Application for ECFMG Certification.
• Have previously been registered for a USMLE Step or Step Component. This means that, if you have never been registered to take a USMLE Step or Step Component, you must apply for and be registered for a USMLE exam before you can submit a Pathways application.

The Pathways

In addition to meeting the requirements in General Eligibility for All Pathways, Pathways applicants also must meet all requirements for the Pathway to which they apply.

Important Note: Applicants who failed Step 2 CS one or more times must apply to Pathway 6 in order to meet the clinical and communication skills requirements for ECFMG Certification, regardless of whether they meet the eligibility requirements for other Pathways.

• Pathway 1: Already Licensed to Practice Medicine in Another Country

  Pathway 1 is for applicants who currently hold or have recently held a license/registration to practice medicine without supervision. Applicants who meet the eligibility requirements for Pathway 1 must apply to Pathway 1 in order to meet the clinical and communication skills requirements for ECFMG Certification, unless they failed Step 2 CS; see Important Note.

  See the Pathway 1 page for more information, including eligible licensure dates.

• Pathway 2: Already Passed an Objective Structured Clinical Examination (OSCE) for Medical Licensure Administered by an Acceptable Medical School

  This Pathway is for applicants who do not meet the eligibility requirements for Pathway 1, but who attend or have graduated from a medical school that administers an OSCE specifically required for medical licensure by the medical regulatory authority (MRA) in that country. The medical school must meet certain ECFMG requirements and the applicant must have successfully completed the OSCE.

  See the Pathway 2 page for more information, including eligible graduation dates and medical school requirements.

• Pathway 3: Medical School Accredited by Agency Recognized by World Federation for Medical Education (WFME)
• Pathway 4: Medical School Accredited by Agency that Has Received a Determination of Comparability by National Committee on Foreign Medical Education and Accreditation (NCFMEA)
• Pathway 5: Medical School Issues Degree Jointly with a U.S. Medical School Accredited by Liaison Committee on Medical Education (LCME)

  Pathways 3, 4, and 5 are for applicants who do not meet the eligibility requirements for Pathway 1 and are students or recent graduates of a medical school that meets eligibility requirements established by ECFMG for Pathway 3, 4, or 5.

  See the page for Pathways 3, 4, and 5 for more information, including eligible graduation dates.

• Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians

  Pathway 6 is for applicants who do not meet the eligibility requirements for Pathway 1, 2, 3, 4, or 5. To meet the requirements for Pathway 6, the applicant’s clinical skills must be evaluated by licensed physicians using ECFMG’s Mini-Clinical Evaluation Exercise (Mini-CEX) for Pathway 6.

  See the Pathway 6 page for more information.

Applying to the Pathways

To meet the clinical and communication skills requirements for ECFMG Certification through one of the Pathways, please follow these steps:

• Consider the timing of your Pathways application. ECFMG Certificates issued to applicants who satisfy the clinical and communication skills requirements for ECFMG Certification through a Pathway are subject to expiration. See Information on Expiration of the ECFMG Certificate below for more information. In addition, if you do not complete your 2025 Pathways application and meet all requirements for your application by the time the current application season ends after the 2025 Match, your application will be rejected and you will be required to reapply to the Pathways in a future application season, and pay the applicable application fees at that time, in order to meet the clinical and communication skills requirements for ECFMG Certification.
• Determine your eligibility to apply to a Pathway by reviewing all information on this website carefully.
• If you believe you are eligible to apply to a Pathway, complete and submit your Application for 2025 Pathways for ECFMG Certification. If you need to meet the clinical and communication skills requirements for ECFMG Certification through the Pathways to participate in the 2025 Match, you must submit your application no later than January 31, 2025, Eastern Time in the United States. IMGs who need to meet the clinical and communication skills requirements for ECFMG Certification and do not submit a 2025 Pathways application by January 31, 2025 will not meet eligibility requirements for the 2025 Match.
• Meet the communication skills requirement by attaining a satisfactory score on each of the four sub-tests (Listening, Reading, Writing, and Speaking) of the OET Medicine test. You should take OET Medicine on or before the last available test date in December 2024. If you test after this date, your OET scores may not be available in time to complete your Pathways application before the 2025 Match.
• Release your OET Medicine scores to ECFMG. See Assessment of Communication Skills, Including English Language Proficiency for instructions. If you are planning to participate in the 2025 Match, ECFMG must receive your scores directly from OET by January 31, 2025. ECFMG will continue to receive and process results after this date, but results received after January 31, 2025 may not be processed in time for you to participate in the 2025 Match.
• Ensure that all required documentation in support of your Pathways application is received by ECFMG. Required documentation in support of your Pathways application must be received no later than January 31, 2025. See the detailed instructions for the Pathway to which you are applying for complete information. It is your responsibility to ensure that ECFMG receives all required documentation.
• Monitor the status of your application by logging into the Application for 2025 Pathways for ECFMG Certification. You will be notified by e-mail when processing of your application is complete. Please note: If you have not met all requirements for your Pathways application when the current application season ends, your application will be rejected and you will be required to reapply and pay any and all required application fee(s) in a future application season in order to meet the clinical and communication skills requirements for ECFMG Certification.

Information on Expiration of the ECFMG Certificate

ECFMG Certificates issued to applicants who satisfy the clinical and communication skills requirements for ECFMG Certification through a Pathway are subject to expiration.

The certificate expiration date is based on the Pathways season in which the Pathways application was completed and accepted as meeting the clinical and communication skills requirements for ECFMG Certification. The expiration date is not based on the calendar year during which the ECFMG Certificate was issued to the applicant. The expiration date will be listed on the ECFMG Certificate as the “valid through” date.

The expiration date is the date through which your certificate remains valid for entry into a U.S. graduate medical education (GME) training program accredited by the Accreditation Council for Graduate Medical Education (ACGME). Expiration dates for ECFMG Certificates issued based on a Pathway are as follows:

For an applicant’s ECFMG Certificate to become valid indefinitely (i.e., no longer subject to expiration), the applicant must meet one of the following requirements:

• successfully completed at least 12 months of clinical education in a U.S. GME training program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or
• successfully completed at least 12 months of clinical education in a U.S. non-standard training program associated with an ACGME-accredited program

If you have met these requirements, see Obtaining Permanent Validation of ECFMG Certificate for information on how to ensure that your ECFMG Certificate is made valid indefinitely.

If you are unable to meet the requirements to have your certificate made valid indefinitely, your ECFMG Certificate will expire. Please monitor this website for forthcoming information on revalidating your ECFMG Certificate. We expect to have a process for revalidation in place by the end of this year.

Impact of Pathways on the Time Limit for Completing Examination Requirements

ECFMG requires that IMGs satisfy the examination requirements for ECFMG Certification within a seven-year period. This means that once you pass an exam, you will have seven years to pass the other exam(s) required for ECFMG Certification. This seven-year period begins on the date of the first exam passed and ends exactly seven years from that date.

Meeting the clinical and communication skills requirements for ECFMG Certification through a Pathway also is subject to this seven-year requirement. This means that your Pathways application must be accepted within the seven-year period. For more information, see the section on Time Limit for Completing Examination Requirements in the applicable edition of the ECFMG Information Booklet.

Please note that it is your responsibility to track your progress toward meeting these requirements for ECFMG Certification. ECFMG will not notify you of upcoming deadlines to meet the seven-year requirement and will not notify you if one (or more) of your passing performances becomes invalid for ECFMG Certification because you failed to meet the seven-year requirement.

The preceding information is current as of May 20, 2024 and is subject to change. Please visit the ECFMG website frequently for updates regarding these requirements.