Educational Commission for Foreign Medical Graduates
According to the US Department of Education, the Educational Commission for Foreign Medical Graduates is "the authorized credential evaluation and guidance agency for non-U.S. physicians and graduates of non-U.S. medical schools who seek to practice in the United States or apply for a U.S. medical residency program. It provides comprehensive information and resources on licensure, the U.S. Medical Licensure Examination, residencies, and recognition."
Through its program of certification, the ECFMG assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education.
ECFMG acts as the registration and score-reporting agency for the USMLE for foreign medical students/ graduates, or in short, it acts as the designated Dean's office for International Medical Graduates in contrast to the American Medical Graduates.
Medical schools in Canada that award the M.D. are not assessed by ECFMG, because the Liaison Committee on Medical Education historically accredited M.D.-granting institutions in both the U.S. and Canada. M.D. graduates of American and Canadian institutions are not considered IMGs in either country.
History
ECFMG was founded in 1956, in response to the increase need for the evaluation of the readiness of international medical graduates entering the physician workforce during the 1950 expansion of US healthcare system. Its initial name was Evaluation Service for Foreign Medical Graduates. Later that year, it was renamed Educational Council for Foreign Medical Graduates. In conjunction with NBME,it created what became known as the ECFMG certification which included examinations and
assessments of English language proficiency. In 1974, it merged with the Commission on Foreign Medical Graduates and changed its name
to its current name Educational Commission for Foreign Medical Graduates.
Certification
The main pathway for international medical graduates who wish to be licensed as a physician in the United States is to complete a U.S. residency hospital program. The general method to apply for residency programs is through the National Resident Matching Program. To participate in the NRMP, an IMG is required to have an ECFMG certification by the "rank order list certification deadline" time.To acquire an ECFMG certification, the candidate must meet these requirements:
- Examination Requirement: Completion of USMLE Step 1 and USMLE [Step 2 Clinical Knowledge]
- Meet the clinical and communication skills requirements
- Medical education credential requirements: A medical diploma of medical education taken at an institution registered in the World Directory of Medical Schools. The official source to confirm that a medical school meets ECFMG's requirements, is the World Directory at www.wdoms.org. Schools that meet the requirements will have an ECFMG note stating this in the schools’ World Directory listing.
Clinical and communication skills requirements
The COVID-19 global pandemic has brought some changes to the ECFMG certification process. First as AAMC suspended temporarily and later eliminated the Step 2 CS examination, ECFMG moved to a pathways model for verification of clinical skills. IMGs who have already taken Step 2 CS may still use it to fulfill this requirement. All other IMGs will need:- Assessment of communication skills, including English language proficiency through the Occupational English Test Medicine exam
- Meet the requirements for one of the pathways below:
| Pathway | Description | Notes |
| Pathway 1 | Already Licensed to Practice Medicine in Another Country | Intended for applicants who currently hold or have recently held a license/registration to practice medicine without supervision |
| Pathway 2 | Already Passed a Standardized Clinical Skills Exam for Medical Licensure | Intended for applicants who do not currently hold, or have not recently held, a license/registration to practice medicine without supervision, but who successfully completed a secure, standardized clinical skills exam as a requirement for medical licensure or registration in a country other than the United States. |
| Pathway 3 | Medical School Accredited by Agency Recognized by World Federation for Medical Education | Intended for applicants who have not yet obtained a license/registration to practice medicine without supervision and who have not already passed an acceptable standardized clinical skills exam for medical licensure. An applicant to Pathway 3, 4, or 5 must be a student or a recent graduate of a medical school that meets eligibility requirements established by ECFMG. |
| Pathway 4 | Medical School Accredited by Agency that Has Received a Determination of Comparability by National Committee on Foreign Medical Education and Accreditation | Intended for applicants who have not yet obtained a license/registration to practice medicine without supervision and who have not already passed an acceptable standardized clinical skills exam for medical licensure. These applicants must be students or recent graduates and must meet eligibility requirements established by ECFMG. |
| Pathway 5 | Medical School Issues Degree Jointly with a U.S. Medical School Accredited by Liaison Committee on Medical Education | Intended for applicants who have not yet obtained a license/registration to practice medicine without supervision and who have not already passed an acceptable standardized clinical skills exam for medical licensure. These applicants must be students or recent graduates and must meet eligibility requirements established by ECFMG. |
| Pathway 6 | Evaluation of Clinical Patient Encounters by Licensed Physicians | Intended for applicants who do not meet the eligibility requirements for Pathway 1, 2, 3, 4, and 5 and/or have failed Step 2 CS one or more times. 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. |
Certification expiration
As of April 2021, ECFMG certifications obtained by fulfilling the clinical and communication skills requirements through a pathway will expire in 2022 if the applicant does not enter an ACGME-accredited training program in 2021 or 2022. If the applicant enters a training program they become permanent after one year of residency.Projects
A pilot project was started in 2012 for an electronic verification system of medical credentials from international medical schools, with participation from approximately 20 international medical schools. After completion of this pilot project, ECFMG now allows all medical schools to register for free.Expected to be implemented in late 2024, a notable development is anticipated in medical education application procedures. ECFMG Status Reports will be integrated into Electronic Residency Application Service submissions, offering vital information for institutions assessing applicants. These reports will specifically indicate whether the candidate's medical school meets the Recognized Accreditation Policy, determined by accreditation from agencies recognized by the World Federation for Medical Education or the National Committee on Foreign Medical Education and Accreditation. This enhancement aims to streamline the evaluation of medical school credentials, enhancing transparency and efficiency in the residency application process. However, IMGs will still be able to pursue ECFMG Certification even if their medical school doesn't meet the Recognized Accreditation Policy, as long as their school meets ECFMG's current requirements.
The accrediting agencies that are WFME recognized are: