ECFMG

Certification
Fact Sheet

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.

Medical School Requirements

The physician’s medical school must meet requirements established by ECFMG. Schools that meet all
requirements will be listed in the World Directory of Medical Schools (World Directory) as meeting
eligibility requirements for their students and graduates to apply to ECFMG for ECFMG Certification and
examination. To confirm that your medical school meets ECFMG’s requirements, access the World Directory
at www.wdoms.org. Medical schools that meet ECFMG’s requirements will have an ECFMG note stating this
in the schools’ World Directory listing. The ECFMG note also will include the graduation years for which
the school meets these requirements. Since ECFMG is a sponsor of the World Directory, the ECFMG note is
located on the “Sponsor Notes” tab of the medical school listing. If there is no ECFMG note on the Sponsor
Notes tab of your medical school’s listing, you are not eligible to apply to ECFMG for ECFMG Certification and
examination.
Important Note: Beginning in 2023, to be eligible for ECFMG Certification, ECFMG will require
that applicants graduate from a medical school that has been appropriately accredited. To satisfy this
requirement, medical schools must be accredited by an agency that has been recognized by the World
Federation for Medical Education through its Programme for Recognition of Accrediting Agencies.
ECFMG is in the process of establishing policies and procedures for implementing this requirement and
will publish updates, as they become available, on the ECFMG website. International medical students
and graduates interested in ECFMG Certification should monitor the ECFMG website for the latest
information.
 Application for ECFMG Certification
IMGs who wish to pursue ECFMG Certification must submit an Application for ECFMG Certification.
The Application for ECFMG Certification consists of an on-line application and the Certification of
Identification Form (Form 186) available through ECFMG’s Interactive Web Applications (IWA).
The Application for ECFMG Certification requires applicants to confirm their identity, contact information, and
graduation from or enrollment in a medical school 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.
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 www.usmle.org.
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 graduation year must be included in the ECFMG note in the medical school’s World Directory
listing. See Medical School Requirements above. 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. For more information, 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 should begin by first confirming that your medical school meets ECFMG requirements.
Once you have confirmed that students/graduates of your medical school are eligible to apply to ECFMG for ECFMG
Certification and examination, you can apply for a USMLE/ECFMG Identification Number. Once you obtain this
number, you can use it to complete the Application for ECFMG Certification. Once ECFMG accepts your Application
for ECFMG Certification, including your notarized Certification of Identification Form (Form 186), 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 www.ecfmg.org. 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 www.acgme.org.
FREIDA™, published by the American Medical Association (AMA), provides access to information on more than
11,000 residency and fellowship programs. You can access FREIDA on the AMA website at www.ama-assn.org/go/freida.
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 www.ecfmg.org/eras. 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
www.nrmp.org 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.
More information on eligibility and deadlines is available from ECFMG’s Exchange Visitor Sponsorship Program at
www.ecfmg.org/evsp.
Additional information is available from the U.S. Department of State Exchange Visitor Program website at
http://j1visa.state.gov. General information on the entry of foreign nationals to the United States is available from
U.S. Citizenship and Immigration Services at www.uscis.gov and the U.S. Department of Homeland Security at
www.dhs.gov.

Resources
ECFMG Certification
Visit the ECFMG website at www.ecfmg.org for access to important updates, application materials, and
publications, including:
• 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 www.ecfmg.org/reporter.
• ECFMG® Fact Card – Summary annual data on IMGs pursuing ECFMG Certification
Applying to Graduate Medical Education Programs

• Accredited Programs and Sponsoring Institutions – www.acgme.org

• FREIDA – www.ama-assn.org/go/freida
• AAMC ERAS website – www.aamc.org/students/medstudents/eras
• ERAS Support Services at ECFMG – www.ecfmg.org/eras

• National Resident Matching Program – www.nrmp.org

Visas

• ECFMG Exchange Visitor Sponsorship Program – www.ecfmg.org/evsp

• ECFMG® J-1 Visa Sponsorship Fact Sheet
• U.S. Department of State Exchange Visitor Program – http://j1visa.state.gov
• U.S. Citizenship and Immigration Services – www.uscis.gov

• U.S. Department of Homeland Security – www.dhs.gov

Additional Information

ECFMG representatives are available to answer your questions by

• e-mail at [email protected], 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

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.

3624 Market Street

Philadelphia, PA 19104-2685 USA
215-386-5900
www.ecfmg.org
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Copyright© 2002-2004, 2007-2012, 2014-2018 by the Educational Commission for

Published November 2002
Foreign Medical Graduates. All rights reserved. The term ECFMG® is registered in the
Last updated September 13, 2018
U.S. Patent and Trademark Office.