Educational Commission for Foreign Medical Graduates

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Through its program of certification, the Educational Commission for Foreign Medical Graduates (ECFMG) assesses the readiness of international medicalgraduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).

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 (IMGs) in contrast to the American Medical Graduates (AMGs).

It conducts three examinations: Step 1, Step 2CK, Step 2CS. The ECFMG certificate is issued to a physician if he or she passes the above the three exams within a time period of seven years.

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 (today, Canada has its own accrediting body that generally follows U.S. standards). M.D. graduates of American and Canadian institutions are not considered IMGs in either country.

ECFMG is a world leader in promoting quality health care—serving physicians, members of the medical education and regulatory communities, health care consumers, and those researching issues in medical education and health workforce planning.

International medical graduates (IMGs) comprise one-quarter of the U.S. physician workforce. Certification by ECFMG is the standard for evaluating the qualifications of these physicians before they enter U.S. graduate medical education (GME), where they provide supervised patient care. ECFMG Certification also is a requirement for IMGs to take Step 3 of the three-step United States Medical Licensing Examination (USMLE) and to obtain an unrestricted license to practice medicine in the United States.

ECFMG provides other programs for IMGs pursuing U.S. GME, including those that assist them with the process of applying for U.S. GME positions; and that sponsor foreign nationals for the J-1 visa for the purpose of participating in such programs. We offer a verification service that allows GME programs, state medical boards, hospitals, and credentialing agencies in the United States to obtain primary-source confirmation that their IMG applicants are certified by ECFMG. The ECFMG Certificate Holders Office (ECHO) provides support and service to ECFMG-certified physicians as they plan their medical careers.

ECFMG partners with the National Board of Medical Examiners (NBME) in administering the Step 2 Clinical Skills (CS) component of USMLE, a requirement for IMGs and for graduates of U.S. and Canadian medical schools who wish to be licensed in the United States or Canada. Through this collaboration, ECFMG uses its experience in assessment to ensure that all physicians entering U.S. GME can demonstrate the fundamental clinical skills essential to providing safe and effective patient care under supervision.

Through more than five decades of certifying IMGs, ECFMG has developed unparalleled expertise on the world’s medical schools, the credentials they issue to their graduates, and the verification of those credentials. ECFMG has expanded this expertise to include credentials related to postgraduate training and registration/licensure through its primary-source credentials verification service for international medical regulatory authorities. And now, through the Electronic Portfolio of International Credentials (EPICSM), we are bringing this expertise to individual physicians and the entities that license, train, educate, and employ them.

ECFMG’s commitment to promoting excellence in international medical education led to the establishment of its nonprofit foundation, the Foundation for Advancement of International Medical Education and Research (FAIMER). FAIMER has assumed responsibility for, and expanded upon, ECFMG’s programs for international medical educators and ECFMG’s research agenda. Through FAIMER, ECFMG offers training in leadership and health professions education; creates and maintains data resources on medical education worldwide; and conducts research on international medical education programs, physician migration, and U.S. physician workforce issues.

ECFMG is a private, nonprofit organization whose 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 of the United States, Inc.; and National Medical Association.

Programs Overview

ECFMG offers a variety of programs for international physicians and other members of the international medical education and regulatory communities. An overview of each program is available below. For detailed information, visit the program’s section of this website.

ECFMG Certification

ECFMG’s program of certification assesses whether international medical graduates are ready to enter U.S. graduate medical education programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). ACGME requires international medical graduates who enter ACGME-accredited programs to be certified by ECFMG. ECFMG Certification assures directors of accredited residency and fellowship programs, and the people of the United States, that international medical graduates have met minimum standards of eligibility.

Certification Verification Service (CVS)

ECFMG’s Certification Verification Service provides prompt, primary-source verification of an international medical graduate’s ECFMG certification status. ECFMG’s CVS provides this verification to entities in the United States that rely on ECFMG Certification to evaluate the qualifications of international physicians. These entities include credentialing agencies; accredited residency programs; state medical licensing boards; and other organizations, such as hospitals and HMOs.

ERAS Support Services at ECFMG

The Electronic Residency Application Service (ERAS®), developed by the Association of American Medical Colleges (AAMC), allows web-based application to first- and second-year (PGY-1 and PGY-2) residency positions in accredited U.S. programs of graduate medical education. ECFMG has been designated by AAMC to assist international medical students and graduates with the ERAS process. In this role, ECFMG issues ERAS Tokens, which allow international medical students/graduates to complete their residency applications on the AAMC website. ECFMG also collects and transmits supporting documents and transmits reports of ECFMG certification status and USMLE transcripts.

Exchange Visitor Sponsorship Program (J-1 visa)

ECFMG is authorized by the U.S. Department of State to sponsor foreign national physicians for the J-1 Exchange Visitor visa for the purpose of participating in U.S. programs of graduate medical education or training. ECFMG is responsible for ensuring that Exchange Visitors and their host institutions meet the federal requirements for participation in the Exchange Visitor Program. ECFMG’s Exchange Visitor Sponsorship Program provides instruction and guidance to teaching hospitals, medical specialty organizations, universities, and international physicians on the credential and immigration requirements for J-1 visa sponsorship.

ECFMG Certificate Holders Office (ECHO)

The ECFMG Certificate Holders Office (ECHO) provides free career planning resources for physicians pursuing ECFMG Certification and graduate medical education (GME) in the United States. Through ECHO, certified physicians can stay connected with ECFMG; communicate with ECFMG; and access a library of resources they need to be better prepared and organized when making important career decisions.

Electronic Portfolio of International Credentials (EPICSM)

EPIC is an on-line tool for physicians and the entities that register/license, employ, train, and educate them. EPIC allows physicians to build a web-based career portfolio of their primary-source verified medical credentials and to have reports on the authenticity of those credentials sent electronically to any organization, anywhere in the world. Medical regulatory authorities, hospitals, academic institutions, and other entities use EPIC to access verification reports on the credentials of their physician applicants.

ECFMG International Credentials Services (EICS)

EICS assists international medical registration authorities in obtaining primary-source verification of medical education and registration credentials of physicians applying for licensure whose medical education or training was completed outside the authorities’ jurisdiction. The physician credentials verified by EICS include medical school diplomas, medical school transcripts, certificates of postgraduate medical training, and certificates of medical registration or licensure.

Provision of USMLE Performance Data to International Medical Schools

ECFMG provides eligible international medical schools with individual and aggregate data on the performance of their students and graduates who apply to ECFMG for USMLE Step 1, USMLE Step 2 Clinical Knowledge (CK), and USMLE Step 2 Clinical Skills (CS).

GEMxSM – Global educational exchange in medicine and the health professions

GEMx is a global partnership for international educational exchange in medicine and the health professions. GEMx Partners are medical schools and other institutions around the world that share a commitment to making international exchange a part of their education programs, and to providing students in medicine and the health professions with increased access to educational exchange opportunities. GEMx’s innovative web-based system both streamlines and enhances the exchange process. Using the GEMx system, participating institutions can publish their elective exchange opportunities on-line and provide detailed information about these opportunities. They can also verify student eligibility and monitor student applications and activity. Students of participating institutions can use the GEMx system to research elective exchange opportunities on-line, and apply directly to participating institutions for opportunities that match their career goals and interests using GEMx’s paperless application process. Students can explore electives based on such information as learning objectives, prerequisites, fees, languages of instruction, and travel information.


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 (abbreviated NRMP, but also called “the Match”). To participate in the NRMP, an IMG is required to have an ECFMG certification[1] by the “rank order list certification deadline” time (usually in February of the year of the match).

To acquire an ECFMG certification, the main requirements are:

  • Completion ofUSMLE Step 1,USMLE Step 2 Clinical KnowledgeandUSMLE Step 2 Clinical Skills
  • A medical diploma ofmedical educationtaken at an institution registered in theInternational Medical Education Directory (IMED)

In comparison, regular graduates from medical schools in the United States need to complete USMLE Steps 1 and 2 as well, but can participate in the NRMP while still doing their final year of medical school before acquiring their medical diplomas.In effect, taking regular administrative delays into account, and with residency programs starting around July, there is a gap of at least half a year for IMGs between graduation from medical school and beginning of a residency program.

A pilot project has started 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 will invite additional medical schools to participate

Register in International Medical Education Directory

Before a medical school is considered for listing in IMED, the authorized agency of the government in the country where the school is located must write to FAIMER to provide the following information. The authorized agency may be the Ministry of Health, Ministry of Education, medical council or other authority.

That the specified medical school is recognized by the government of the country for award of either the Doctor of Medicine (M.D.) degree or the other equivalent Bachelor of Medicine, Bachelor of Surgery (M.B.B.S) degree The date on which recognition was granted That the specified medical school has a physical campus in the country and the address of that campus. Whether instruction has begun at the school, and on what date. If instruction has not yet begun, the date classes are expected to begin. If applicable, the name of the university with which the medical college is affiliated. That graduates of the specified medical school eligible for medical licensure in the country The date on which graduates of the specified medical school became eligible for medical licensure

The letter must be received directly from the Ministry of Health or other authority, on letterhead stationery, with the signature and seal of the Minister or appropriate official.