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USMLE
Information Booklet 2005
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Educational Commission
for Foreign Medical Graduates
Form 100S, August 2004
3624 Market Street
Philadelphia, PA 19104-2685 USA
Apply on-line for
E C F M G® C E R T I F I C A T I O N
2005
INFORMATION
BOOKLET
See page vii for important
updates on:
Certification News
The ECFMG® Reporter, a free
e-mail newsletter for applicants,
provides important updates on
ECFMG Certification and entry
into graduate medical education in
the United States.
The ECFMG® Reporter
Subscribe today at
Step 1 and Step 2 (Clinical Knowledge and Clinical
Skills) of the United States Medical Licensing
Examination™ (USMLE
™)
at
Changes to exam eligibility
requirements
Providing the final medical
school transcript to ECFMG
Transition to USMLE
™
Step 2 CS
h
h
h
i
ABOUT THIS PUBLICATION
The ECFMG Information Booklet contains detailed information on ECFMG’s program of certification and
ECFMG’s other programs and services for international medical students and graduates. The 2005 edition of
the Information Booklet is associated with corresponding application materials for Step 1 and Step 2 (Clinical
Knowledge and Clinical Skills components) of the United States Medical Licensing Examination™
(USMLE
™).
Applicants for examination must use the appropriate edition of the Information Booklet / application materials.
The 2005 Information Booklet and USMLE
application materials pertain to eligibility periods in 2005. If your
eligibility period extends into 2006 and you test in 2006, you must become familiar with and will be subject to
the policies and procedures detailed in the 2006 Information Booklet. The 2006 Information Booklet /
application materials are expected to be available in August 2005. Eligibility periods are explained on pages
21-23.
The USMLE
[bleep] of Information provides information about the United States Medical Licensing
Examination, the single, three-step examination program for medical licensure in the United States. The
USMLE
[bleep] of Information is available on the USMLE
website at and from ECFMG,
upon request. In the event that information about the USMLE
in the ECFMG Information Booklet differs from
the corresponding information in the USMLE
[bleep] of Information, the information in the USMLE
[bleep]
of Information shall govern.
Applicants for ECFMG Certification are required to read both the ECFMG Information Booklet and
the USMLE
[bleep] of Information.
Although current at the time of publication, the information contained in this booklet is subject to change. If
changes occur, information will be posted on the ECFMG website. You must obtain the most recent
information to ensure an accurate understanding of current policies and procedures.
The ECFMG® Reporter, ECFMG’s free e-mail newsletter, provides important updates on ECFMG
Certification and entry into graduate medical education in the United States. All applicants for ECFMG
Certification should subscribe to The ECFMG® Reporter. See E-Newsletters on page vi.
HOW TO OBTAIN THIS PUBLICATION
Ø Access the ECFMG Information Booklet / USMLE
[bleep] of Information on-line and apply on-line for
USMLE
Step 1, Step 2 CK, and Step 2 CS on the ECFMG website at
Ø Download the ECFMG Information Booklet / USMLE
[bleep] of Information and application materials
for USMLE
Step 1, Step 2 CK, and Step 2 CS from the ECFMG website at
Ø If you are not able to access these materials on-line, contact ECFMG in writing (mail or fax) to obtain
photocopies by mail. See General Inquiries on page ii.
® The terms ECFMG®, CSA®, and FAIMER® are registered in the U.S. Patent and Trademark Office.
Copyright © 2004 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved. Portions reprinted, with
permission, from the USMLE
2005 [bleep] of Information, copyright © 2004 by the Federation of State Medical Boards of the United States,
Inc., and the National Board of Medical Examiners® (NBME®); and the GMED Companion: An Insider’s Guide to Selecting a Residency
Program, 2004-2005, copyright © 2004 by the American Medical Association.
ii
COMMUNICATING WITH ECFMG
Applicant Information
Use ECFMG's On-line Applicant Status and Information System (OASIS) to check the status of items
related to ECFMG Certification, such as your exam applications, score reports, and medical education
credentials; general information, such as your name and contact information; and your ECFMG financial
account.
To access OASIS, visit the ECFMG website at
General Inquiries & Correspondence —
Contact Applicant Information Services at:
ECFMG
3624 Market Street
Philadelphia, PA 19104-2685 USA
Always include your USMLE
/ ECFMG
Identification Number, if one has been assigned,
when communicating with ECFMG.
TEL: (215) 386-5900
(Telephone assistance is available between 9:00 a.m.
and 5:00 p.m., Eastern Time, Monday through Friday.)
FAX: (215) 386-9196
E-MAIL:
Registration Services —
Exam Applications / Other Service Requests,
such as requests for USMLE
Transcripts,
including payments
By mail to:
ECFMG / Registration Services
PO Box 48087
Newark, NJ 07101-4887 USA
By courier service to:
ECFMG
c/o Image Remit
205 North Center Drive
Commerce Center
North Brunswick, NJ 08902 USA
Certification Statements (Form 183) for online
exam applications
By mail or courier service to:
IWA
ECFMG
3624 Market Street
Philadelphia, PA 19104-2685 USA
iii
COMMUNICATING WITH ECFMG (continued)
Certification Verification Service (CVS) —
Request Forms and Payments
By mail to:
ECFMG / CVS Department
PO Box 48083
Newark, NJ 07101-4883 USA
By courier service to:
ECFMG / CVS Department
c/o Image Remit
205 North Center Drive
Commerce Center
North Brunswick, NJ 08902 USA
Correspondence and Inquiries to:
ECFMG / CVS Department
PO Box 13679
Philadelphia, PA 19101-3679 USA
TEL: (215) 386-5900
Electronic Residency Application Service (ERAS® ) —
Request Forms and Payments
By mail to:
ECFMG / ERAS Program
PO Box 48087
Newark, NJ 07101-4887 USA
By courier service to:
ECFMG
c/o Image Remit
205 North Center Drive
Commerce Center
North Brunswick, NJ 08902 USA
Correspondence and Inquiries to:
ERAS
ECFMG
3624 Market Street
Philadelphia, PA 19104-2685 USA
TEL: (215) 386-5900
FAX: (215) 222-5641
Supporting Documents for Scanning
By mail to:
ECFMG / ERAS Program
PO Box 11746
Philadelphia, PA 19101-0746 USA
By courier service to:
ERAS
ECFMG
3624 Market Street
Philadelphia, PA 19104-2685 USA
Do not send supporting documents by fax.
iv
Exchange Visitor Sponsorship Program (EVSP) —
Applications and Payments
If paying on-line using OASIS
By mail or courier service to:
ECFMG / Exchange Visitor Sponsorship
Program
3624 Market Street
Philadelphia, PA 19104-2685 USA
If enclosing a check or money order
By mail to:
ECFMG / Exchange Visitor Sponsorship
Program
PO Box 48087
Newark, NJ 07101-4887 USA
By courier service to:
ECFMG
c/o Image Remit
205 North Center Drive
Commerce Center
North Brunswick, NJ 08902 USA
Correspondence and Inquiries to:
ECFMG / Exchange Visitor Sponsorship
Program
3624 Market Street
Philadelphia, PA 19104-2685 USA
TEL: (215) 823-2121
FAX: (215) 386-9766
ECFMG International Credentials Services (EICS) — ics
EICS is a credentials verification service offered to international organizations and authorities involved in
medical registration, licensing, and assessment. EICS is not involved with the ECFMG Certification
process. Applicants for ECFMG Certification should not submit credentials to EICS. Credentials
submitted to EICS for ECFMG Certification may be misdirected, resulting in their delayed processing.
ECFMG / International Credentials Services TEL: (215) 823-2274
PO Box 13795
Philadelphia, PA 19101-3795 USA FAX: (215) 966-3129
v
ON-LINE SERVICES
Convenient access to information and services is available on the ECFMG website at
ECFMG's on-line services are:
Ø Available 24 hours / day, 7 days / week; and
Ø Offered to users at no cost.
On-line Applicant Status and Information System (OASIS)
The On-line Applicant Status and Information System (OASIS) is a web-based information service for
ECFMG applicants and ECFMG-certified physicians.
You can use OASIS to check the status of:
Ø Exam applications and score reports,
Ø USMLE
scheduling permits,
Ø TOEFL
® score acceptance,
Ø Medical education credentials,
Ø USMLE
transcript requests (NOTE: The status
of requests for electronic transmittal of
USMLE
transcripts via ERAS is not available
through OASIS.),
Ø Standard ECFMG Certificate, and
Ø Requests for permanent validation of the
certificate.
You can also check:
Ø Name of record,
Ø Contact information, and
Ø Status of ECFMG financial account.
You can use OASIS to:
Ø Make on-line payments to your ECFMG financial account.
Ø Update your contact information, including your e-mail address, mailing address, and telephone and fax
numbers.
Ø Request an ERAS Token.
Ø Request a permanent validation sticker for your Standard ECMFG Certificate.
Interactive Web Application (IWA)
The Interactive Web Application is ECFMG's web-based application service for ECFMG applicants. You can
use IWA to:
Ø Apply on-line for USMLE
Step 1, Step 2 CK, and Step 2 CS, and
Ø Request an extension of your USMLE
Step 1 / Step 2 CK eligibility period (for registered applicants).
On-line applicants submit most application information, including payment, to ECFMG via the Internet. IWA
provides applicants with on-line instructions, the ability to save a partially completed application, and on-line
validation that prevents many common errors. ECFMG processes on-line applications typically within ten
business days of receipt of the completed Certification Statement.
ECFMG also accepts paper exam applications and requests for USMLE
eligibility period extensions. Paper
application materials are available on the ECFMG website at and from ECFMG, upon request
(see General Inquiries on page ii). ECFMG processes paper applications typically within four weeks of
receipt.
vi
Step 2 CS Calendar
The Step 2 CS Calendar allows unrestricted access to the calendar of available test dates at all Clinical Skills
Evaluation Centers. All visitors to the ECFMG website can access the Step 2 CS Calendar.
Step 2 CS Scheduling
Step 2 CS Scheduling allows registered applicants to check available test dates at all Clinical Skills Evaluation
Centers and schedule, cancel, reschedule, and confirm testing appointments.
E- Newsletters
Subscription to ECFMG’s e-newsletters is free, and issues are delivered to subscribers by e-mail.
Ø The ECFMG® Reporter –
Important, updated information for international medical students and graduates pursuing ECFMG
Certification and graduate medical education in the United States.
Ø ECFMG-ERAS News –
Important updates for international medical students and graduates using the Electronic Residency
Application Service (ERAS) to apply for residency positions in U.S. programs of graduate medical
education.
Ø The ECFMG Correspondent –
Issues of interest to ECFMG-certified physicians.
ECFMG Website
Visit the ECFMG website at for:
Ø Information on ECFMG’s programs,
Ø Publications and forms,
Ø On-line services, and
Ø Important updates.
vii
CERTIFICATION NEWS
Changes to Eligibility Requirements for Taking Step 2 CK and Step 2 CS
To apply for and take the exams required for ECFMG Certification, international medical students and
graduates must satisfy certain requirements. Some of the eligibility requirements for taking Step 2 CK and
Step 2 CS will change for individuals who apply using the 2005 USMLE
application materials.
These changes do not affect the requirements for ECFMG Certification. The requirements for ECFMG
Certification remain unchanged. The changes affect only the point at which medical school students can apply
for and take Step 2 CK and Step 2 CS, and the sequence in which applic ants can take the exams required for
ECFMG Certification.
Change #1 – Medical Education Requirement for Students Applying for Step 2 CK or Step 2 CS
New Requirement: To take Step 2 CK or Step 2 CS, medical school students must have completed at least
two years of medical school. This eligibility requirement means that students must have completed the basic
medical science component of the medical school curriculum. For Step 2 CK, students who apply must meet
this requirement by the beginning of the three-month eligibility period they select on the application. For Step
2 CS, students must meet this requirement at the time of application, since the eligibility period assigned for
Step 2 CS begins upon completion of registration.
For individuals who apply using the 2005 application materials, this requirement replaces the previous
requirement, described below.
Previous Requirement: To take Step 2 CK or Step 2 CS, medical school students were required to be within
twelve months of completing the full didactic curriculum at their medical school.
Change #2 – Examination Prerequisite for Step 2 CS
New Requirement: There is no examination prerequisite for Step 2 CS. This means that applicants are no
longer required to have passed Step 1 before applying for Step 2 CS. Applicants for ECFMG Certification may
take Step 1, Step 2 CK, and Step 2 CS in any sequence, provided that they meet all other eligibility
requirements.
For individuals who apply using the 2005 application materials, this requirement replaces the previous
requirement, described below.
Previous Requirement: To apply for Step 2 CS, all applicants (students and graduates) must have passed
Step 1.
With the implementation of these changes, the eligibility requirements for Step 2 CK and Step 2 CS become
the same as those for Step 1. As a result, the same eligibility requirements now apply to all examinations
required for ECFMG Certification.
Applicants should also be familiar with ECFMG's recommendations to applicants for Step 2 CK and Step 2
CS. See page 17 for complete information.
For complete information on eligibility, see Eligibility for Examination on page 16.
viii
Provision of Final Medical School Transcript
When ECFMG sends your medical diploma to your medical school for verification, ECFMG will request the
medical school to include your final medical school transcript when the school returns the verification of your
medical diploma to ECFMG. If ECFMG is unable to obtain your final medical school transcript directly from
your medical school, ECFMG will contact you and request that you submit to ECFMG copies of your final
medical school transcript. ECFMG will then, in turn, send a copy of your final medical school transcript to
your medical school for verification. The medical education credential requirements for ECFMG Certification
are not considered complete until ECFMG receives and verifies both the final medical diploma and final
medical school transcript. See Provision of Credentials and Translations on page 34.
Transition to USMLE
™ Step 2 CS
USMLE
Step 2 Clinical Skills (Step 2 CS) has replaced the former ECFMG Clinical Skills Assessment (CSA®)
for the purpose of ECFMG Certification. The transition to Step 2 CS has resulted in important changes in
policies and procedures related to ECFMG Certification. If you are an applicant for ECFMG Certification, you
should be familiar with the following changes:
Ø Step 2 CS is the exam currently administered that satisfies the clinical skills requirement for ECFMG
Certification. If you have not satisfied this requirement, you must pass Step 2 CS. See Clinical Skills
Requirement on page 15.
Ø Effective June 14, 2004, the Test of English as a Foreign Language™ (TOEFL
®) is no longer a
requirement for ECFMG Certification. The current examination requirements for ECFMG Certification
are described on pages 6-7.
Ø Effective June 14, 2004, passing performances on the English Test, and the CSA taken and passed on or
after June 14, 2001, are not subject to expiration for the purpose of entry into graduate medical education.
ECFMG-certified physicians who passed these exams for ECFMG Certification may be eligible to request
permanent validation sticker(s) for the exam(s) to be affixed to the Standard ECFMG Certificate. See
Validity of the Certificate for Entry into Graduate Medical Education on page 8.
Ø Passing Step 2 CS will be required to Register for Step 3 for international medical graduates who have not
passed the former ECFMG CSA. ECFMG-certified physicians, and physicians who have successfully
completed Fifth Pathway programs, who have not taken and passed either Step 2 CS or the ECFMG CSA
may Register for Step 3 through June 30, 2005. After that point, these physicians will have to have taken
and passed either Step 2 CS or the CSA in order to Register for Step 3. See USMLE
Step 2 Clinical Skills
(CS) Examination and Eligibility in the USMLE
[bleep] of Information.
The ECFMG® Reporter
Applicants who supply their e-mail addresses to us as part of the application process will automatically receive
our electronic newsletter, The ECFMG® Reporter. The ECFMG® Reporter provides important information
regarding the ECFMG certification process and entry into graduate medical education in the United States. The
ECFMG® Reporter may also advise you of services and programs offered by other organizations in connection
with the certification process or graduate medical education in the United States.
The ECFMG® Reporter is a free publication. ECFMG will not share The ECFMG® Reporter subscriber
database with third parties. Interested individuals can join or leave The ECFMG® Reporter subscriber list or
update their e-mail addresses at any time by visiting the ECFMG website at
or by writing to: Director of Communications, ECFMG, 3624 Market
Street, Philadelphia, PA, 19104-2685, USA.
Please note that ECFMG may share certain information contained in your exam applications with other
organizations under specified circumstances. For further information regarding ECFMG’s data collection and
privacy practices, please refer to our Privacy Policy available on the ECFMG website at
ix
CONTENTS
ABOUT THIS PUBLICATION ................. i
HOW TO OBTAIN THIS PUBLICATION ........................................................................................................................... i
COMMUNICATING WITH ECFMG ...ii
ON-LINE SERVICES ..................................v
CERTIFICATION NEWS ........................vii
ACRONYM KEY .........................................xi
FREQUENTLY ASKED QUESTIONS ..1
ECFMG CERTIFICATION.......................6
Requirements for ECFMG Certificatio6
Examination Requirements .............6
Medical Education Credential Requirements .............................................................................................................7
Standard ECFMG Certificate..................8
Validity of the Certificate for Entry into Graduate Medical Education ..................................................................8
Confirmation of ECFMG Certification Status.............................................................................................................9
GENERAL REGISTRATION INFORMATION...............................................................................................................10
USMLE
/ ECFMG Identification Number.........................................................................................................................10
Name of Applicant..................................10
Changing or Verifying Your Name .............................................................................................................................11
Contact Information ...............................12
Payment ....................................................12
Refunds.............................................13
EXAMINATION REQUIREMENTS ...14
The United States Medical Licensing Examination (USMLE
) .......................................................................................14
Registration Entity and Test Delivery Entity.....................................................................................................................14
Step 1 and Step 2.............................14
Step 3 ................................................14
Medical Science Examination Requirement ......................................................................................................................15
Clinical Skills Requirement ..................15
Time Limit for Completing Examination Requirements .................................................................................................16
Eligibility for Examination....................16
Medical School Students ...............16
Medical School Graduates ............17
Applying for Examination.....................18
When to Apply ........................................19
Fees............................................................19
Examinees with Disabilities..................20
Testing Locations....................................20
Step 1 and Step 2 CK .....................20
Step 2 CS ..........................................21
Eligibility Periods...................................21
Step 1 and Step 2 CK .....................21
Eligibility Period Extension..22
Step 2 CS ..........................................22
Your Scheduling Permit ........................23
Step 1 and Step 2 CK .....................23
Step 2 CS ..........................................23
Replacement Scheduling Permits.24
Step 1 and Step 2 CK .............24
Step 2 CS ..................................24
Scheduling................................................24
Step 1 and Step 2 CK .....................24
Step 2 CS ..........................................25
How Step 2 CS Dates Become Available ...........................................................................................................25
Rescheduling ...........................................25
x
Step 1 and Step 2 CK .....................25
Step 2 CS ..........................................26
Preparation ...............................................27
Format of the Exams ......................27
Sample Test Materials ....................27
Step 1 / Step 2 CK Practice Session at a Prometric Test Center.............................................................................27
Taking the Exam.....................................28
Step 1 / Step 2 CK ..........................28
Step 2 CS ..........................................28
Travel Status....................................29
Acceptable Identification...............29
Scoring and Score Reporting ................30
Minimum Passing Scores ..............30
Reporting of Scores ........................30
Step 1 / Step 2 CK ..................30
Step 2 CS ..................................31
Score Rechecks ...............................31
USMLE
Transcripts ......................31
CSA Performance History ............31
Testing Conditions, Validity of Scores, and Irregular Behavior ....................................................................................32
Testing Conditions..........................32
Validity of Scores ...........................32
Irregular Behavior...........................32
Reexamination and Reapplication .......33
MEDICAL EDUCATION CREDENTIALS ........................................................................................................................34
Provision of Credentials and Transl34
Credentials for ECFMG Certification .........................................................................................................................34
Final Medical Diploma ..........34
Final Medical School Tran35
Name on Medical Diploma and Medical School Transcript...........................................................................36
Credentials for Exam Registratio37
English Translations.......................37
Verification of Credentials ............38
Irregular Behavior...........................38
Representative Examples of Irregular Behavior................................................................................................39
The Fifth Pathway Program..........39
The Fifth Pathway and Students Attending Medical Schools in Mexico..............................................................40
The Fifth Pathway and Students Attending Other Medical Schools ......................................................................40
ENTRY INTO GRADUATE MEDICAL EDUCATION IN THE UNITED STATES ............................................41
Residency Training Programs ...............41
ACGME Accreditation ..................41
The Graduate Medical Education Directory ............................................................................................................41
Number and Availability of Residency Positions.....................................................................................................42
Selecting Residency Programs .....42
ECFMG Certification.....................42
Applying to Graduate Medical Education Programs ........................................................................................................43
Electronic Residency Application Service (ERAS)..................................................................................................43
National Residency Matching Program (NRMP) ....................................................................................................43
Obtaining a Visa......................................45
Examination Requirements Under the Health Professions Educational
Assistance Act of 1976 (PL94-484).........................................................................................................................45
Exchange Visitor Sponsorship Program (J-1 Visa) ..................................................................................................45
STATEMENT OF VALUES, MISSION, AND PURPOSES ..........................................................................................47
ORGANIZATIONAL MEMBERS .......48
APPENDIX 1: Reference Guide for Medical Education Credentials ..................................................................................49
APPENDIX 2: Testing Regions and International Test Delivery Surcharges for USMLE
Step 1 and Step 2 CK......54
xi
ACRONYM KEY
AAMC Association of American Medical Colleges
ABMS American Board of Medical Specialties
ACGME Accreditation Council for Graduate Medical Education
AMA American Medical Association
AOA American Osteopathic Association
CD Compact Disc
CIN Candidate Identification Number
CK Clinical Knowledge, a component of USMLE
Step 2
CS Clinical Skills, a component of USMLE
Step 2
CSA Clinical Skills Assessment, formerly administered by ECFMG
CVS Certification Verification Service
ECFMG Educational Commission for Foreign Medical Graduates
ERAS Electronic Residency Application Service
ETS Educational Testing Service
EVSP Exchange Visitor Sponsorship Program
FAIMER® Foundation for Advancement of International Medical Education and
Research
FLEX Federation Licensing Examination
FMGEMS Foreign Medical Graduate Examination in the Medical Sciences
FSMB Federation of State Medical Boards of the United States, Inc.
GME Graduate Medical Education
IMED International Medical Education Directory
IMG International Medical Graduate
IWA Interactive Web Application
JCAHO Joint Commission on Accreditation of Healthcare Organizations
LCME Liaison Committee on Medical Education
NBME National Board of Medical Examiners
NRMP National Resident Matching Program
OASIS On-line Applicant Status and Information System
SP Standardized Patient
TOEFL
Test of English as a Foreign Language
USMLE
United States Medical Licensing Examination
VQE Visa Qualifying Examination
® Registered in the U.S. Patent and Trademark Office.
1
FREQUENTLY ASKED QUESTIONS
ECFMG Certification
1. What is ECFMG Certification?
Medical schools outside the United States and Canada
vary in their educational standards and curricula. The
purpose of ECFMG Certification is to assess the readiness of graduates of these schools to enter U.S. residency
and fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education
(ACGME). To be certified by ECFMG, you must pass a series of exams; you must also fulfill ECFMG’s
medical education credential requirements. These requirements include providing ECFMG with copies of your
medical education credentials, which ECFMG will verify directly with your medical school. See ECFMG
Certification on page 6.
2. Why would I want to be certified by ECFMG?
If you are an international medical graduate and wish to enter an ACGME-accredited residency or fellowship
program in the United States, you must be certified by ECFMG before you can enter the program. You must
also be certified by ECFMG if you wish to take Step 3 of the three-step United States Medical Licensing
Examination (USMLE
). ECFMG Certification is also one of the requirements to obtain an unrestricted license
to practice medicine in the United States. See ECFMG Certification on page 6.
3. How can I find out if students / graduates of my medical school are eligible for ECFMG Certification?
To be eligible for certification by ECFMG, among other requirements, your medical school must be listed in
the International Medical Education Directory (IMED) of the Foundation for Advancement of International
Medical Education and Research (FAIMER). If you are a medical school student and you want to apply for
examination, your medical school must be listed in IMED and your medical school's "Graduation Years" must
be listed as "Current," both at the time you apply for the exam and at the time you take the exam. If you are a
medical school graduate, your medical school and graduation year must be listed in IMED to be eligible for
examination and for ECFMG Certification. To verify that you meet these requirements, access IMED on the
ECFMG website at See ECFMG Certification on page 6.
4. How do I begin the certification process?
The certification process begins when you submit your first exam application to ECFMG. At this time,
ECFMG will assign you an identification number that you will use throughout the certification process. See
USMLE
/ ECFMG Identification Number on page 10.
5. How long does the certification process take?
The time required to complete the certification process is different for each applicant. You may apply for the
required exams as soon as you meet the eligibility requirements for examination. All of the exams required for
ECFMG Certification are offered continuously throughout the year.
Both medical school students and graduates may begin the certification process. However, since one of the
requirements for ECFMG Certification is that your medical education credentials be independently verified by
ECFMG with your medical school, you cannot complete the certification process until you graduate. The time
required for some aspects of the certification process, such as the time required by your medical school to
verify your medical education credentials, is beyond the control of ECFMG. See ECFMG Certification on
page 6.
2
6. In what order do I take the exams required for ECFMG Certification?
To be eligible for ECFMG Certification, you must, among other requirements, pass USMLE
Step 1, Step 2
CK, and Step 2 CS. See Examination Requirements on page 14. Once you meet the eligibility requirements for
examination, you can take these exams in any order. See Eligibility for Examination on page 16.
7. How can I have ECFMG confirm to a medical licensing authority or residency / fellowship program
that I am ECFMG-certified?
ECFMG will confirm your certific ation status when it receives a request directly from a medical licensing
authority, residency / fellowship program official, or other appropriate organization. For status reports sent to
medical licensing authorities, the request can also be sent to ECFMG by you. Approximately two weeks are
required for the confirmation to be completed. Please note that there may be a fee for this service. See
Confirmation of ECFMG Certification Status on page 9. If you apply to residency programs through ERAS,
ECFMG will send an electronic ECFMG Status Report automatic ally to all of the programs to which you
applied. See Electronic Residency Application Service on page 43.
USMLE
Step 1 and Step 2 (CK and CS)
8. How can I apply?
You can apply on-line using ECFMG's Interactive Web Application (IWA). For more information, visit
ECFMG's website at You can also download the paper USMLE
application materials from
the ECFMG website. If you do not have access to the Internet, you can request a photocopy of these materials.
See How To Obtain This Publication on page i.
9. How can I prepare for the exams?
Information on preparing for the exams is available in this booklet and in the USMLE
[bleep] of Information.
Sample test materials for all Steps and Step Components are available on the USMLE
Orientation Materials
compact disc (CD), which ECFMG sends to applicants when they are registered. The sample test materials on
the CD and additional information on examination content and test formats are available on the USMLE
website at See Preparation on page 27.
10. When and where can I take Step 1 and Step 2?
Step 1 and Step 2 (CK and CS) are offered continuously throughout the year. Applicants registered for these
exams are assigned an eligibility period during which they must take the exam. See When to Apply on page 19
and Eligibility Periods on page 21.
Step 1 and Step 2 CK are offered worldwide at test centers of Prometric , a division of Thomson Learning, Inc.
For information on Prometric test centers offering USMLE
, visit the Prometric website at
Step 2 CS is administered at Clinical Skills Evaluation Centers in Atlanta, Chicago,
Houston, Los Angeles, and Philadelphia in the United States. See Testing Locations on page 20.
11. Do I need to graduate from medical school before taking the exams?
Both students and graduates may take the exams. To take the exams, medical school students must have
completed at least two years of medical school. This eligibility requirement means that students must have
completed the basic medical science component of the medical school curriculum. Other eligibility
requirements apply to both students and graduates. Refer to Eligibility for Examination on page 16.
3
12. What if I cannot take an exam once I have registered?
Once registered, you cannot cancel or postpone your registration (except as described below for Step 1 / Step 2
CK). If you do not take the exam, you will not receive a refund or credit of your exam fee(s). For detailed
information on ECFMG’s payment policy, refer to Payment on page 12.
Although you cannot cancel your registration, there are options that provide flexibility. Registered applicants
can change their test date and / or test center, subject to availability. See Rescheduling on page 25. If you are
unable to take Step 1 / Step 2 CK during your assigned eligibility period, you can request an extension of your
eligibility period for a fee. See Eligibility Period Extension on page 22.
13. Is there a limit to the number of times I can take an exam?
For the purpose of ECFMG Certification, there is no limit on the number of times you can take a Step or
Step Component you have not passed. If you fail a Step or Step Component, you may retake it, but you must
reapply and pay the appropriate fee(s). Certain restrictions apply when retaking the same Step. Once you pass
a Step or Step Component, you may not repeat it, and you will have seven years to pass the other Step(s) and
Step Component(s) required for ECFMG Certification. See Time Limit for Completing Examination
Requirements on page 16 and Reexamination and Reapplication on page 33.
English Language Proficiency Test
14. How do I fulfill the English language proficiency requirement for ECFMG Certification?
Effective June 14, 2004, applicants for ECFMG Certification are no longer required to pass the Test of English
as a Foreign Language (TOEFL
). Currently, applicants satisfy this requirement by passing Step 2 CS, which
has a distinct, separately scored subcomponent that assesses spoken English proficiency. Passing Step 2 CS
also satisfies the clinical skills requirement for ECFMG Certification.
15. What if I have already passed an English test?
If you passed an English test, such as the TOEFL
exam or the former ECFMG English test, and you also
passed the former ECFMG CSA, you can use these passing performances to satisfy the clinical skills
requirement for ECFMG Certification. See Clinical Skills Requirement on page 15.
If you passed an English test but did not pass the former ECFMG CSA, you must still pass Step 2 CS to fulfill
the clinical skills requirement for ECFMG Certification. The date of your passing performance on the English
test will not appear on your ECFMG Certificate when it is issued.
If you are certified by ECFMG and the English test pass date and “valid through” date appear on your ECFMG
Certificate, you may be eligible for a permanent validation sticker for the English test to be affixed to your
Standard ECFMG Certificate. See Validity of the Certificate for Entry into Graduate Medical Education on
page 8.
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16. Does my English test date expire?
Before June 14, 2004, pas sing performances on the English test were valid for two years from the date passed
for the purpose of entering graduate medical education. Applicants whose English test dates had expired were
required to pass another English test to revalidate this English test date before entering graduate medical
education.
Effective June 14, 2004, passing performances on the English test, regardless of the date passed, do not expire
for the purpose of entering graduate medical education. If you passed an English test for ECFMG Certification
and were certified before June 14, 2004, you may request a permanent validation sticker for your English test
date. See Validity of the Certificate for Entry into Graduate Medical Education on page 8.
ECFMG Clinical Skills Assessment (CSA)
17. How do I fulfill the clinical skills requirement for ECFMG Certification?
USMLE
Step 2 CS has replaced the ECFMG CSA as the exam that satisfies the clinical skills requirement for
ECFMG Certification. Applicants who have not passed the ECFMG CSA must take USMLE
Step 2 CS. See
Examination Requirements on page 14.
18. What if I have already passed the ECFMG CSA?
If you have passed the ECFMG CSA, you will not be required to pass Step 2 CS for ECFMG Certification. See
Examination Requirements on page 14. Additionally, applicants who have passed the CSA will not be required
to pass Step 2 CS to meet the eligibility requirements for Step 3. See USMLE
Step 2 Clinical Skills (CS)
Examination and Eligibility in the USMLE
[bleep] of Information.
Effective June 14, 2004, passing performances on the CSA that took place on or after June 14, 2001 do not
expire for the purpose of entering graduate medical education. If you are certified by ECFMG and the CSA
pass date on your certificate is June 14, 2001 or later, you may request a permanent validation sticker for your
CSA date. See Validity of the Certificate for Entry into Graduate Medical Education on page 8.
If you passed the CSA before June 14, 2001, your passing performance on the CSA remains subject to
expiration for the purpose of entry into graduate medical education. See Validity of the Certificate for Entry
into Graduate Medical Education on page 8.
Medical Education Credentials
19. What is a final medical school transcript?
The final medical school transcript is an official document that is the record of the graduate’s medical
education, issued by the medical school or university, upon or after graduation.
The format of the final medical school transcript may vary among institutions. The final medical school
transcript contains the name of the medical school or university and the name of the graduate. Other items that
may be contained in the final medical school transcript include, but are not limited to, the dates of attendance,
courses taken, credits for each course, grade in each course, summary of transfer credit accepted and the name
of the institution from which the credit was accepted, title of the degree awarded, date degree was awarded,
program of study (i.e., medicine), and date the transcript was issued.
5
20. How will I know if ECFMG has received verification of my medical diploma and transcript from my
medical school?
ECFMG will notify you when it sends the request for verification of your medical education credentials to
your medical school. After ECFMG receives the verification of your diploma and / or your final medical
school transcript from your medical school, ECFMG will send you another notification. You can check the
status of your medical education credentials using OASIS (see page v). See Verification of Credentials on page
38.
Fifth Pathway Program
21. What if I plan to attend a Fifth Pathway program?
If you intend to complete a Fifth Pathway program, you are required to notify ECFMG of this intent. See The
Fifth Pathway Program on page 39.
ERAS
22. What medical specialties are participating in the Electronic Residency Application Service (ERAS) in
2005?
Most specialties participate in ERAS. For the list of participating specialties, visit the ERAS website of the
Association of American Medical Colleges (AAMC) at Programs participating in ERAS
will, in principle, no longer accept paper applications. However, there may be exceptions by individual
program directors. You should contact the programs directly for their policies.
Payment
23. How do I pay for the exam(s)?
If you apply for an exam or request a service on-line, you can pay the required fees on-line with a credit card
(Visa, MasterCard, or Discover) or with an electronic payment from your U.S. checking account. If you submit
a paper exam application or request for service and you have a USMLE
/ ECFMG Identification Number, you
can pay in advance using OASIS. All applicants submitting paper applications / requests can pay by credit
card, check, or wire transfer by completing the payment section of the application / request form. Payment for
all services is due at the time of application. If you do not include full payment, your application / request
for service will be rejected. See Payment on page 12.
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ECFMG CERTIFICATION
The Educational Commission for Foreign Medical Graduates (ECFMG), through its program of certification,
assesses whether international medical graduates are ready to enter residency or fellowship programs in the
United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).
ECFMG and its organizational members define an international medical graduate as a physician who received
his / her basic medical degree or qualification from a medical school located outside the United States and
Canada
*. To be eligible for ECFMG Certification, the physician's medical school and graduation year must
be listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of
International Medical Education and Research (FAIMER). To verify that a particular medical school and
graduation year are listed, access IMED on the ECFMG website at
Citizens of the United States who have completed their medical education in schools outside the United States
and Canada
are considered international medical graduates; non-U.S. citizens who have graduated from
medical schools in the United States and Canada
are not considered international medical graduates.
ECFMG Certification assures directors of ACGME-accredited residency and fellowship programs, and the
people of the United States, that international medical graduates have met minimum standards of eligibility
required to enter such programs. ECFMG Certification does not, however, guarantee that these graduates will
be accepted into programs, since the number of applicants frequently exceeds the number of available
positions.
ECFMG Certification is one of the eligibility requirements for international medical graduates to take Step 3 of
the three-step United States Medical Licensing Examination (USMLE
). Medical licensing authorities in the
United States require ECFMG Certification, among other requirements, to obtain an unrestricted license to
practice medicine.
Requirements for ECFMG Certification
To be eligible for certification by ECFMG, international medical graduates must meet the following
examination and medical education credential requirements.
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. To
meet the medical science examination requirement for ECFMG Certification, applicants must pass both Step 1
and Step 2 CK within a specified period of time. For detailed information, including information on time limits
for completing the examinations for ECFMG Certification and former examinations that satisfy this
requirement, refer to Examination Requirements on page 14.
* The United States and Canada
refer to the geographic locations where citizens are issued passports by the governments of either
the United States or Canada
.
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2. Satisfy the clinical skills requirement.
This requirement includes demonstration of data gathering and communication (including spoken English)
skills. Step 2 CS of the USMLE
is the exam currently administered that satisfies this requirement. Specific
time limits for passing Step 2 CS for ECFMG Certification may apply. For detailed information, including
information on time limits for completing the examinations for ECFMG Certification and using a passing
performance on the former ECFMG CSA to satisfy this requirement, refer to Examination Requirements on
page 14.
Medical Education Credential Requirements
The physician's medical school and graduation year must be listed in the International Medical Education
Directory (IMED). International medical graduates must have had at least four credit years (academic years for
which credit has been given toward completion of the medical curriculum) in attendance at a medical school
that is listed in IMED. IMED is available on the ECFMG website at IMED is maintained by
the Foundation for Advancement of International Medical Education and Research (FAIMER), a non-profit
foundation of ECFMG. IMED contains information supplied by countries about their medical schools.
FAIMER is not an accrediting agency.
Applicants for ECFMG Certification 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. When ECFMG sends your medical diploma to your medical
school for verification, ECFMG will request that the medical school include your final medical school
transcript when the school returns the verification of your medical diploma to ECFMG. An applicant's
credentials are not considered complete until ECFMG receives verification of the medical diploma and the
final medical school transcript directly from the medical school. For detailed information, see Medical
Education Credentials on page 34.
IMPORTANT NOTE: Submitting altered or falsified documents to ECFMG may be sufficient
cause for ECFMG to bar you from an exam, to terminate your participation in an exam, to
withhold and / or invalidate the results of an exam, to withhold a certificate, revoke a
certificate, or to take other appropriate action. ECFMG may also report instances of altered
or falsified documents to the USMLE
Committee on Irregular Behavior, FSMB Board
Action Databank, state medical licensing authorities, and directors of graduate medical
education programs , or to any other organization or individual who, in the judgment of
ECFMG, has a legitimate interest in such information. In all cases when the ECFMG
Committee on Medical Education Credentials or the CSA Committee on Irregular Behavior
has taken an action with respect to an examinee, an annotation will be included in the
ECFMG Status Report and ECFMG Certification Verification Service (CVS) Report. See
Irregular Behavior on page 38.
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Standard ECFMG Certificate
ECFMG issues the Standard ECFMG Certificate to applicants who meet all of the examination and medical
education credential requirements. Applicants must also pay any outstanding charges on their ECFMG
financial accounts before their certificates are issued. Standard ECFMG Certificates are sent approximately
two weeks after all of these requirements have been met. Currently, ECFMG sends the Standard ECFMG
Certificate to the applicant's address of record by Federal Express. If your address of record with ECFMG is a
U.S. post office box, the certificate will be sent by certified mail.
The Standard ECFMG Certificate includes:
Ø the name of the applicant;
Ø the applicant’s USMLE
/ ECFMG
Identification Number;
Ø the dates that the examination requirements
were met;
Ø the date that the certificate was issued; and
Ø the dates through which the passing
performances on certain exams, if applicable,
remain valid for the purpose of entry into
graduate medical education. (See Validity of
the Certificate for Entry into Graduate
Medical Education below).
Applicants may use a valid Standard ECFMG Certificate to enter an accredited program of graduate medical
education.
Validity of the Certificate
for Entry into Graduate Medical Education
For applicants who satisfy the clinical skills requirement for ECFMG Certification by passing Step 2 CS, the
certificate remains valid indefinitely for the purpose of entering programs of graduate medical education.
For applicants who satisfy the clinical skills requirement by passing the former ECFMG CSA and an
English language proficiency test, passing performance on the CSA may expire for the purpose of entering
programs of graduate medical education, as described below.
Passing performances on CSA administrations that took place before June 14, 2001 are valid for three
years from the date passed for the purpose of entering programs of graduate medical education. The date
through which passing performance on the CSA remains valid for entry into graduate medical education (the
CSA “valid through” date) is listed on the applicant’s Standard ECFMG Certificate. If the applicant has
entered a program before expiration of the valid through date, the applicant may request permanent validation
of the certificate. This means that the CSA date is no longer subject to expiration. To request permanent
validation, the applicant and an authorized official of the training institution must complete a Request for
Permanent Validation of Standard ECFMG Certificate (Form 246), available on the ECFMG website. On
receipt of such official documentation, ECFMG will provide the applicant with a “valid indefinitely” sticker to
be affixed to the certificate. If an applicant who passed CSA before June 14, 2001 does not enter a program of
graduate medical education within three years of the CSA pass date, the applicant’s CSA passing performance
will expire for the purpose of entering graduate medical education. Before entering a program, these applicants
must pass Step 2 CS. Passing performance on Step 2 CS does not expire for the purpose of entry into graduate
medical education. Applicants who revalidate their certificates by passing Step 2 CS will be sent a permanent
validation sticker after passing Step 2 CS.
Effective with the implementation of Step 2 CS on June 14, 2004, passing performances on CSA
administrations that took place on or after June 14, 2001 are not subject to expiration for the purpose of
entering programs of graduate medical education. Applicants who are certified by ECFMG and eligible for
permanent validation of the CSA date based on this policy change can request a permanent validation sticker
9
by accessing OASIS on the ECFMG website or by completing and submitting to ECFMG a Special Request
for Permanent Validation Sticker (Form 295), available on the ECFMG website. For additional information on
eligibility and procedures for requesting a permanent validation sticker based on the policy changes effective
June 14, 2004, see Important Changes to Standard ECFMG® Certificate. This announcement is available on
the ECFMG website.
Before the implementation of Step 2 CS on June 14, 2004, passing performances on the English language
proficiency test were valid for two years from the date passed for the purpose of entering programs of
graduate medical education, and applicants with expired English test “valid through” dates were required to
pass a subsequent English test before entering such programs. Effective with the implementation of Step 2 CS
on June 14, 2004, passing performances on the English language proficiency test, regardless of the date passed,
are not subject to expiration for the purpose of entering programs of graduate medical education. Applicants
who are certified by ECFMG and eligible for permanent validation of the English test date based on this policy
change can request a permanent validation sticker by accessing OASIS on the ECFMG website or by
completing and submitting to ECFMG a Special Request for Permanent Validation Sticker (Form 295),
available on the ECFMG website. For additional information on eligibility and procedures for requesting a
permanent validation s | |
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