TM A Division of Intealth INFORMATION BOOKLET ECFMG® CERTIFICATION 2025 August 21, 2024 • Monitor the ECFMG website at www.ecfmg.org for any changes to the information in this booklet. • Subscribe to The ECFMG Reporter e-newsletter. • Follow us on social. IntealthTM brings together the expertise of ECFMG and FAIMER® to advance quality in health care education worldwide in order to improve health care for all. Stay Up toDate Introduction About the ECFMG Information Booklet and Application Materials..................1 Important Notices.......................................................4 Guide to On-line Services and Forms.............. 6 ECFMG Certification About ECFMG Certification...................................8 Requirements for ECFMG Certification..........9 Standard ECFMG Certificate............................. 11 Your Record USMLE/ECFMG Identification Number........12 Your Name.....................................................................13 Changing Your Name...............................................14 Contact Information................................................15 Your Financial Account...........................................16 Irregular Behavior.....................................................17 Application for ECFMG Certification Application for ECFMG Certification.............22 Examinations for ECFMG Certification Examination Requirements................................23 Time Limit for Completing Examination Requirements.............................25 Eligibility for Examination International Medical School Students........28 International Medical School Graduates.....30 Reverification of Eligibility...................................32 TABLE OF CONTENTS The United States Medical Licensing Examination (USMLE) About USMLE.............................................................33 Registration and Test Delivery Entities........34 Applying for Examination.....................................35 Scheduling the Examination...............................38 Preparing for Examination..................................40 Taking the Examination..........................................41 USMLE Program and Irregular Behavior.....43 Examination Results...............................................44 Reexamination and Reapplication..................46 Medical Education Credentials Medical Education Credential Requirements..................................48 ECFMG Policy on Transfer Credits..................49 Credentials for ECFMG Certification..............51 Final Medical Diploma and Transcript...........53 Transcript(s) to Document Transferred Credits..............................................54 Name on Medical Diploma and Transcript(s)....................................................55 English Translations................................................57 Verification of Credentials...................................58 Appendix Related ECFMG Services.....................................59 ® The terms ECFMG® , FAIMER® and CSA® are registered in the U.S. Patent and Trademark Office. Copyright © 2024 by Intealth. All rights reserved. Portions reprinted, with permission, from the USMLE 2025 Bulletin of Information, copyright © 2024 by the Federation of State Medical Boards (FSMB) of the United States, Inc., and the National Board of Medical Examiners (NBME). The USMLE is a joint program of FSMB and NBME. Introduction About the ECFMG Information Booklet and Application Materials The ECFMG Information Booklet contains detailed information on ECFMG’s program of certification. ECFMG is a division of Intealth™ . The information contained in this booklet pertains only to the ECFMG certification process and related applications and services. Applicants for examination must use the applicable edition of the Information Booklet. The 2025 Information Booklet pertains to eligibility periods in 2025. If your eligibility period extends into 2026 and you test in 2026, you must become familiar with and will be subject to the policies and procedures detailed in the 2026 Information Booklet. The 2026 Information Booklet is expected to be available in August 2025. See the information on eligibility periods under Applying for Examination in The United States Medical Licensing Examination® (USMLE® ) section of this booklet. The USMLE Bulletin of Information provides information about the USMLE, a three-step examination for medical licensure in the United States. In the event that information about the USMLE in the ECFMG Information Booklet differs from the corresponding information in the USMLE Bulletin of Information, the information in the USMLE Bulletin of Information controls. Required Reading Applicants for examination are required to read and become familiar with the information contained in and referenced in both the ECFMG Information Booklet and the USMLE Bulletin of Information. The USMLE Bulletin of Information is available on the USMLE website . Applicants also must carefully review and be familiar with the detailed instructions for the USMLE application and the Policies and Procedures Regarding Irregular Behavior. Staying Up-to-Date Although current at the time of publication, the information contained in the 2025 ECFMG Information Booklet and 2025 USMLE Bulletin of Information is subject to change. If changes occur, information will be posted on the ECFMG and USMLE websites. You are responsible for checking the ECFMG and USMLE websites for updates and changes in policies and procedures. We provide important updates on ECFMG Certification and entry into graduate medical education in the United States in The ECFMG® Reporter newsletter and on Instagram. We encourage applicants to subscribe to The ECFMG® Reporter and to follow Intealth on Instagram . Page 1 Deadlines – Eastern Time The Information Booklet describes deadlines related to exam applications, scheduling, and other services. Unless otherwise indicated, deadlines are calculated using Eastern Time in the United States. Privacy Consistent with Intealth’s Privacy Notice, ECFMG may share the information contained in your application, or that otherwise may become available to ECFMG, with any federal, state or local governmental department or agency, with any hospital, training program, or any other organization or individual who, in the judgment of ECFMG, has a legitimate interest in such information. This may include reporting determinations of irregular behavior to the USMLE Committee for Individualized Review, Federation of State Medical Boards of the United States, U.S. state and international medical licensing authorities, graduate medical education programs, and to any other organization or individual who, in the judgment of ECFMG, has a legitimate interest in such information. For further information regarding our data collection and privacy practices, please refer to our Privacy Notice . Information and Documents You Provide to Us The information you provide to us as part of any application or service request will become a part of your permanent record, including the information you provide as part of the process of obtaining a USMLE/ECFMG Identification Number or other identification number. All correspondence with us, including e-mails, also will become a part of your permanent record. All documents that you submit to us as part of the certification process, including supporting documentation, translations, etc., will become part of your permanent record and will not be returned to you. Do not send original documents. Application/Service Request Processing We strive to ensure proper processing of applications for ECFMG Certification and examination, related service requests, and the information contained in such applications and requests. In the unlikely event that an error occurs in the processing of applications, requests, or associated materials, we will make reasonable efforts to correct the error, if possible, or permit you either to reapply at no additional fee or to receive a refund. These are the exclusive remedies available to applicants for errors in processing applications and other service requests related to ECFMG Certification, examination, and the other services described in this booklet. Please note that ECFMG will not provide services of any kind if doing so would be considered violative of any applicable international, federal, state, or local laws or regulations. Additionally, ECFMG may delay or suspend provision of services while investigating whether the services or surrounding circumstances violate such laws, regulations, or ECFMG’s policies and procedures. Page 2 ® The terms ECFMG®, FAIMER® and CSA® are registered in the U.S. Patent and Trademark Office. Copyright © 2024 by Intealth. All rights reserved. Portions reprinted, with permission, from the USMLE 2025 Bulletin of Information, copyright © 2024 by the Federation of State Medical Boards (FSMB) of the United States, Inc., and the National Board of Medical Examiners (NBME). The USMLE is a joint program of FSMB and NBME. Page 3 Introduction Important Notices This Information Booklet reflects information available and requirements in place at the time of publication (August 21, 2024). International medical graduates pursuing ECFMG Certification should monitor the ECFMG and USMLE websites for the most current information. Launch of MyIntealth™ We are in the process of launching MyIntealth, a new on-line environment that will provide access to our on-line services. MyIntealth will offer users many benefits, including a single user account and common user experience for all ECFMG services. MyIntealth will replace most of ECFMG’s current on-line services, including but not limited to: Interactive Web Applications (IWA) On-line Applicant Status and Information System (OASIS) ECFMG Credentials Upload Tool The launch of MyIntealth also will change the way that applicants access other ECFMG on-line services, such as those related to the Pathways, and will eliminate many forms for applicants pursuing ECFMG Certification and U.S. graduate medical education. The launch of MyIntealth will result in significant changes to policies and procedures described in this booklet. Applicants who plan to use ECFMG services in late 2024 and early 2025 should monitor the ECFMG website for updates and instructions on how to prepare. Impact of Change to Accreditation Body for Medical Schools in Canada Effective in July 2025 Currently, medical education programs in Canada leading to the MD degree are accredited by both the Liaison Committee on Medical Education (LCME) and the Committee on Accreditation of Canadian Medical Schools (CACMS). Effective July 1, 2025, CACMS will become the sole accrediting body for medical education programs in Canada. Accreditation by LCME establishes eligibility to take the United States Medical Licensing Examination® (USMLE®) and to enter U.S. residency programs accredited by the Accreditation Council for Graduate Page 4 Medical Education (ACGME). In the absence of LCME accreditation for Canadian medical education programs, Canadian medical school graduates will establish their eligibility for USMLE and ACGMEaccredited residency programs through ECFMG Certification. This means that individuals who graduate from Canadian medical schools on or after July 1, 2025 will be considered international medical graduates for the purpose of entry into graduate medical education (GME) programs in the United States, and, in order for these graduates to enter ACGME-accredited residency programs, the ACGME will require that they either obtain ECFMG Certification or hold a full and unrestricted license to practice medicine in the U.S. licensing jurisdiction in which the ACGMEaccredited program is located. ECFMG Certification is the standard for evaluating the qualifications of international medical graduates entering the U.S. health care system and includes requirements for medical schools, examination requirements (which include USMLE Step 1 and Step 2 Clinical Knowledge among other requirements), and verification of medical education credentials directly with the issuing institution. For more detailed information, please visit our ECFMG Certification Overview. Individuals who will graduate from Canadian medical schools on or after July 1, 2025, will be able to apply for ECFMG Certification beginning in late spring 2025, prior to the start of the 2026 residency application cycle in the United States. Additional details and a definitive date when these individuals can begin applying for ECFMG Certification will be provided in a future update. In the interim, these individuals should continue to apply for USMLE exams as planned and based on current policies and procedures. Individuals who will graduate from medical schools in Canada on or after July 1, 2025, and who plan to pursue U.S. GME should monitor the ECFMG and USMLE websites for detailed information on applying for ECFMG Certification and USMLE. Page 5 Introduction Guide to On-line Services and Forms Important Note: We are in the process of launching MyIntealth, a new on-line environment that will provide access to our on-line services. MyIntealth will offer users many benefits, including a single user account and common user experience for all ECFMG services. MyIntealth will replace most of ECFMG’s current on-line services, including but not limited to: Interactive Web Applications (IWA) On-line Applicant Status and Information System (OASIS) ECFMG Credentials Upload Tool The launch of MyIntealth also will change the way that applicants access other ECFMG on-line services, such as those related to the Pathways, and will eliminate many forms for applicants pursuing ECFMG Certification and U.S. graduate medical education. The launch of MyIntealth will result in significant changes to policies and procedures described in this booklet. Applicants should continue to monitor the ECFMG website for updates and instructions on how to prepare for the transition to MyIntealth. Use Interactive Web Applications (IWA) to: Obtain a USMLE/ECFMG Identification Number Complete the Application for ECFMG Certification, including the notarized Certification of Identification Form (Form 186) Apply for USMLE Access your Certification Statement (Form 183) if your medical school prefers to verify student/graduate status via paper form Read about ECFMG’s Provision of Performance Data to Medical Schools and request to withhold your exam results from your medical school Access your USMLE scheduling permit (when available) Request to extend a USMLE Step 1/Step 2 CK eligibility period Use ECFMG Credentials Upload Tool to: Submit your final medical diploma and other related documents to meet the medical education credentials requirements Page 6 Use Application for Pathways for ECFMG Certification to: Apply to a Pathway to meet the clinical skills and communication skills requirements for ECFMG Certification Use On-line Applicant Status and Information System (OASIS) to: Check and update your contact information Check the status of your medical education credentials Check and make a payment to your financial account Access your USMLE score report (when available) Confirm whether you have submitted an Application for ECFMG Certification and have a valid Certification of Identification Form (Form 186) on file Use Forms to: Change the name or date of birth in your record Change your USMLE Step 1 or Step 2 CK testing region Request an official ECFMG CSA History Chart Request a Step 1 or Step 2 CK score recheck Make a payment to your financial account Use E-Newsletters to: Subscribe/unsubscribe from e-newsletters Change the e-mail address you use to subscribe to e-newsletters Use mail/courier service: If you are unable to use the ECFMG Credentials Upload Tool to submit your final medical diploma and other related documents, you may submit paper copies. Mailing Address: Intealth ECFMG Certification Program 3624 Market Street, 1st Floor Philadelphia, PA 19104, USA We will not accept letters or other deliveries that arrive with postage or other fees due. Do not send original documents. The photocopy of your credential or related document must be 216 mm x 279 mm (8½ in x 11 in). If the document is larger than 216 mm x 279 mm (8½ in x 11 in), you must send a reduced photocopy that is 216 mm x 279 mm (8½ in x 11 in). Page 7 ECFMG Certification About ECFMG Certification 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) . ACGME requires international medical graduates who enter ACGME-accredited programs to be certified by ECFMG. 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 to enter such programs. ECFMG Certification does not, however, guarantee that these graduates will be accepted into programs; the number of applicants each year exceeds the number of available positions. ECFMG Certification is also one of the eligibility requirements for international medical graduates to take Step 3 of the three-step USMLE . Medical licensing authorities in the United States require that international medical graduates be certified by ECFMG, among other requirements, to obtain an unrestricted license to practice medicine. ECFMG defines an international medical graduate as a physician who received his/her basic medical degree from a medical school located outside the United States and Canada*. 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. Important Note: Individuals who will graduate from Canadian medical schools on or after July 1, 2025 will be considered international medical graduates for the purpose of entry into graduate medical education programs in the United States, and, in order for these graduates to enter ACGME-accredited residency programs, the ACGME will require that they either obtain ECFMG Certification or hold a full and unrestricted license to practice medicine in the U.S. licensing jurisdiction in which the ACGME-accredited program is located. Please refer to the Important Notices section of this booklet for more information. * 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. Page 8 01234ÿ16789 9 89  697668ÿ 7ÿ01234ÿ16789 9 89  369 ÿ  ÿ697668 ÿ!"#ÿ$ÿ% !&ÿ'!()ÿ*ÿ!"#+ ÿ!"# ÿ!"# , ÿ!"#ÿ$ÿ% !&ÿ'!() -..9 89 ÿ 7ÿ01234ÿ16789 9 89  / "0!&"1ÿ$ÿ21"0!&"1ÿ34 ÿ!"#, % !&ÿ'!(ÿ5674 1") 899!&"1ÿ$ÿ:/3%;ÿ/ "0!&"1 Page 9 01234526475ÿ9 4 3 56 ÿÿÿ! " #4$2%ÿ0# $26475ÿ& # 5642%ÿ9 4 3 56 '() *!+ '()ÿ*!+ ÿ,(!+ÿÿ- ) )!(ÿ).!ÿ)( /!ÿ.)ÿÿ)!(ÿ).!ÿ)( )!(ÿ).!ÿ)( ,(!ÿ)ÿ,!).ÿ/0)0ÿ10.(ÿ234 Page 10 ECFMG Certification Standard ECFMG Certificate ECFMG issues the Standard ECFMG Certificate to applicants who meet all of the requirements for certification. International medical graduates must also pay any outstanding charges on their financial accounts before their certificates are issued. Standard ECFMG Certificates are issued to applicants approximately two weeks after all of these requirements have been met. The date that the Standard ECFMG Certificate is issued is the date an international medical graduate is considered certified by ECFMG. Currently, ECFMG sends the Standard ECFMG Certificate to the applicant’s address of record by FedEx. The Standard ECFMG Certificate includes: The name of the applicant; The certificate number; How the examination requirements were met; The date that the certificate was issued; and The valid through date, if applicable. See Expiration of the ECFMG Certificate Based on a Pathway below. Expiration of the ECFMG Certificate Based on a Pathway If you meet the clinical skills requirement and the communication skills requirement for ECFMG Certification through a Pathway, your ECFMG Certificate is subject to expiration. Your certificate will expire when your Pathway expires, unless you meet the requirements to have your certificate made valid indefinitely (i.e., no longer subject to expiration). For information on obtaining permanent validation of the ECFMG Certificate, refer to the Pathways in the ECFMG Certification section of the ECFMG website. For detailed information on expiration of the ECFMG Certificate, and information on revalidating a Pathway to revalidate your ECFMG Certificate, refer to the Pathways in the ECFMG Certification section of the ECFMG website. Confirming ECFMG Certification to Third Parties ECFMG offers the Certification Verification Service (CVS) to provide primary-source confirmation of the ECFMG Certification status of international medical graduates. ECFMG will confirm your certification status when a request is received from a U.S. medical licensing authority, residency program director, hospital, or other organization that, in the judgment of ECFMG, has a legitimate interest in such information. For more information, see Confirming ECFMG Certification to Third Parties in Related ECFMG Services. Page 11 Your Record USMLE/ECFMG Identification Number Before you can submit an Application for ECFMG Certification or apply to ECFMG for an exam, you must obtain a USMLE/ECFMG Identification Number. You can obtain a USMLE/ECFMG Identification Number via our on-line services. To obtain a USMLE/ECFMG ID, you must provide certain information, including your name as it appears on your current, unexpired passport; date of birth; address of residence; and medical school information. If ECFMG determines that the biographic information you submit is inaccurate, not complete, or insufficient to assign a USMLE/ECFMG Identification Number to you, your request for the USMLE/ECFMG Identification Number will not be processed. If you fail to provide your name exactly as it appears on your current, unexpired passport, you will be required to submit acceptable documentation, as described in Changing Your Name in Your Record, to change your name of record with us. Once we inform you of your number, you must include it on all communications, applications, medical education credentials, request forms, and payments that you send to us. You will only be assigned one USMLE Identification Number. Your USMLE Identification Number cannot be changed. Obtaining or attempting to obtain a USMLE/ECFMG Identification Number after one has been assigned to you may result in a finding of irregular behavior. If you forget or lose your USMLE/ECFMG Identification Number, you can obtain it via our on-line services or by contacting ECFMG. To protect the privacy of applicants, we will not provide USMLE/ECFMG Identification Numbers by telephone. Important Note: As part of the application processes, you will be asked if you previously submitted an Application for ECFMG Certification and/or an application for examination to ECFMG. You also will be asked if you were previously assigned a USMLE Identification Number. If you were previously assigned a USMLE Identification Number or have submitted a prior application to ECFMG, you must answer “Yes” to the applicable question(s), even if you submitted the prior application under a different name or did not take the exam for which you applied. You must answer “Yes” regardless of whether you submitted an on-line application or a paper application. If you were previously assigned a USMLE Identification Number or have submitted an application to ECFMG but indicate that you were not previously assigned a number or have not applied previously, this may result in a finding of irregular behavior and permanent annotation of your record. See Policies and Procedures Regarding Irregular Behavior. Page 12 Your Record Your Name You must ensure that your name of record with us matches your name exactly as it appears on your current, unexpired passport. Your name of record will appear on your Standard ECFMG Certificate once you have met all requirements for certification. You must use this name consistently in all communications you send to us, including applications and requests for other services. Failure to use your name of record consistently in all communications with us may delay exam registration. It may also prevent you from taking an exam for which you are registered and scheduled. You can check your name of record via our on-line services. If the name in your record does not match your name exactly as it appears on your passport, you must follow our established process to request a change in your name of record. See Changing Your Name in Your Record. Your name of record will appear on your exam scheduling permit. Your name, as it appears on your scheduling permit, must exactly match the name on the form(s) of identification you present at the test center. The only acceptable differences are variations in capitalization; the presence of a middle name, middle initial or suffix on one document and its absence on the other; or the presence of a middle name on one and middle initial on the other. Please review your scheduling permit for additional details. See information on required identification under Taking the Examination in The United States Medical Licensing Examination (USMLE) section of this booklet. If the name on your scheduling permit has been misspelled, contact ECFMG immediately. Use the contact information for General Inquiries on the Contact Us page of the ECFMG website. If you change your name of record while you are registered for an exam, a revised scheduling permit reflecting this change will be issued. ECFMG will send your revised scheduling permit via e-mail. You must present the revised scheduling permit at the test center on your exam date. Name changes must be received and processed by ECFMG no later than seven business days before your testing appointment, or you will not be able to test. If you have a valid Certification of Identification Form (Form 186) on file with us, it will be invalidated when your name of record is changed, and you will be required to complete a new Certification of Identification Form (Form 186) before you may apply for examination. If the name on your medical diploma, transcript, or other credential does not match exactly the name in your record, you must submit documentation, as described in Verifying Your Name in Medical Education Credentials, that verifies the name on your medical diploma, transcript, or other credential is (or was) your name. Page 13 Your Record Changing Your Name If your name of record does not match your name exactly as it appears on your current, unexpired passport, you must follow our established process to request a change of name in your record. You will be required to provide a reason for the name change, as well as supporting documentation. Additional information and instructions are provided with the form. Important Notes: If you change your name of record while you are registered for an exam, a revised scheduling permit reflecting this change will be issued. ECFMG will send your revised scheduling permit via e-mail. You must present the revised scheduling permit at the test center on your exam date. Name changes must be received and processed by ECFMG no later than seven business days before your testing appointment, or you will not be able to test. If you have a valid Certification of Identification Form (Form 186) on file with us, it will be invalidated when your name of record is changed, and you will be required to complete a new Certification of Identification Form (Form 186) before you may apply for examination. Page 14 Your Record Contact Information The contact information in your record with us consists of your e-mail address, your address of residence, and your phone number. We will use your address of residence as your mailing address. Certain ECFMG correspondence, including your Standard ECFMG Certificate, requires a full mailing address. You should ensure that the contact information in your record is current. You can check and update your contact information via our on-line services. You cannot submit changes to your contact information by email. We will not process changes to contact information received from any person other than the applicant. Changing your e-mail address of record does not update your e-mail address in your e-newsletter subscription(s). You can change your e-newsletter subscription preferences via the ECFMG website. To protect the privacy of applicants, ECFMG will e-mail applicant-specific information only to the applicant’s e-mail address of record. If your e-mail inquiry requires a specific response, you must send your inquiry from the e-mail address in your record. For further information regarding our data collection and privacy practices, please refer to our Privacy Notice . Page 15 Your Record Your Financial Account You can access your financial account with us via our on-line services. For a list of fees for ECFMG services that applicants encounter most frequently while pursuing ECFMG Certification and entry into U.S. programs of graduate medical education, see the Fees and Payment section of the ECFMG website. You should also read and become familiar with the information on payment, acceptable methods of payment, refunds, and forfeiture of funds in that section. Page 16 Your Record Irregular Behavior A. Policies Regarding Irregular Behavior 1. Irregular behavior includes all actions or attempted actions on the part of applicants, examinees, potential applicants, others when solicited by an applicant and/or examinee, a medical school official, or any other person or entity that would or could subvert the examination, certification or other processes, programs, or services of ECFMG, including, but not limited to, the ECFMG Exchange Visitor Sponsorship Program, ECFMG International Credentials Services (EICS), the Electronic Portfolio of International Credentials (EPIC), and Electronic Residency Application Service (ERAS) Support Services at ECFMG. Such actions or attempted actions are considered irregular behavior, regardless of when the irregular behavior occurs, and regardless of whether the individual committing the action is certified by ECFMG or eligible for ECFMG Certification and in the case of a medical school, regardless of whether a medical school official is also charged. Examples of irregular behavior include, but are not limited to, submission of any falsified or altered document to ECFMG, whether submitted by the individual or by a third party, such as a medical school or other entity, on behalf of the individual; failing to comply with United States Medical Licensing Examination (USMLE) or ECFMG policies, procedures, and/or rules; falsification of information on applications, submissions, or other materials to ECFMG; taking an examination when not eligible to do so, submission of any falsified or altered ECFMG document to other entities or individuals; a medical school providing false information to ECFMG regarding its students or a medical school providing misleading information to its students regarding ECFMG Certification. 2. The Medical Education Credentials Committee’s determination of irregular behavior is sufficient cause for ECFMG to bar an individual from future examinations, to bar an individual from other ECFMG programs and services, to withhold and/or invalidate the results of an examination, to withhold an ECFMG Certificate, to revoke an ECFMG Certificate, or to take other appropriate actions for a specified period of time or permanently. The Medical Education Credentials Committee’s determination of irregular behavior is also sufficient cause for ECFMG to remove a Sponsor Note from the World Directory of Medical Schools in accordance with its Medical School Requirements for ECFMG Certification Eligibility Policy and Procedures (aka “ECFMG Medical School Listing Policy”) for a specified period of time or permanently or to take other appropriate actions. ECFMG may report the Medical Education Credentials Committee’s determination of irregular behavior to the USMLE Committee for Individualized Review, Federation of State Medical Boards of the United States, U.S. state and international medical licensing authorities, directors of graduate medical education programs, and to any other organization or individual who, in the sole judgment of ECFMG, has a legitimate interest in such information. 3. If the Medical Education Credentials Committee determines that an individual engaged in irregular behavior, a permanent annotation to that effect will be included in the individual’s ECFMG record. This annotation will appear on the ECFMG Certification Verification Service (CVS) and ECFMG Status Reports Page 17 for the individual. If the individual has an EPIC Portfolio, a permanent annotation will be included on all EPIC Reports with respect to that individual. Additional information explaining the basis for the determination of irregular behavior and the resulting action(s) will accompany every ECFMG Status Report, CVS Report, and EPIC Report, and may also be provided to legitimately-interested entities; this additional information may be provided, regardless of the date of the conduct or activity that comprises the irregular behavior. 4. If the Medical Education Credentials Committee determines that a medical school has committed irregular behavior, ECFMG may remove its Sponsor Note for the medical school in accordance with the ECFMG Medical School Listing Policy. ECFMG may report the determination of irregular behavior to any organization or individual who, in the sole judgment of ECFMG, has a legitimate interest in such information. 5. Notice of the Medical Education Credentials Committee’s determination of irregular behavior is periodically reported to the Intealth Board of Trustees. B. Procedures Regarding Irregular Behavior 1. After receipt of a report or other information suggesting irregular behavior on the part of an individual or entity, ECFMG staff will review the information and will assess whether there is sufficient evidence of irregular behavior to proceed with an investigation. When indicated and feasible, staff will conduct a follow-up investigation to gather additional information. 2. If the individual is an examinee and the review referenced above will not be concluded until after the typical period for the reporting of exam scores, the examinee will be notified that the reporting of the exam scores in question is being delayed. 3. If the ECFMG staff finds that there exists a reasonable basis to conclude that an individual or entity may have engaged in irregular behavior, the matter will be referred to the Medical Education Credentials Committee. ECFMG may withhold services from the individual or entity pending a determination from the Medical Education Credentials Committee. If the individual referred is an examinee, the examinee’s exam scores will be withheld, if not already released, and the examinee may not be permitted to sit for subsequent examinations, nor will applications for examination be processed. If the individual referred is an applicant for J-1 Sponsorship with the ECFMG Exchange Visitor Sponsorship Program or is currently being sponsored by ECFMG, ECFMG will notify the United States Department of State of the pending allegation if required to do so by regulation. If a school or other academic institution is referred, ECFMG may implement additional requirements on the school and its students to demonstrate that it has the staff, policies/procedures, and facilities necessary for the school’s students and graduates to fulfill ECFMG’s requirements to become ECFMG certified and/or take such other measures to protect the health and safety of the public. Page 18 4. Concurrent with the referral to the Medical Education Credentials Committee, the individual or entity will be advised in writing of the nature of the alleged irregular behavior and will be provided with a copy of the Policies and Procedures Regarding Irregular Behavior. If the alleged irregular behavior is related to a shared ECFMG and USMLE policy, the USMLE program will also be advised of the allegation. The individual/entity will be given an opportunity to provide written explanation and to present other relevant information. Any such written explanation or other relevant information must be received by ECFMG by the deadline communicated to the individual/entity. Submissions received after the deadline will be considered by the Medical Education Credentials Committee at its discretion. The individual/entity may also request the opportunity to appear in person before the Medical Education Credentials Committee, and may be represented by legal counsel, if desired. For in-person appearances before the Medical Education Credentials Committee, a stenographic or audio recording will be made of that portion of the proceedings during which the individual/representative(s) for the entity are in attendance. Any statements made by the individual or individual(s) representing the entity during an in-person appearance before the Medical Education Credentials Committee will be under oath. All hearings involving applicants for ECFMG’s certification program will be held in English and interpreters will not be permitted. For hearings involving applicants to ECFMG’s other programs and services, ECFMG will allow an interpreter if obligated to provide services in languages other than English. In these circumstances, if an interpreter is desired, the applicant must request one in writing by the response deadline outlined in ECFMG’s letter to the applicant. ECFMG will then provide the interpreter. All in-person hearings for entities charged with irregular behavior will be conducted in English and interpreters will not be permitted. 5. Individuals/entities charged with irregular behavior who wish to request a deferral of the ECFMG Committee’s review of the allegation must (1) submit the request in writing and (2) provide the reason for the request. If ECFMG staff determine that the granting of the request could have a material impact on the individual’s or entity’s opportunity to refute the allegation then staff, at its discretion, can grant the request and defer an ECFMG action for up to six (6) months. Unless the individual/entity can demonstrate compelling circumstances, ECFMG staff should not grant more than two deferral requests. Notwithstanding the foregoing, if the individual charged with irregular behavior is ECFMG Certified, a candidate for residency, or practicing medicine, or if the entity is a medical school, ECFMG staff will only grant the request for deferral if, in its sole discretion, ECFMG believes that public health and safety is not at risk. If the deferral request is granted, ECFMG will notify appropriate institutions and authorities of the individual’s or entity’s pending irregular behavior charge. 6. All pertinent information regarding the irregular behavior, including any explanation or other information that the individual/entity may provide, will be provided to the Medical Education Credentials Committee. The Medical Education Credentials Committee, based on the information available to it, will determine whether the preponderance of the evidence indicates that the individual/entity engaged in irregular behavior. If the Medical Education Credentials Committee determines that the individual/entity engaged in irregular behavior, the Medical Education Credentials Committee will determine what action(s) will be taken as a result of the irregular behavior. ECFMG will notify the individual/entity whether the Medical Education Credentials Committee determined the individual engaged in irregular behavior and of any action(s) taken pursuant thereto. Page 19 7. The Medical Education Credentials Committee’s determination of irregular behavior and any action(s) taken pursuant thereto (a “decision” of the Medical Education Credentials Committee) may be appealed to the Review Committee for Appeals if the individual/entity has a reasonable basis to believe the Medical Education Credentials Committee did not act in compliance with the Medical Education Credentials Committee Policies and Procedures or that the Medical Education Credentials Committee’s decision was clearly contrary to the weight of the evidence before it. The notice of appeal must be received by ECFMG within thirty (30) days of the date on which the notification advising the individual of the Medical Education Credentials Committee’s decision was mailed to the individual. The appeal of a decision of the Medical Education Credentials Committee is governed by the Medical Education Credentials Committee’s Rules of Appellate Procedure. 8. Petitions for reconsideration of a decision of the Medical Education Credentials Committee will be reviewed by the Medical Education Credentials Committee only in extraordinary cases. Any such petition must first be considered by ECFMG staff, who, after discussion with the Medical Education Credentials Committee Chair, may deny the request or place it on the agenda for consideration by the full Medical Education Credentials Committee at a regularly scheduled meeting. Absent the submission of newly discovered material evidence not previously available to the petitioner and, therefore, not available to the Medical Education Credentials Committee, petitions for reconsideration typically will be denied. Generally, ECFMG will not consider as newly discovered evidence actions that the individual/entity has taken after the irregular behavior has occurred and/or after the finding of irregular behavior by the Medical Education Credentials Committee. C. Representative Examples of Irregular Behavior Representative examples of allegations of irregular behavior and actions taken by the ECFMG Medical Education Credentials Committee include, but are not limited to, the following: Providing false information on an application submitted to ECFMG The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in connection with an individual who provided false information on an application submitted to ECFMG as part of the certification process. In that application, the individual certified he was a student enrolled in medical school when, in fact, he previously had been dismissed from medical school and, therefore, was no longer a student. Following review, the ECFMG Medical Education Credentials Committee determined the individual had engaged in irregular behavior and took action to bar the individual from ECFMG Certification, thereby rendering the individual ineligible to apply for USMLE examinations leading to ECFMG Certification. A permanent annotation was added to the individual’s record. Providing false information to ECFMG as part of the ECFMG On-line Authentication Process, which is a prerequisite to submitting an application for examination The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in connection with an individual who provided false information to ECFMG as part of the ECFMG On-line Authentication Process, which is used to obtain a USMLE/ECFMG Identification Number and is a prerequisite to submitting an application for examination. During the on-line authentication process, Page 20 the individual certified he had not previously submitted an application for examination to ECFMG when he had not only previously applied for, but had taken examinations. Following review, the ECFMG Medical Education Credentials Committee determined the individual had engaged in irregular behavior and took action to bar the individual from ECFMG Certification, thereby rendering the individual ineligible to apply for USMLE examinations leading to ECFMG Certification. A permanent annotation was added to the individual’s record. Submitting a fraudulent medical diploma and providing false information on an application submitted to ECFMG The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in connection with an individual who submitted a fraudulent medical diploma and provided false information on an application submitted to ECFMG. Following review, the ECFMG Medical Education Credentials Committee determined the individual had engaged in irregular behavior and took action to bar the individual from ECFMG Certification, thereby rendering the individual ineligible to apply for USMLE examinations leading to ECFMG Certification. A permanent annotation was added to the individual’s record. Submitting a falsified medical school transcript and providing false information to ECFMG The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in connection with an authorized medical school official who submitted a fraudulent medical school transcript and provided false information to ECFMG. Following review, the ECFMG Medical Education Credentials Committee determined the authorized medical school official had engaged in irregular behavior and determined that ECFMG will not accept any documents signed and/or certified by the medical school official for ECFMG on behalf of the medical school, or any other medical school, for a minimum of five years. A permanent annotation was added to the medical school official’s record. Submitting a falsified passport and providing false information on an application submitted to ECFMG The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in connection with an individual who submitted a falsified passport and provided false information on an application submitted to ECFMG. Following review, the ECFMG Medical Education Credentials Committee determined that the individual had engaged in irregular behavior. A permanent annotation was added to the individual’s record. Submitting falsified Mini-CEX documentation on an application submitted to ECFMG The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in connection with an individual who submitted fraudulent Mini-Clinical Evaluation Exercises (Mini-CEX) as part of an Application for Pathways for ECFMG Certification. Following review, the ECFMG Medical Education Credentials Committee determined that the individual had engaged in irregular behavior and took action to bar the individual from ECFMG Certification, thereby rendering the individual ineligible to apply for USMLE examinations leading to ECFMG Certification. A permanent annotation was added to the individual’s record. Page 21 Application for ECFMG Certification Application for ECFMG Certification To be eligible for ECFMG Certification, you must complete an Application for ECFMG Certification, which confirms your intent to pursue ECFMG Certification and your understanding of the purpose of the certification program. The Application for ECFMG Certification consists of an on-line application and the Certification of Identification Form (Form 186) that must be completed and notarized via NotaryCam. You should read the detailed instructions for the application before you begin working on it. Instructions on how to complete Form 186 using NotaryCam are included with the form. You must have your USMLE/ECFMG Identification Number before you can begin the Application for ECFMG Certification. For the current fee for submitting an Application for ECFMG Certification, see the Fees page of the ECFMG website. As part of the Application for ECFMG Certification, you will be asked to confirm the name, date of birth, and gender in your record with us. If this information does not match exactly the information on your current, unexpired passport, you must have the information in your record changed to reflect the information as it appears on your passport before you can complete the Application for ECFMG Certification. Instructions for how to correct this information will be provided at the time of application. If you are a medical school student, you will be asked to confirm that you are officially enrolled in a medical school that is listed in the World Directory  with an ECFMG note stating it meets ECFMG eligibility requirements, and that the “Graduation Years” in the ECFMG note in your medical school’s World Directory listing are listed as “Current.” If you are a medical school graduate, you will be asked to confirm that you are a graduate of a medical school that is listed in the World Directory with an ECFMG note stating it meets ECFMG eligibility requirements, and that your graduation year is included in the ECFMG note in your school’s World Directory listing. See Medical School Requirements. An Application for ECFMG Certification will not be considered complete until ECFMG receives and processes both the on-line part of the application and the notarized Form 186 from NotaryCam. Once your Application for ECFMG Certification, including Form 186, has been accepted by ECFMG, it typically remains valid throughout the certification process. You can use our on-line services to confirm that you have submitted an Application for ECFMG Certification and have a valid Form 186 on file. Page 22 Examinations for ECFMG Certification Examination Requirements To be eligible for ECFMG Certification, you must satisfy the medical science examination requirement, the clinical skills requirement, and the communication skills requirement. ECFMG has established time limits for completing these examination requirements for ECFMG Certification. See Time Limit for Completing Examination Requirements in Examinations for ECFMG Certification. Medical Science Examination Requirement To satisfy the medical science examination requirement for ECFMG Certification, you must pass Step 1 and Step 2 Clinical Knowledge (CK) of the United States Medical Licensing Examination (USMLE). Refer to the USMLE Bulletin of Information for more information. Clinical Skills Requirement and Communication Skills Requirement To satisfy the clinical skills requirement and the communication skills requirement for ECFMG Certification, you must: Have satisfied the requirements of an ECFMG Pathway, which includes attaining a satisfactory score on the Occupational English Test (OET) Medicine, that is valid for ECFMG Certification, OR Have a passing performance on the former Step 2 Clinical Skills (CS) component of USMLE that is valid for ECFMG Certification. Important Note on Validity of Pathways: The Pathways are offered on a seasonal application cycle, and international medical graduates should consider the timing of their applications carefully. If you meet the clinical skills requirement and communication skills requirement for ECFMG Certification through the Pathways, your accepted Pathway is subject to expiration. The expiration date is based on the Pathways season for which the Pathways application was accepted. An accepted, unexpired Pathway is required to become ECFMG Certified. An accepted, unexpired Pathway also is required to participate in the National Resident Matching Program® (NRMP®) Main Residency Match® (The Match®). For detailed information on the Pathways, including expiration dates for each Pathways season, refer to the ECFMG Certification section of the ECFMG website. International medical graduates also should be aware that ECFMG Certificates issued based on a Pathway are subject to expiration. See Standard ECFMG Certificate in ECFMG Certification for more information. Page 23 Important Note: Prior to its discontinuation by the USMLE program in 2020, Step 2 CS was the exam that satisfied the clinical skills and communication skills requirements for ECFMG Certification. A passing performance on the former Step 2 CS component of USMLE that is valid for ECFMG Certification still satisfies the clinical skills and communication skills requirements. This means that, if you have a passing performance on Step 2 CS that is valid for ECFMG Certification, you do not have to (and are not eligible to) pursue a Pathway. Certain Former Exams Not Accepted All international medical graduates pursuing ECFMG Certification must meet the current examination requirements. Passing performance on the following former examinations cannot be used to meet the examination requirements for ECFMG Certification: ECFMG Examination; Federation Licensing Examination (FLEX); Visa Qualifying Examination (VQE); Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS); NBME Part I and Part II; and ECFMG Clinical Skills Assessment (CSA). Page 24 Examinations for ECFMG Certification Time Limit for Completing Examination Requirements ECFMG requires that international medical graduates 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 meet the other examination requirements for ECFMG Certification. This seven-year period begins on the date of the first exam passed and ends exactly seven years from that date. Important Note: Accepted Pathways are subject to this seven-year requirement. This means that your Pathways application must be accepted within the seven-year period in order to meet the clinical skills requirement and communication skills requirement for ECFMG Certification. Once you satisfy all exam requirements for ECFMG Certification within a seven-year period, you have met the time limit for completing examination requirements. However, accepted Pathways are subject to expiration for other purposes, including for becoming ECFMG Certified and for entering the NRMP Match. If you have satisfied all examination requirements within a seven-year period but need to revalidate a Pathway for other purposes, the revalidation can occur outside of the sevenyear period. For detailed information on Pathways expiration and revalidation, refer to the ECFMG Certification section of the ECFMG website. If you do not satisfy all examination requirements within a maximum of seven years, your earliest passing performance will no longer be valid for ECFMG Certification. It is your responsibility to track your progress toward meeting the exam 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 sevenyear requirement. Examples: An international medical graduate passed Step 1 on January 20, 2018 and Step 2 CS on February 20, 2020. He has through January 20, 2025 to take and pass Step 2 CK to satisfy the remaining exam requirements for ECFMG Certification. If he does not take and pass Step 2 CK on or before January 20, 2025, his passing performance on Step 1 would no longer be valid for ECFMG Certification. An international medical graduate passed Step 1 on November 30, 2017 and Step 2 CK on February 1, 2021. She has through November 30, 2024 to satisfy the clinical skills and communication skills requirements for ECFMG Certification through a Pathway. If she does not have an accepted Pathways application on record by November 30, 2024, her passing performance on Step 1 will no longer be valid for ECFMG Certification. Page 25 An international medical graduate passed Step 1 on January 15, 2018, and her 2021 Pathways application was accepted on February 1, 2021. Her Pathway will expire on December 31, 2024 (the expiration date for all 2021 Pathways). If she passes Step 2 CK on November 1, 2024, she will have met ECFMG's time limit for completing the exam requirements. However, her Pathway is still subject to expiration for other purposes, including for becoming ECFMG Certified and for entering the NRMP Match. Since the applicant met ECFMG’s time limit for completing the exam requirements, revalidation of a Pathway for these purposes can occur outside of the seven-year period. Under this ECFMG requirement, more than one passing performance can become invalid for ECFMG Certification. Examples: An international medical graduate passed Step 1 on April 1, 2017, and passed Step 2 CK on May 1, 2018. She had through April 1, 2024 (seven years from her Step 1 passing performance) to complete a Pathway, satisfying the remaining exam requirements for ECFMG Certification. She did not have an accepted Pathways application by April 1, 2024, so her passing performance on Step 1 is no longer valid for ECFMG Certification. Her earliest USMLE passing performance that is valid for ECFMG Certification is now the Step 2 CK passing performance on May 1, 2018. She now has through May 1, 2025 (seven years from her Step 2 CK passing performance) to pass Step 1 and complete a Pathway, satisfying the remaining exam requirements for ECFMG Certification. If she does not pass Step 1 and complete a Pathway by May 1, 2025, her passing performance on Step 2 CK will no longer be valid for ECFMG Certification. An international medical graduate passed Step 1 on January 15, 2018 and her 2021 Pathways application was accepted on February 1, 2021. Her Pathway will expire on December 31, 2024 (the expiration date for all 2021 Pathways). The applicant has until December 31, 2024 to pass Step 2 CK before her Pathway expires. If the applicant does not pass Step 2 CK before this date, she will have until January 15, 2025, to pass Step 2 CK and complete Pathways revalidation. If she does not, her passing performance on Step 1 will no longer be valid for ECFMG Certification. If you have passed a USMLE Step but this passing performance is no longer valid for ECFMG Certification, you may request an exception to retake the previously passed exam that is no longer valid. The USMLE program limits to four the total number of times an examinee can take the same Step. See Reexamination and Reapplication in The United States Medical Licensing Examination (USMLE) section of this booklet. Important Notes: Time limits to complete the USMLE for the purpose of U.S. medical licensure are established by state medical licensing authorities and may require completion of all Steps (including Step 3, which is not required for ECFMG Certification) within a certain number of years. Information regarding specific state requirements can be obtained on the Federation of State Medical Boards website . Page 26 Applicants who retake a previously passed Step to comply with a time limit should understand the implications of a failing retake performance on their Step 3 eligibility. See Retaking Previously Passed Steps in the USMLE Bulletin of Information. A passing performance that is no longer valid for ECFMG Certification will still appear on a USMLE transcript. Page 27 Eligibility for Examination The eligibility requirements for examination differ depending on whether you are an international medical school student or an international medical school graduate. International Medical School Students To be eligible for Step 1 and Step 2 Clinical Knowledge (CK), you must be officially enrolled in a medical school that is listed in the World Directory  with an ECFMG note stating it meets ECFMG eligibility requirements, both at the time that you apply for examination and on your test day. In addition, the “Graduation Years” in the ECFMG note in your medical school’s World Directory listing must be “Current” at the time you apply and on your test day. See Medical School Requirements. An authorized official of your medical school must certify your current enrollment status; instructions will be provided at the time of application for examination. As soon as you graduate and receive your medical diploma, you must submit a copy of your medical diploma to ECFMG. See Final Medical Diploma and Transcript in Medical Education Credentials. In addition to being currently enrolled as described above, to be eligible for Step 1 and Step 2 CK, you must have completed at least two years of medical school. This eligibility requirement means that you must have completed the basic medical science component of the medical school curriculum by the beginning of your eligibility period. Although you may apply for and take the examinations after completing the basic medical science component of your medical school curriculum, it is recommended that you complete your core clinical clerkships, including actual patient contact, before taking Step 2 CK. Important Notes: If your eligibility for an exam changes after you apply but before you take the exam, you are required to inform ECFMG’s Applicant Information Services immediately in writing of this change in your status. Use the contact information for General Inquiries on the Contact Us page of the ECFMG website. Such changes in your eligibility status include, but are not limited to, the following: Medical school students who transfer to another medical school after submitting an application for examination must inform ECFMG immediately in writing of this transfer. Medical school students who have been dismissed or withdraw(n) from medical school are not eligible for USMLE, even if they are appealing the school’s decision to dismiss them or are otherwise contesting their status. Medical school students who have been dismissed or withdraw(n) from medical school must inform ECFMG immediately in writing of their dismissal or withdrawal. Page 28 Medical school students who take a leave of absence should consult with their medical schools about whether they will be considered officially enrolled in medical school during leave. Your medical school may consider a student on leave of absence to be withdrawn from medical school. Medical school students who are not officially enrolled in medical school are not eligible to apply for or take USMLE. Applicants who take a leave of absence after submitting an application for examination to ECFMG must inform ECFMG immediately in writing of this leave. Failure to inform ECFMG that you may no longer be eligible to take the examination may result in a finding of irregular behavior and permanent annotation of your record. See Policies and Procedures Regarding Irregular Behavior. If you take a Step for which you are not eligible, results for that exam may not be reported or, if previously reported, may be canceled. Page 29 Eligibility for Examination The eligibility requirements for examination differ depending on whether you are an international medical school student or an international medical school graduate. International Medical School Graduates To be eligible for Step 1 and Step 2 CK, you must be a graduate of a medical school that is listed in the World Directory  with an ECFMG note stating it meets ECFMG eligibility requirements. Your graduation year must be included in the "Graduation Years" listed in the ECFMG note in your medical school’s World Directory listing. See Medical School Requirements. You 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 with an ECFMG note stating it meets ECFMG eligibility requirements. An authorized official of your medical school must certify your status as a graduate of the school; instructions will be provided at the time of application. You must submit a copy of your medical diploma at the time of exam application if your diploma has not been sent to ECFMG previously. The exact degree title of the final medical diploma you must have earned (and must provide) in order to be eligible for ECFMG Certification and the examinations required for certification is listed in the Reference Guide for Medical Education Credentials on the ECFMG website. If you have graduated and met all requirements for your medical diploma but your medical diploma has not yet been issued, a letter signed by an authorized official of your medical school must be submitted with your exam application. The letter you submit must be the original document and must be written on your medical school’s letterhead. The letter must include the following statement: This is to confirm that [applicant name] has graduated and completed all requirements to receive the [degree title] degree from [medical school/university name]. The degree will be issued [month and year]. You must then submit a copy of your medical diploma to ECFMG as soon as your diploma is issued. See Medical Education Credentials. All documents that are not in English must be accompanied by an official English translation that meets ECFMG’s translation requirements. See English Translations in Medical Education Credentials. All credentials and documentation required to complete your exam application must be received within four weeks of the date you submit the on-line portion of your application, or your exam application will be rejected. Page 30 Important Notes: If your eligibility for an exam changes after you apply but before you take the exam, you are required to inform ECFMG’s Applicant Information Services immediately in writing of this change in your status. Use the contact information for General Inquiries on the Contact Us page of the ECFMG website. Failure to inform ECFMG that you may no longer be eligible to take the examination may result in a finding of irregular behavior and permanent annotation of your record. See Policies and Procedures Regarding Irregular Behavior. If you take a Step for which you are not eligible, results for that exam may not be reported or, if previously reported, may be canceled. If you have already been granted a physician license by a U.S. medical licensing authority based on other licensure examinations, including but not limited to, the Federation Licensing Examination (FLEX), the Medical Council of Canada Qualifying Examination, NBME certifying examinations, or the National Board of Osteopathic Medical Examiners COMLEX-USA, or by exception, you may not be eligible to take the USMLE. Please contact ECFMG if you have questions about your eligibility. Page 31 Eligibility for Examination Reverification of Eligibility ECFMG reserves the right to reverify your eligibility for examination at any time during the application and registration process. If your medical school informs ECFMG that your status has changed, and ECFMG determines you are no longer eligible for examination, your registration will be canceled. If you have failed to inform ECFMG of this change in your status, it may result in a finding of irregular behavior and permanent annotation of your record. See Policies and Procedures Regarding Irregular Behavior. For medical school students, ECFMG may reverify your status as a student officially enrolled in medical school. If reverification is requested by ECFMG, ECFMG may cancel your registration or withhold your score report until ECFMG has received reverification of your status directly from the medical school. If your registration is canceled, you may be required to reapply. For medical school graduates, ECFMG may reverify your medical education credentials with the issuing medical school. If such reverification is requested by ECFMG, you will be registered for examination only after ECFMG has received reverification of your credentials directly from the medical school. If reverification is requested by ECFMG after you have been registered for examination, ECFMG may cancel your registration or withhold your score report until ECFMG has received reverification of your medical education credentials directly from the issuing school. If your registration is canceled, you may be required to reapply. Page 32 The United States Medical Licensing Examination (USMLE) About USMLE The USMLE is a three-step examination for medical licensure in the United States. The USMLE provides a common system to evaluate applicants for medical licensure. The USMLE is sponsored by the Federation of State Medical Boards (FSMB)  and the National Board of Medical Examiners (NBME) . To learn more, visit the USMLE website . If you apply for examination, you are required to read the USMLE Bulletin of Information for detailed information on the USMLE. Page 33 The United States Medical Licensing Examination (USMLE) Registration and Test Delivery Entities Step 1 and Step 2 Clinical Knowledge (CK) ECFMG registers international medical students/graduates for Step 1 and Step 2 CK. This means that ECFMG processes your exam application and payment, verifies your eligibility, and notifies you of the outcome of your application. The NBME serves as the registration entity for students/graduates of U.S. and Canadian medical school programs accredited by the Liaison Committee on Medical Education (LCME)  and U.S. medical schools accredited by the Commission on Osteopathic College Accreditation (COCA) . For eligible international medical students/graduates applying for Step 1/Step 2 Clinical Knowledge (CK), ECFMG forwards registration information to NBME, and NBME issues the exam scheduling permits. ECFMG sends these applicants their scheduling permits via e-mail. Scheduling and test centers for USMLE Step 1 and Step 2 CK are provided by Prometric . Prometric serves as the test delivery entity for all examinees taking Step 1/Step 2 CK. Step 1 and Step 2 CK are delivered at Prometric test centers worldwide. For all applicants, NBME is responsible for scoring USMLE exams and for issuing the score reports. ECFMG sends an e-mail notification to international medical students/graduates when their Step 1 and Step 2 CK score reports are available. Step 3 The FSMB is the organization that registers all Step 3 applicants. To be eligible for Step 3, international medical graduates must be certified by ECFMG, among other requirements. See Eligibility for the USMLE Steps in the USMLE Bulletin of Information. If you have not met all eligibility requirements, your application for Step 3 will not be accepted. For detailed information and application procedures for Step 3, contact the FSMB . Scheduling and test centers for Step 3 are provided by Prometric , which serves as the test delivery entity for all Step 3 examinees. USMLE Step 3 is delivered at Prometric test centers in the United States. For all applicants, NBME is responsible for scoring USMLE exams and for issuing the score reports. FSMB notifies examinees when their Step 3 score reports are available. Page 34 The United States Medical Licensing Examination (USMLE) Applying for Examination Before applying to ECFMG for examination: International medical students/graduates must complete an Application for ECFMG Certification, including the notarized Certification of Identification Form (Form 186). See Application for ECFMG Certification. ECFMG must accept the Application for ECFMG Certification, including the notarized Form 186. International medical students/graduates must read the applicable editions of the ECFMG Information Booklet and the USMLE Bulletin of Information. Important Note: Please note that ECFMG will not provide services of any kind if doing so would be considered violative of any applicable international, federal, state, or local laws or regulations. Additionally, ECFMG may delay or suspend provision of services while investigating whether the services or surrounding circumstances violate such laws, regulations, or ECFMG’s policies and procedures. You can apply for USMLE Step 1 and/or Step 2 CK via our on-line services. You should read the detailed instructions for the application for examination before you begin working on the application; these resources will help you plan the timing of your application and outline any necessary items (such as forms that must be completed by your medical school) that require advance planning. Important Note: You should also consider deadlines imposed by the National Resident Matching Program (NRMP)  and graduate medical education (GME) programs. It is solely the responsibility of the applicant to complete the exam requirements in time to meet deadlines imposed by the NRMP and/or GME programs. Since the number of applicants seeking to complete exams may exceed the spaces available in time to meet those deadlines, there is no guarantee that sufficient spaces will be available for all applicants to meet deadlines imposed by the NRMP and/or GME programs. ECFMG assumes no liability of any kind if an applicant does not complete the exam requirements in time to have results available to meet NRMP and/or GME program deadlines. See Examination Results for information on scoring turnaround times. Exam Fees For Step 1 or Step 2 CK , there is an examination fee. Each exam also has an additional international test delivery surcharge if you choose a testing region other than the United States/Canada. You must pay all Page 35 applicable fees at the time you apply for examination. For the current exam fees and international test delivery surcharges, see the Fees page on the ECFMG website. Eligibility Periods When you apply for Step 1 or Step 2 CK, you must select an eligibility period during which you would prefer to take the exam. The eligibility period you are assigned will be listed on your scheduling permit. You must take the exam during the eligibility period assigned to you. If you are unable to take Step 1/Step 2 CK during the eligibility period assigned to you, you may request a one-time, contiguous eligibility period extension via our on-line services. Additional information and instructions are provided with the application. If you do not take Step 1/Step 2 CK during your original or extended eligibility period or if you are unable to extend your eligibility period, you must reapply by submitting a new application and fee(s), if you wish to take the exam. Testing Locations Step 1 and Step 2 CK are delivered at Prometric test centers worldwide. Prometric's test centers are grouped into defined testing regions. When you apply for Step 1 or Step 2 CK, you must choose the testing region where you want to take the exam. A list of Prometric testing regions is available on the ECFMG website. You can take the exam at any test center in your testing region that offers USMLE, provided there is space available on the date you choose. The test centers available for USMLE Step 1 and Step 2 CK are subject to change. To obtain current information on specific test centers, visit the Prometric website  or follow instructions on the scheduling permit for contacting Prometric. If you are unable to keep your Step 1 or Step 2 CK testing appointment at the test center you select, you can reschedule for a different test center within your testing region, subject to availability. Rescheduling fees may apply. A fee schedule is posted on the USMLE website . Refer to your scheduling permit for details. If you are unable to take Step 1 or Step 2 CK in the testing region you selected, you may request a change to your testing region. Additional information and instructions are provided with the form. Examinees with Disabilities Requesting Test Accommodations The USMLE program provides reasonable accommodations for examinees with disabilities as defined by the Americans with Disabilities Act (ADA). If you are an individual with a disability under the ADA and Page 36 require test accommodations to access the exam, visit the USMLE website  before you apply for information regarding test accommodations, including procedures, guidelines, and documentation requirements. Requesting Additional Break Time Only Examinees who require additional break time for medical conditions or for other reasons, may apply for additional break time/standard testing time. See the USMLE Bulletin of Information for more information. Pre-approved Items A list of approved personal items that may be permitted in the secure testing area, subject to inspection by test center staff, is available on the USMLE website . See also the USMLE Bulletin of Information for more information. Page 37 The United States Medical Licensing Examination (USMLE) Scheduling the Examination Once ECFMG verifies that you are eligible to test and your registration is complete, your scheduling permit will be issued. If you apply for more than one exam at the same time, you will be issued separate scheduling permits for each exam. ECFMG will send your scheduling permit to your e-mail address of record. You will not receive the scheduling permit or notification by postal mail. Important Note: For Step 1 and Step 2 CK, if the beginning of your assigned eligibility period is more than six months in the future, your scheduling permit will not be available or sent via e-mail until approximately six months before the beginning of the assigned eligibility period. The scheduling permit is a very important document; it includes your assigned eligibility period, a description of the form(s) of identification you must bring to the test center on your exam date, and instructions for scheduling your testing appointment. You must bring your scheduling permit to the test center on your exam date. Your name, as it appears on your scheduling permit, must exactly match the name on your form(s) of identification. The only acceptable differences are variations in capitalization; the presence of a middle name, middle initial or suffix on one document and its absence on the other; or the presence of a middle name on one and middle initial on the other. Please review your scheduling permit for additional details. If you do not bring a copy of your scheduling permit (electronic or paper) and required identification on each day of your exam, you will not be allowed to take the exam. If you are not allowed to take the exam, you must pay a fee to reschedule your exam. Your rescheduled testing appointment must fall within your assigned eligibility period. If the name listed on your scheduling permit is not correct, contact ECFMG immediately. Use the contact information for General Inquiries on the Contact Us page of the ECFMG website. If your name of record with us is changed while you are registered for an exam, a revised scheduling permit reflecting this change will be issued. ECFMG will send your revised scheduling permit via e-mail. You must bring the revised scheduling permit to the test center. Name changes must be received and processed by ECFMG no later than seven business days before your testing appointment, or you will not be able to test. For Step 1 or Step 2 CK, if your eligibility period is extended or your testing region is changed while you are registered, a revised scheduling permit reflecting this change will be issued. You must bring the revised scheduling permit to the test center. If you lose your scheduling permit, you can access it via our on-line services. Page 38 Scheduling You can schedule your testing appointment as soon as you obtain your exam scheduling permit. Please refer to your scheduling permit for instructions on reviewing available test dates and centers and scheduling a testing appointment. Test dates are provided on a first-come, first-served basis. The USMLE program cannot guarantee the availability of test centers. Therefore, you should contact Prometric to schedule as soon as possible after receiving your scheduling permit. It is also recommended that you schedule your test dates early in your eligibility period to provide flexibility in case you need to reschedule. If you do not schedule and take the exam within your eligibility period, you must reapply by submitting a new application and exam fee(s) if you wish to take the exam. Rescheduling If you are unable to keep your Step 1 or Step 2 CK testing appointment, you are permitted to change (reschedule, cancel, change test center location) your appointment within your eligibility period. Rescheduling fees may apply. A fee schedule is posted on the USMLE website . Refer to your scheduling permit for details on contacting Prometric to change your appointment. If you cannot take the Step 1 or Step 2 CK exam during your assigned eligibility period, you may request a one-time, contiguous eligibility period extension via our on-line services. Additional information and instructions are provided with the application. If you cannot take the Step 1 or Step 2 CK exam in the testing region you selected, you may request to change your testing region. Additional information and instructions are provided with the form. Page 39 The United States Medical Licensing Examination (USMLE) Preparing for Examination For detailed information on test lengths and formats, see The USMLE: Purpose, Format, and Test Lengths in the USMLE Bulletin of Information. See also USMLE Checklist: What Do I Need To Do in the USMLE Bulletin of Information. Practice materials for all Steps are available in the Prepare for Your Exam  section of the USMLE website. The NBME offers web-based self-assessments to help medical students and graduates evaluate their readiness for Step 1, Step 2 CK, and Step 3. For complete information, see Taking an NBME SelfAssessment  on the NBME website. Practice Sessions for USMLE Step 1, Step 2 CK, and Step 3 are available at Prometric test centers to registered applicants for a fee. These sessions are provided primarily to give examinees the opportunity to become familiar with the Prometric test center environment. For more information, see USMLE Computer-based Testing Practice Session  on the USMLE website. Important Note: Test preparation courses and materials are available from individuals and companies not associated with the USMLE. It is unlawful for any test preparation service or program to use, disclose, distribute, or solicit content from recent test takers, or to otherwise provide access to questions or answers from actual USMLE exams. If there is evidence that you enrolled in, participated in, or used any test preparation program or service that distributes, provides access to, or uses USMLE content (questions or answers), or provides a forum for others to share such information, your registration and/or testing may be canceled, your scores on the USMLE may be withheld or canceled, and you may be subject to further sanctions. See Irregular Behavior in the USMLE Bulletin of Information. ECFMG also regularly reviews allegations of irregular behavior in conjunction with its programs and services. See Policies and Procedures Regarding Irregular Behavior, which may apply. Page 40 The United States Medical Licensing Examination (USMLE) Taking the Examination For detailed information on arrival times, and procedures upon arrival and throughout the testing day, see Examination Day and Testing in the USMLE Bulletin of Information. You should also refer to your scheduling permit for important information. Important Note: Once you enter your candidate identification number (CIN) and launch the examination, you cannot cancel or reschedule that examination. If you start the examination but do not complete it, the attempt may appear as "incomplete" on your USMLE transcript. When you arrive at the test center, you must present your scheduling permit and the required identification as described on your scheduling permit. If you do not bring a copy of your scheduling permit (electronic or paper) and required identification on each day of your exam, you will not be admitted to the test and will be required to pay a fee to reschedule your test. Your name, as it appears on your scheduling permit, must match the name on your form(s) of identification exactly. The only acceptable differences are variations in capitalization; the presence of a middle name, middle initial or suffix on one document and its absence on the other; or the presence of a middle name on one and middle initial on the other. Please review your scheduling permit for additional details. If the name listed on your scheduling permit is not correct, contact ECFMG immediately. Use the contact information for General Inquiries on the Contact Us page of the ECFMG website. If your name of record is changed while you are registered for an exam, a revised scheduling permit reflecting this change will be issued. ECFMG will send your revised scheduling permit via e-mail. You must bring this revised scheduling permit to the test center. Name changes must be received and processed by ECFMG no later than seven business days before your testing appointment, or you will not be able to test. For Step 1 or Step 2 CK, if your eligibility period is extended or your testing region is changed while you are registered, a revised scheduling permit reflecting this change will be issued. You must bring the revised scheduling permit to the test center. Required Identification Your name, as it appears on your scheduling permit, must exactly match the name on your form(s) of identification. The only acceptable differences are variations in capitalization; the presence of a middle name, middle initial or suffix on one document and its absence on the other; or the presence of a middle name on one and middle initial on the other. Please review your scheduling permit for additional details. Since your name on the scheduling permit appears in the Latin alphabet (in "English language letters"), Page 41 the name on your identification must also appear in the Latin alphabet. The spelling of the name on your scheduling permit must match exactly the spelling of the name on the form(s) of identification you present at the test center. If the names do not match as described above, you will not be allowed to take the exam. See Your Name in Your Record. The form of identification you present must be one of the forms of unexpired, government-issued identification listed below that contains your name in the Latin alphabet, your signature, and your recent photograph. The following forms of identification are acceptable, only if they meet all of these requirements: Passport Driver's license with photograph National identity card Other form of unexpired, government-issued identification Travel Status Applicants traveling to the United States to take an exam are responsible for making the necessary travel and accommodation arrangements. If you are neither a U.S. citizen nor a U.S. lawful permanent resident, you are responsible for obtaining required travel documents. These documents may include a visa to enter the United States. The requirements of the U.S. Department of Homeland Security (DHS) and U.S. embassies and consulates regarding issuance of visas and travel to and from the United States are subject to change. You should review current requirements before applying for a visa. For additional information, visit the DHS website  and the U.S. Department of State website . Page 42 The United States Medical Licensing Examination (USMLE) USMLE Program and Irregular Behavior The USMLE program defines irregular behavior as including, "any action by applicants, examinees, potential applicants, or others that could compromise the validity, integrity, or security of the USMLE process." Test center staff monitor, in person and via video/audio recording, administration of the USMLE Steps and are required to report any violations of the USMLE or test center rules. You must follow instructions from test center staff throughout the examinations; failure to do so may result in a finding that you have engaged in irregular behavior and permanent annotation of your USMLE transcript. See Testing Regulations and Rules of Conduct and Irregular Behavior in the USMLE Bulletin of Information. See ECFMG’s Policies and Procedures Regarding Irregular Behavior, which also may apply. Important Notes: Seeking, providing, and/or obtaining information relating to examination content that may give or attempt to give unfair advantage to anyone who may be taking the examination, which includes postings regarding examination content and/or answers on the Internet, is a violation of the USMLE Rules of Conduct. Evidence of violation of any test administration rule, including the USMLE Rules of Conduct, will result in actions being taken under USMLE Policies and Procedures Regarding Irregular Behavior. If you are found to have engaged in irregular behavior, your score report and transcripts will include this finding, you may be barred from taking the USMLE in the future, and your score may be canceled. Anomalous performance and/or unusual testing history may impact your access to the USMLE. If your performance raises concerns about your readiness to test or your motivation to pass, the USMLE program reserves the right to restrict your future access to its examinations and/or to impose conditions upon future access. Do not test if you are not able or not ready on your scheduled test date. Taking a Step examination to familiarize yourself with the examination format, or for any reason other than to pass, is prohibited and may result in restrictions on your future access to the USMLE. The above-described conduct may also be considered irregular behavior under ECFMG’s Policies and Procedures Regarding Irregular Behavior. Page 43 The United States Medical Licensing Examination (USMLE) Examination Results The USMLE program provides a recommended pass or fail outcome on all Step examinations. For ECFMG Certification, you must obtain at least the USMLE-recommended pass outcome for each required Step. See Examination Requirements in Examinations for ECFMG Certification. Score Reporting Results for Step 1 and 2 CK are typically available two to four weeks after your test date. However, in rare cases, various factors may delay score reporting. When selecting your test date and inquiring about results, you should allow at least eight weeks to receive notification that your score report is available. ECFMG reserves the right to reverify with the medical school the eligibility of medical school students and graduates who are registered for examination. If ECFMG requests reverification of your student/graduate status with your medical school, your score report will be issued only after reverification of your status has been received by ECFMG. Score reports are issued in electronic format only and can be accessed via our on-line services. Once your score report has been issued, ECFMG will send a notification to your e-mail address of record. Score reports are available for approximately 365 days from the date of e-mail notification. Once the score report is removed from our on-line services, your results will be provided to you only in the form of an official USMLE transcript; see USMLE Transcripts below. Therefore, it is strongly recommended that you print and/or save your score report while it is available. Important Note: ECFMG may provide your medical school with data on your performance on administrations of USMLE Step 1 and Step 2. Data provided include whether you passed or failed the exam administration and your numerical score, if one was reported for your exam administration. Information about ECFMG’s Provision of Performance Data to Medical Schools and an option for you to withhold your exam results from your medical school are available via our on-line services. See Score Reporting in the USMLE Bulletin of Information for additional information. For up-to-date information on minimum passing scores, examination performance data, and general scoring methodology, please visit the USMLE website . Page 44 Score Validity The USMLE program reserves the right to cancel exam results that are at or above the passing level, prior to or after release, if the USMLE program has a good faith basis for questioning whether the exam result(s) represent a valid measure of knowledge or competence as assessed by the examination. If there are questions related to the validity of your exam result and your result has not yet been reported, your official score report may be delayed or withheld pending completion of further review and/or investigation. Whether questions relating to the validity of your exam result arise after your result has been reported or before, the USMLE reserves the right to cancel the result if it has a good faith basis for questioning the validity of your result. If your result is being investigated for validity concerns, you will be notified in writing by the USMLE Office of the Secretariat. See Score Validity in the USMLE Bulletin of Information. USMLE Transcripts For information on what is included on an official USMLE transcript and how to request one, please visit the USMLE website . If you apply to residency programs, you may request electronic transmittal of your USMLE transcript to these programs through the residency application service. For additional information, refer to the Electronic Residency Application Service (ERAS) Support Services section of the ECFMG website. Important Note: If you took the former ECFMG CSA, your USMLE transcript will indicate only that you have CSA examination history. It will not provide any additional information on your attempt(s) on the CSA. To request official copies of your CSA performance history, you must submit your request for an official CSA history chart to ECFMG with the appropriate fee. Additional information and instructions are provided with the form. Score Rechecks For all Steps, a highly rigorous process is used to ensure the accuracy of scores, including a parallel scoring method involving independent scoring systems. Therefore, a change in your score or in your pass/fail outcome based on a recheck is an extremely remote possibility. To date, the score recheck process has not resulted in a score change. However, a recheck will be performed if you submit a request and the fee for this service to the organization that registered you for your examination. For Step 1/Step 2 CK, additional information and instructions are provided with the form. Your request must be received no later than 90 days after your result was released to you. See Score Rechecks in the USMLE Bulletin of Information for more information. Page 45 The United States Medical Licensing Examination (USMLE) Reexamination and Reapplication USMLE policy generally does not allow applicants to retake a Step if they have already passed that Step. However, there are exceptions for the purpose of complying with a time limit imposed by a U.S. medical licensing authority or another authority recognized by the USMLE program. See Time Limit for Completing Examination Requirements below. If you fail a Step, you must reapply, including payment of the appropriate fee(s), to retake the exam. If you do not take an exam during your assigned eligibility period, you must reapply, including payment of the appropriate fee(s), if you wish to take the exam; in this event, you may reapply at any time, however, ECFMG cannot begin to process a subsequent application for this exam until at least four weeks after the end of the eligibility period for the exam you did not take. Number of Attempts Allowed The USMLE program limits to four the total number of times an examinee can take the same Step. Examinees who have attempted a Step four or more times, including incomplete attempts, and have not passed are ineligible to apply for any Step in the USMLE exam sequence. Attempts at the formerly administered Step 2 CS count toward the limit. All attempts at a Step are counted toward the limit, regardless of when the exams were taken. For the purpose of U.S. medical licensure, state medical licensing authorities may limit the number of attempts allowed to pass each Step. Information regarding specific state requirements can be obtained on the Federation of State Medical Boards (FSMB) website . Time Between Examination Attempts The USMLE program has established rules on how quickly you can retake the same Step. You may not take the same examination more than three times within a 12-month period. Your fourth attempt must be at least 12 months after your first attempt at that exam and at least six months after your most recent attempt at that exam. This includes incomplete attempts. Example: An examinee took and failed her first attempt at Step 1 on January 15, 2023, her second attempt at Step 1 on April 15, 2023, and her third attempt at Step 1 on September 15, 2023. In January 2024, the examinee applied for a fourth attempt at Step 1 and wanted the March-AprilMay eligibility period. The earliest date that was both 12 months after her first attempt on January 15, 2023 and six months after her most recent attempt on September 15, 2023 was March 15, Page 46 2024. Since the March- April-May eligibility period began before this date, the earliest eligibility period that the applicant could request was April-May-June. When you reapply, your eligibility period will be adjusted, if necessary, to comply with these rules. You must read the editions of the ECFMG Information Booklet and the USMLE Bulletin of Information that pertain to the eligibility period in which you take the exam. Time Limit for Completing Examination Requirements For the purpose of ECFMG Certification, you must satisfy the examination requirements for ECFMG Certification within a seven-year period. If you do not satisfy the examination requirements for ECFMG Certification within a maximum of seven years, your earliest passing performance will no longer be valid for ECFMG Certification. See Time Limit for Completing Examination Requirements in Examinations for ECFMG Certification. If you have passed a USMLE Step but this passing performance is no longer valid for ECFMG Certification, you may request an exception to retake the previously passed exam that is no longer valid. The USMLE program’s policy on attempt limits may impact an applicant’s ability to retake the examination that is no longer valid. For the purpose of U.S. medical licensure, time limits to complete the USMLE are established by state medical licensing authorities and may require completion of all Steps (including Step 3, which is not required for ECFMG Certification) within a certain number of years from the date the first Step is passed. Information regarding specific state requirements can be obtained on the FSMB website . You may request an exception to retake a previously passed exam to comply with the time limit of a U.S. medical licensing authority. Visit the USMLE website  for more information. Important Notes: You may only request an exception at the time that you apply for the previously passed exam. Complete requirements and instructions will be provided at the time of exam application. Exceptions to the reexamination requirements are not approved prior to your submitting the exam application. Applicants who retake a previously passed Step to comply with a time limit should understand the implications of a failing retake performance on their Step 3 eligibility. See Retaking Previously Passed Steps in the USMLE Bulletin of Information. Page 47 Medical Education Credentials Medical Education Credential Requirements To be eligible for ECFMG Certification, you 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 with an ECFMG note stating it meets ECFMG eligibility requirements. Your graduation year must be included in the ECFMG note in your medical school’s World Directory listing. See Medical School Requirements. There are restrictions on credits transferred to the medical school that awards your medical degree that can be used to meet ECFMG’s medical education credential requirements. Important Notes: Graduates not eligible for admission to the exams or for ECFMG Certification include, but are not limited to: Graduates with degrees only in stomatology, ayurvedic or homeopathic medicine; graduates awarded only the diploma of Physician-EpidemiologistHygienist, Physician-Biochemist, Physician-Cyberneticist, Physician-Biophysicist, Licensed Medical Practitioner, or Assistant Medical Practitioner; and graduates awarded degrees in specialties other than Clinical Medicine (such as in Traditional Chinese Medicine). Implementation of the Recognized Accreditation Policy will begin in late 2024. Once the policy is in effect, it will not impact an individual's eligibility for certification. IMGs will still be able to apply for and obtain ECFMG Certification, regardless of whether their medical school meets the current requirements of the Recognized Accreditation Policy. Any updates or changes to the policy will be communicated well in advance. For more information on this policy, visit www.intealth.org/accreditation/. International medical graduates must document the completion of all requirements for, and receipt of, the final medical diploma. ECFMG verifies every international medical graduate’s final medical diploma with the appropriate officials of the medical school that issued the diploma. When ECFMG requests verification of your medical diploma from your medical school, ECFMG will request the medical school to provide your final medical school transcript. Verification by ECFMG with the issuing school may also be required for transcripts that are submitted to document transferred credits. An international medical graduate’s credentials are not considered complete until ECFMG receives and accepts verification of the final medical diploma, final medical school transcript, and, if required, transfer credit transcript(s) directly from the issuing school(s). Please do not send original documents, as they will not be returned to you. Please do not send any credentials not required (such as licenses, certificates of full registration, high school diplomas, academic awards, etc.). Submission of unnecessary documents can delay the processing of your exam application. Page 48 Medical Education Credentials ECFMG Policy on Transfer Credits Transfer credits are credits earned for a course taken at one institution (such as a medical school) that are accepted by a medical school toward meeting its degree requirements. For example, a student attends a medical school for one year and earns credits for 12 courses. The student transfers to another medical school, which accepts the credits for those 12 courses toward meeting its degree requirements. The credits for those 12 courses are then referred to as transfer credits. If you transferred credits to the medical school that awarded or will award your medical degree, you must disclose and document these credits when you apply to ECFMG for examination, regardless of when the credits were earned. See Credentials for ECFMG Certification in Medical Education Credentials. Failure to disclose and document these credits may have a number of negative consequences, including delaying exam registration and certification by ECFMG, and may result in a finding of irregular behavior and permanent annotation of your record. See Policies and Procedures Regarding Irregular Behavior. Additionally, for the purpose of ECFMG Certification, credits that are transferred to the medical school that awarded or will award your medical degree must meet all of the following criteria: All credits must have been transferred from a medical school that is either: located in the United States or Canada and listed in the World Directory , or listed in the World Directory with an ECFMG note stating it meets ECFMG eligibility requirements. Credits must be for courses that were passed at the medical school at which the course was taken. Credits may only be transferred from one medical school to the medical school which awards the final degree. If your transferred credits do not comply with all the criteria listed above, you will not meet the requirements to be registered by ECFMG for examination or the requirements to be certified by ECFMG. If your transferred credits do not meet all the criteria listed above, you may request an exception from the ECFMG Medical Education Credentials Committee. Important Note: The requirement that credits must be transferred from a medical school that meets the criteria above does not apply to credits transferred only to the pre-medical portion of the curriculum of the medical school that awarded or will award the medical degree. If you transferred credits to the pre-medical portion of the curriculum at the medical school that awarded or will award your medical degree from an institution that does not meet the criteria listed above, Page 49 you must provide ECFMG with a letter from the medical school that awarded or will award your medical degree confirming that the credits were transferred to the pre-medical portion of the curriculum only. This letter must be on the letterhead of the medical school and be signed by an authorized official of your medical school. This letter must be submitted in conjunction with the application for examination. Applications received without this letter may be rejected. This letter is in addition to disclosing and documenting all transferred credits as described above. The intent of this policy on transfer credits is to preserve the appropriate education of medical school graduates applying to ECFMG for Certification. The provisions of this policy will be applied by ECFMG in its sole discretion in order to effectuate the intent of this policy. Important Note: Transfer credits that ECFMG reviewed and deemed to have met requirements for ECFMG Certification prior to August 27, 2019, will remain acceptable, and these applicants will be allowed to proceed with Certification and the examinations leading to Certification. All future transfer activity will be subject to the policy as stated here. Page 50 Medical Education Credentials Credentials for ECFMG Certification The credentials required for ECFMG Certification are: Final Medical Diploma Final Medical School Transcript Transcript(s) to Document Transferred Credits, if applicable All documents that are not in English must be accompanied by an official English translation that meets ECFMG’s translation requirements. See Final Medical Diploma and Transcript, Transcript(s) to Document Transferred Credits, and English Translations for complete information on required items. If you are a medical school graduate when you submit your first exam application, your diploma and transcript(s) to document transferred credits (if applicable) must be submitted at the same time as this initial exam application. If you have graduated and met all requirements for your medical diploma but your medical diploma has not yet been issued, a letter completed and signed by an authorized official of your medical school must be submitted at the same time as your exam application. Each medical school has been requested to provide ECFMG with a list of authorized officials. The letter you submit must be completed and signed by an official on this list. The official must provide his/her name, official title, and the institution name. The official must affix the institution’s seal to the letter. The letter also must include the following statement: This is to confirm that [applicant name] has graduated and completed all requirements to receive the [degree title] degree from [medical school/university name]. The degree will be issued [month and year]. You must then submit a copy of your diploma to ECFMG as soon as the diploma is issued. If you graduated from medical school and do not submit a copy of your medical diploma or a letter from your medical school, as described above, within four weeks of submitting the on-line portion of your exam application, and these documents have not been received previously by ECFMG, your exam application will be rejected. If you are a medical school student when you submit your first exam application, submit copies of your medical education credentials as soon as you graduate and receive them. Page 51 You may not submit the credentials required for ECFMG Certification to ECFMG until you apply for an exam. If you send credentials to ECFMG before you apply for an exam, they will not be processed. You can submit your credentials via our on-line services. Additional information and instructions are provided with the exam application. If your credentials are complete, you are generally not required to resend these documents when you apply for subsequent exams. When your credentials have been processed, ECFMG will notify you. You can also check the status of your credentials via our on-line services. If you have questions or concerns about your credentials, you can contact ECFMG using the contact information for General Inquiries on the Contact Us page of the ECFMG website. Page 52 Medical Education Credentials Final Medical Diploma and Transcript Final Medical Diploma ECFMG requires all medical school graduates to submit a copy of their final medical diploma. Do not send an original diploma. You can submit your credentials via our on-line services. Additional information and instructions are provided with the exam application. The exact degree title of the final medical diploma you must have earned (and must provide) in order to be eligible for ECFMG Certification and the examinations required for Certification is listed in the Reference Guide for Medical Education Credentials on the ECFMG website. The Reference Guide lists these medical credential qualifications by medical school and graduation year. Although this Reference Guide is based upon information that was current at the time of publication, this information is subject to change. You must submit the copy of the final medical diploma in the original language, containing the issue date and all of the appropriate signatures of the medical school and/or university officials. Documents that are not in English must be accompanied by an official English translation that meets ECFMG’s translation requirements. See English Translations in Medical Education Credentials. Do not submit professional evaluations of your final medical diploma. ECFMG does not accept such evaluations in lieu of your final medical diploma. If you are submitting the copy of your medical diploma with an exam application, follow the instructions for additional documents in the exam application. The name on your medical diploma should match exactly the name in your record. If the name on your diploma does not match your name of record, you must submit documentation that verifies the name on your diploma is (or was) your name. See Name on Medical Diploma and Transcript(s) in Medical Education Credentials. Final Medical School Transcript When ECFMG requests verification of your medical diploma from your medical school, ECFMG will request the medical school to provide your final medical school transcript. If ECFMG is unable to obtain your final medical school transcript directly from your medical school, ECFMG will contact you and provide detailed instructions. Page 53 Medical Education Credentials Transcript(s) to Document Transferred Credits If you have transferred credits to the medical school that awarded or will award your medical degree, you must document these credits when you apply for examination, regardless of when the credits were earned. You must send to ECFMG a copy of an official transcript issued by the school or institution at which the course was taken. You can submit your credentials via our on-line services. Additional information and instructions are provided with the exam application. You must submit the copy of the transcript in the original language. Documents that are not in English must be accompanied by an official English translation that meets ECFMG’s translation requirements. See English Translations in Medical Education Credentials. Do not submit professional evaluations of your transcript. ECFMG does not accept such evaluations in lieu of your transcript. To submit the transcript to ECFMG, follow the instructions for additional documents in the exam application. The name on your transcript(s) to document transferred credits should match exactly the name in your record. If the name on your transcript does not match your name of record, you must submit documentation that verifies the name on your transcript is (or was) your name. See Name on Medical Diploma and Transcript(s) in Medical Education Credentials. Page 54 Medical Education Credentials Name on Medical Diploma and Transcript(s) Your name as it appears on all credentials sent to ECFMG should be consistent and should match exactly the name in your record. If the names do not match exactly, you must submit documentation that verifies the name on your medical diploma/transcript(s) is (or was) your name. The documentation must show your name exactly as it appears on your medical diploma/transcript(s). See Your Name in Your Record and Verifying Your Name below. If the name on your credentials does not match the name in your record and you do not submit acceptable documentation that verifies the name on your credentials is (or was) your name, your exam application will be rejected. If your exam application is rejected due to a name discrepancy, ECFMG will contact you to request additional information. An example of a discrepancy that requires such verification would be if your record lists your married name, but your medical diploma/transcript(s) lists your maiden name. Verifying Your Name If your name of record does not match exactly your name as listed on your medical diploma, transcript, or other credential, you must verify that the name on these documents is (or was) your name. To verify your name, submit to ECFMG a copy of one of the documents listed below that verifies the name on your medical diploma, transcript, or other credential. The name in your record will not be changed if you are verifying your name. For the purpose of verifying your name, examples of the document(s) you may submit include: Expired Passport (including the pages with your photograph and the expiration date) Birth Certificate Marriage Certificate/License (if name discrepancy is due to name change after marriage) Official Court Order/Name Change Documentation Official Immigration Document, including U.S. Resident Alien Card U.S. Naturalization Certificate Permanent Residence Card Driver’s License Page 55 If additional documentation is required for the purposes of verifying your name, and you cannot provide one of the documents listed above, ECFMG will consider accepting a letter from an authorized official of your medical school that verifies that the name on your medical diploma, transcript, or other credential is (or was) your name. If you choose to submit a letter from your medical school to verify the name on your credential, the letter must be completed and signed by an authorized official of your medical school. Each medical school has been requested to provide ECFMG with a list of authorized officials. The letter you submit must be completed and signed by an official on this list. The official must provide his/her name, official title, and the institution name. The official must also affix the institution’s seal to the letter. The letter must be on letterhead and must include the following statement: This certifies that the names [name on document] and [name in ECFMG record] belong to one and the same person. See additional important information on documents below. Important Information on Documents for Changing or Verifying Your Name Attestations are not acceptable as documentation to change or verify your name. Please do not submit an original document; a copy of the document is sufficient. All documents submitted to change or verify your name that are not in English must be accompanied by an official English translation that meets ECFMG's translation requirements. See English Translations in Medical Education Credentials. All documents submitted to change or verify your name, including translations, will become a part of your permanent record and will not be returned to you. Page 56 Medical Education Credentials English Translations Documents must be submitted to ECFMG in the original language. Any document submitted to ECFMG that is not in English must be accompanied by an official English translation that meets ECFMG’s translation requirements. Please see the English Translations page in the Resources section of the ECFMG website for ECFMG’s translation requirements, our recommended translation service, and other important information. Original language documents that are not accompanied by an English translation that meets ECFMG’s translation requirements will not be accepted. Likewise, English translations that are not accompanied by the original language document will not be accepted. Documents submitted to ECFMG as part of the exam application and certification processes, including translations, will not be returned. Important Note: If the credential provided by your medical school is not in English and an acceptable English translation is not provided by the medical school, ECFMG will have the credential translated into English by an independent translation service. ECFMG will charge your financial account for the translation and will subsequently notify you of the charge. ECFMG will not notify you before sending the document for translation. For information on the translation fee and how to make a payment to your financial account, see Fees and Payment in the Resources section of the ECFMG website. Page 57 Medical Education Credentials Verification of Credentials ECFMG verifies every international medical graduate’s final medical diploma with the appropriate officials of the medical school that issued the diploma. At the same time, ECFMG requests the medical school to provide the final medical school transcript. Transcripts to document transferred credits are also subject to verification by ECFMG with the issuing school. You will not fulfill the ECFMG medical education credential requirements until verification of your final medical diploma, final medical school transcript, and, if required, transfer credit transcript(s) is received directly from the issuing school(s) and accepted by ECFMG. ECFMG will notify you when your diploma has been sent to your medical school for verification. As part of the verification process, ECFMG also may provide the medical school with other documents, including a copy of your identification form to aid in identification. ECFMG will follow up with your medical school if the requested verification is not received in a timely manner. ECFMG will notify you after receiving and evaluating the verification from your medical school. You can check the status of your medical education credentials on-line via our on-line services. ECFMG reserves the right to reverify with the medical school the eligibility of medical school graduates who apply for examination. This may include reverification of the graduate’s medical education credentials with the issuing medical school. If such reverification is requested, the graduate will be registered for examination only after ECFMG has received reverification directly from the medical school. If reverification is requested after the graduate has been registered for examination, ECFMG may cancel the graduate’s registration or withhold the graduate’s score report until ECFMG has received reverification directly from the issuing school. If your registration is canceled, you may be required to reapply. Important Notes: Applicants are responsible for any fees associated with the verification of the final medical diploma, final medical school transcript, and transcript(s) to document transferred credits. If your medical school charges a fee for the verification of your diploma and/or transcript, ECFMG will advise you to contact your medical school directly regarding the fee and the method of payment. If the final medical school transcript provided by your medical school is not in English and an acceptable English translation is not provided by the medical school, ECFMG will have the transcript translated into English by an independent translation service. ECFMG will charge your financial account for the translation, and will subsequently notify you of the charge. ECFMG will not notify you before sending the document for translation. For information on the translation fee and how to make a payment to your financial account, see Fees and Payment in the Resources section of the ECFMG website. Page 58 Appendix Related ECFMG Services Confirming ECFMG Certification to Third Parties ECFMG’s Certification Verification Service (CVS) provides primary-source confirmation of the ECFMG Certification status of international medical graduates. The Joint Commission, the organization that evaluates and accredits U.S. health care organizations and programs, has determined that direct verification with ECFMG of a physician’s certification status satisfies The Joint Commission’s requirement for primary-source verification of medical school completion for graduates of international medical schools. ECFMG will confirm your certification status when a request is received from a U.S. medical licensing authority, residency program, hospital, or other organization that, in the judgment of ECFMG, has a legitimate interest in such information. For status reports sent to medical licensing authorities, the request can also be made by you. Requesting organizations must normally secure and retain your signed authorization to obtain certification information. For more information, visit www.ecfmg.org/cvs. Residency Application Support Services The Association of American Medical Colleges (AAMC) established the Electronic Residency Application Service (ERAS) to allow medical students and graduates to apply electronically for residency positions in accredited U.S. programs of graduate medical education. Most U.S. graduate medical education programs participate in ERAS. If you apply to participating programs, you must submit your residency application using ERAS. ECFMG serves as the designated Dean’s office for students and graduates of international medical schools, assisting these individuals with the ERAS application process for first- and second-year (PGY-1 and PGY-2) residency positions. ECFMG also supports individuals applying to residency programs through other residency application services, including Residency Centralized Application Service (ResidencyCAS) and the Central Application (CentralApp). For detailed, up-to-date information on our residency application support services, visit www.ecfmg.org/eras. Page 59 J-1 Visa Sponsorship Foreign national physicians who seek entry into U.S. programs of graduate medical education or training must obtain an appropriate visa that permits clinical training activities. One visa commonly used by foreign national physicians is the J-1, a temporary nonimmigrant visa offered through BridgeUSA, a critical program within the Bureau of Educational and Cultural Affairs (ECA) of the U.S. Department of State. The U.S. Department of State has designated us as a BridgeUSA sponsor for all exchange visitor (J-1) physicians who participate in clinical training programs. Sponsorship is also available for physicians’ eligible dependents. We do not sponsor physicians for other U.S. visa types. For detailed, up-to-date information on our J-1 visa sponsorship program, visit www.ecfmg.org/evsp. Page 60