ECFMG certification is one of the requirements for international medical graduates who want to complete their medical residency or get licensed to practice as a physician in the US. The Educational Commission for Foreign Medical Graduates evaluates and approves medical graduates from foreign countries wanting to practice in the US to get licensed. The certification is essentially a stamp of approval for IMGs to continue their medical training and work as a doctor without graduating from a US medical school. In this blog, we’ll explore what ECFMG certification means, how to get certified as an IMG and how to apply for residency programs in the US and Canada.

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7 min read

What is ECFMG Certification? Who is Considered an IMG? How to Get ECFMG Certification: Step-by-Step Guide ECFMG Certification: Applying to Residency in the US and Canada FAQs

What is ECFMG Certification?

To enter the US healthcare system and practice as a physician on an unrestricted licensed, international medical graduates (MG) need to obtain ECFMG certification.

The Educational Commission for Foreign Medical Graduates evaluates and certifies the education and qualifications of IMGs who want to become licensed as physicians in the US. Getting your ECFMG certification is also the first step to applying to residency programs in the US.

The Accreditation Council for Graduate Medical Education (ACGME) requires all IMGs who enter ACGME-accredited programs to be certified. IMGs also need certification in order to take the US Medical Licensing Exam or USMLE Step 3 after their residency, the final step to becoming a fully licensed physician in the United States.

Note that there are no residency programs that don’t require ECFMG certification in the US, so IMGs are required to obtain certification before applying.

For IMGs applying to residency programs in Canada, they do not need to obtain certification, but they do need to meet the requirements of the Medical Council of Canada (MCC) for foreign medical graduates.

Who is Considered an IMG?

When it comes to the definition of international medical graduate (or foreign medical graduate), it’s important to know which category you fall into, so you know whether you need certification or not.

Of course, medical students who graduate from medical schools in the US are US medical graduates, or USMGs and do NOT require ECFMG certification. But graduates from medical schools in Canada (CMGs) fall into the same category and do not need to get certified. This is because the US and Canada co-accredit medical schools and recognize the medical education and standards in each country as being comparable to one another.

CMGs can freely apply to residency programs in the US or Canada. However, CMGs still need to get licensed in order to practice in the US by taking and passing the USMLE.

Premeds who are not US or Canadian citizens who graduate from medical schools that accept international students in either country are classified as Non-US IMGs. These med grads do not need to get ECFMG certified.

Medical school graduates who ARE considered IMGs are all students who graduate from international medical schools, outside of the US and Canada. This includes US citizens who attend Caribbean medical schools or who go to medical school in Europe. In this case, you will be classified as a US IMG.

  1. Medical graduates who DO NOT need ECFMG certification = USMGs, CMGs and Non-US IMGs
  2. Medical graduates who need ECFMG certification = IMGs, US citizens who graduate from international med schools.

How to Get ECFMG Certification: Step-by-Step Guide

Before you can start the ECFMG certification process as an IMG, you’ll need to meet all the requirements outlined by the commission. Then you’ll apply for certification, go through the process and receive your seal of approval. After that, your next steps will be applying for residency.

First, we’ll cover the requirements for ECFMG certification and how to meet them:

Medical School Requirements

International medical graduates need to check that their medical school is recognized by the ECFMG as meeting all eligibility requirements. This basically means that the medical school you graduate from has an accreditation that is recognized by the ECFMG.

You can check to see if your school is eligible on the World Directory of Medical Schools. Make sure your medical school has the ECFMG listed under the “sponsor notes” tab, meaning your program is eligible. The ECFMG will also list which graduation years are eligible, so if you graduated from a program outside these years, you may not be eligible for ECFMG certification.

Application Requirements

If your medical school meets the eligibility requirements, you as an IMG can apply for ECFMG certification. You will need to complete an online application as well as fill out a Certification of Identification (form 186) and notarize it.

The certification application can be completed online through the Interactive Web Applications (IWA) portal. First-time users will need to register and create an account.

Exam Requirements

To become certified, IMGs need to complete both licensing exam requirements AND clinical skills requirements.

The exam requirements are simple: you’ll need to complete the USMLE Step 1 and USMLE Step 2 CK to demonstrate both your medical knowledge and clinical knowledge and abilities. It’s important to properly prepare for both exams and plan your test-taking schedule. Both exams are long and comprehensive and require enough studying to ace them. Luckily, there are USMLE Step 1 prep courses and USMLE Step 2 prep courses that can help you with the necessary study prep and organization.

To prove your clinical and communication skills and meet the requirements, you’ll go through one of the ECFMG pathways and pass the Occupational English Test-Medicine (OET). The pathways are different ways to certify that you possess the clinical abilities and communication skills necessary to enter a US residency program. The pathway that is best for you will depend on your status and education, so check the requirements for each pathways carefully.

Credential Requirements

Finally, to get ECFMG certification, you need to have graduated from medical school and received your medical diploma. This means receiving credit for 4 credit years of a medical education. Note that there are limits on the eligibility of transfer credits, and you will need to document the completion of your credits and receipt of your medical diploma.

The ECFMG will also verify your diploma with your medical school and request your official transcripts from your school. The time it takes to complete the verification process can vary depending on your medical school’s processes.

Here's an overview of the ECFMG Certification steps:

Steps to Get ECFMG Certified

Once you’ve met all the eligibility requirements, meaning you have graduated from medical school and had your credentials verified, you are able to start the certification process. You can complete the online application and apply to write the necessary exams.

Here’s a short overview of the steps to get ECFMG certification:

  1. Check that your medical school is listed on the World Directory of Medical Schools and has the ECFMG listed as a sponsor
  2. Complete your medical school education and gather necessary documentation
  3. Submit your diploma and credits for verification by the ECFMG
  4. Create an account through the IWA and fill out the online application form
  5. Fill out Form 186 and get it notarized
  6. Study for and take the USMLE Step 1
  7. Study for and take the USMLE Step 2 CK
  8. Submit your test scores to the ECFMG
  9. Complete one of the 6 ECFMG pathways
  10. Take and pass the OET Medicine

To make sure you’ve completed all the necessary steps, or get additional information on applying for certification, check out the ECFMG information booklet here.

Here’s how to get into residency programs as an IMG:

ECFMG Certification: Applying to Residency in the US and Canada

Once you receive your ECFMG certification, you’re able to participate in the National Resident Matching Program (NRMP) Match!

Applicants to residency programs or an ERAS fellowship program in the US will complete and submit an application through the Electronic Residency Application Service (ERAS). Since the match application cycle can go by quickly, it’s a good idea to plan your ERAS timeline, make note of deadlines and check the requirements.

Here are some of the main components of the ERAS application:

If you’re not familiar with the ERAS application process, it’s a good idea to get some expert help from an ERAS application review service who can check your application and provide feedback.

Applying to residency programs in Canada as an IMG

To be eligible to apply for residency programs in Canada, you must be either a Canadian citizen or permanent resident of Canada. You are also eligible if you have graduated from an accredited US medical school.

To fulfill the requirements of the MCC, you need to write and pass both the NAC OSCE and the MCCQE Part 1 to demonstrate your medical knowledge and clinical knowledge. To get ready for these exams, you can take an MCCQE prep course for international students or a NAC OSCE prep course.

IMGs who want to apply to residency programs in Canada will use the CaRMS application, or Canadian Resident Matching Service. The CaRMS application includes many of the same elements of the ERAS application, including a CaRMS personal letter, a CaRMS reference letter and CaRMS interview.

How competitive are residency programs for IMGs?

Residency programs in the US and Canada are highly competitive, but especially for international applicants. Depending on the medical specialty, the level of competitiveness can vary. Overall, non-US IMGs have a match rate just over 59%, while US IMGs had an overall match rate just over 67%.

Non-US IMG Match Rate Overall

US IMG Match Rate Overall

For better chances of matching, check out the most IMG friendly residency programs and apply to the specialties that have the highest match rates for IMGs. These include some of the most IMG-friendly internal medicine residency programs and IMG-friendly family medicine residency programs.

Other great ways to increase your odds of matching as an IMG include taking electives or gaining clinical experience as an IMG in the US and Canada. You can also consider applying for a pre-residency fellowship as an IMG to gain more experience and education to give yourself an edge over the competition. Getting strong clinical experiences demonstrate that you are prepared to excel in a US residency program and that you have some familiarity with the US healthcare system. Both are essential for convincing residency programs to accept you.

To ace your residency applications as an IMG, don’t forget to prepare for residency interviews. This is your opportunity to make a strong first impression and stand out from the crowd. If you want expert help preparing for your interviews, there are residency interview coaching services. Or, check out our IMG residency interview prep guide.


1. What is ECFMG Certification?

ECFMG certification is essentially the stamp of approval for international medical graduates to apply for medical residency programs or fellowships in the US. Without this certification, IMGs cannot apply for residency programs or practice as a physician in the US.

2. Is ECFMG certification required?

Yes. There are no residency programs in the US that do not require ECFMG certification, so if you are an IMG, you need to get certified. 

3. Do Canadian medical graduates require ECFMG certification?

No. Canadian medical graduates are not considered IMGs when applying to US residency programs and can freely apply, so long as they meet all other requirements and have a current work visa to work in the US.

4. How do I get ECFMG certification?

To get ECFMG certification, you’ll need to ensure both your medical school and your credits are recognized and eligible per the ECFMG. Your credentials as a medical graduate will need to be verified. From there, you’ll need to take and pass the USMLE Step 1 and USMLE Step 2 CK exams and complete one of the ECFMG pathways to prove your clinical and communication abilities.

5. Is ECFMG certification valid in Canada?

Not exactly. Canadian residency programs require IMGs to complete all the requirements laid out by the Medical Council of Canada to apply for residency, but this does not necessarily include ECFMG certification.

6. Which countries require ECFMG certification?

Countries that may require you to get ECFMG certification include the US, Canada, the UK, Australia and New Zealand.

7. Who needs to get ECFMG certified?

IMGs and US IMGs both need to get ECFMG certified to apply for residency programs in the US. This means any medical student who graduates from an international medical school needs to be certified, even if they are a US or Canadian citizen.

8. How long does ECFMG certification take?

The process to get certified can vary depending on the individual and how long it takes to get your medical diploma verified by the ECFMG. Each of the ECFMG pathways can take some time to complete, and you’ll also need to take two licensing exams, so the timeline to completion will vary from student to student.

To your success,

Your friends at BeMo

BeMo Academic Consulting

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