ECFMG pathways include the different options for International Medical Graduates who want to enter the US healthcare system to get certified as licensed physicians. Certification through the ECFMG is critical to get into residency programs as an IMG in the US. The ECFMG pathways are designed to streamline the process for application and certification and make sure you meet all the requirements to work as a resident doctor in the US. In this blog, we’ll look at the requirements for ECFMG certification, the six different ECFMG pathways and how to apply for the pathway that’s best for you.

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Article Contents
5 min read

Requirements for ECFMG Certification ECFMG Pathways: 6 Ways to Get Certified as an IMG How to Apply to ECFMG Pathways How to Get ECFMG Certification in Canada FAQs

Requirements for ECFMG Certification

Before you can receive ECFMG certification and apply for the NRMP match in the US or practice as a physician in the US, you’ll need to ensure you meet all the general requirements for certification. There are two primary requirements for ECFMG certification:

  1. Medical Science Examination Requirements
  2. Clinical Skills and Communication Skills Requirement

The step-by-step guide to get ECFMG certified is as follows:

1. Check that your medical school needs to be listed in the World Directory of Medical Schools and noted as meeting all ECFMG eligibility requirements. *There will be a note next to the medical school listings that meet these requirements

2. Document all the requirements for a final medical school diploma at your school, and verify that you have received your diploma. The ECFMG will need to verify this information.

3. You must register for or pass the USMLE Step 1 and USMLE Step 2 CK (medical science exam requirement)

4. You will need to complete and submit the ECFMG application for certification through the Interactive Web Applications (IWA) portal

5. Complete the clinical and communication skills requirement by attaining a satisfactory score on the Occupational English Test (OET)

6. Completing an ECFMG pathway application and meeting all requirements

ECFMG pathways consist of the different pathways to final ECFMG certification you can take as an IMG. We’ll explore all of these pathways in detail next.

ECFMG Pathways: 6 Ways to Get Certified as an IMG

Educational Commission for Foreign Medical Graduates (ECFMG) certification is a requirement for all International Medical Graduates (IMGs) who are entering the U.S. health care system and plan to apply for the NRMP Main Residency Match.

There are 6 ECFMG pathways to certification, depending upon your level of education, licensure status and experience.

ECFMG Pathway 1

This pathway is for applicants who are already licensed to practice medicine in another country.

ECFMG Pathway 2

This pathway is for applicants who do not meet the requirements for pathway 1, but have already passed an objective structured clinical examination (OSCE) for medical licensure administered by an acceptable medical school.

ECFMG Pathway 3, 4 and 5

These pathways are for IMGs who do not meet the requirements for pathway 1, and are recent graduates or students of a medical school that is approved by the ECFMG.

ECFMG Pathway 6

This pathway is for all applicants who do not meet the eligibility requirements for any of the other 5 pathways.

For this pathway, an applicant’s clinical skills are evaluated by licensed physicians using the ECFMG’s Mini Clinical Evaluation Exercise (Mini-CEX).

The Mini-CEX is composed of six real in-person clinical evaluations, conducted by ECFMG approved licensed physicians. Applicants need to achieve a satisfactory score in all 6 evaluations of the Mini-CEX, at which point their evaluators will submit a report to the ECFMG. Applicants are evaluated in each of the four clinical skills components:

  • Medical Interviewing Skills
  • Physical Examination Skills
  • Professionalism/Communication Skills
  • Clinical Reasoning & Judgment

You can prepare for the Mini-CEX evaluation by gaining some clinical experience as an IMG and improving your patient assessment skills. These experiences will help you to understand and meet the clinical skills standards you’ll be evaluated on during the Pathway 6 application.

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How to Apply to ECFMG Pathways

Step 1: Apply for ECFMG Certification

To apply to any of the 6 ECFMG pathways, you will first need to create an online account and submit an ECFMG certification application. The application is a short, online application form where you can fill out your personal information and medical education history. You’ll also need to complete and notarize an certificate of identification form (form 186) and pay the application fee.

You can create an ECFMG account and complete the application and identification forms through the ECFMG’s Interactive Web Applications (IWA) service.

To create an account as a first-time user, you’ll need a USMLE identification number or ECFMG identification number. You can request one through the IWA website. If you’ve already taken and passed the USMLE Step 1, you may already have an identification number available.

Read through the application instructions carefully before you submit, as you won’t be able to change any details later on. Complete application instructions are found on the IWA service website or the ECFMG website.

Step 2: Apply for an ECFMG Pathway

Once you’ve submitted your application for certification, you’ll login and complete your Application for Pathways for ECFMG Certification.

Inside the application portal, you’ll be able to take and complete the four sub-tests of the Occupational English Test (OET), which are Listening, Reading, Writing and Speaking. It’s best to complete these tests before the last available test date, so your scores are ready to be released before the ECFMG pathways application deadline of January 31.

From the online portal, you’ll also be able to upload any supporting documentation required by your pathway, and monitor the status of your ECFMG pathways application. You’ll be notified by email when your application is approved.

How to Get ECFMG Certification in Canada

IMGs wanting to apply for residency positions in Canada need to do so through the CaRMS match service and application.

While Canada does not use the ECFMG pathways or certification process, the Medical Council of Canada (MCC) does use the ECFMG to verify medical graduates’ credentials and eligibility to apply for residency positions in Canada.

In general, to satisfy the requirements laid out by the MCC to participate in the Canadian Match, IMGs will need to pass the MCCQE Part 1 and the NAC OSCE, which are the equivalent of the ECFMG’s medical science exam requirement. Students who are preparing to take these exams can find MCCQE prep courses for international students and NAC OSCE prep courses to help them study and pass these exams!

Students and graduates who want to practice medicine in Canada will need to fill out an application on PhysiciansApply and satisfy all requirements before entering the match.

To participate in the Match, IMGs need to meet the requirements of the MCC as well as all provincial requirements, depending on where you are applying. You can find all the provincial requirements for IMGs to residency positions in Canada here.


1. What is ECFMG certification?

The ECFMG certification is the standard used to evaluate the credentials and qualifications of international medical graduates who want to enter the US healthcare system or participate in the US Main Residency Match. 

2. What are the ECFMG pathways?

There are 6 ECFMG pathways. The requirements and eligibility for each pathway depend on the level of medical education you have received, which medical licensing exams or clinical exams you have passed, and your licensure status.

3. Do I need to be ECFMG certified?

Yes. There are no residency programs that don’t require ECFMG certification in the US, so you need to get certified through one of the 6 ECFMG pathways. The ACGME requires all IMGs who want to join an ACGME-accredited residency program in the US to have certification, and ECFMG certification is also required for IMGs to take the USMLE Step 3 and become a fully licensed physician in the US.

4. Does Canada require ECFMG certification?

While the Medical Council of Canada does not require IMGs to get certified through the ECFMG, it does use the organization to verify IMG credentials and eligibility. IMGs who want to participate in the Canadian Residency Match must satisfy all requirements laid out by the MCC and provincial regulating bodies.

5. Who is considered an IMG in the US and Canada?

In the US and Canada, IMGs are all medical school graduates who graduated from a medical school outside of the US and Canada. The title of IMG applies to all international graduates, regardless of their citizenship status. International students who graduated from a medical school in the US or a medical school in Canada are NOT considered IMGs, although they may have to satisfy different eligibility requirements to enter the Residency Match in either country.

6. How do I apply for ECFMG pathways?

To apply for the ECFMG pathways, you’ll first need to complete an application for ECFMG certification through the Interactive Web Applications (IWA) service, so the organization can verify your medical school credentials and identity. You can then login to the ECFMG pathways online portal to complete the Occupational English Test and upload any necessary documents.

7. What are the requirements for ECFMG certification?

To get certified by the ECFMG as an international medical graduate, you first need to check that your medical school is listed on the World Director of Medical Schools and meets all ECFMG eligibility requirements. From there, you will need to verify that you have received a medical school diploma from your institution, register for or pass the USMLE Step 1 and Step CK examinations, and apply for ECFMG certification. Finally, you will apply through one of six ECFMG pathways to complete your certification.

8. Which ECFMG pathway is right for me?

To determine which ECFMG pathway is right for you, read over the eligibility requirements carefully to decide which pathway you should take. You may need to check the accreditation of your medical school, medical school graduation requirements in your country and ECFMG eligibility requirements.

9. Do Canadians need ECFMG certification?

No. Canadian medical graduates (CMGs) are eligible to participate in the US Main Match without getting ECFMG certification and can enroll in a residency position in the US provided they have the appropriate visa.

Canadian physicians can apply to work in the US, provided they are fully licensed. There are 44 states which consider Canadian medical school education and residency as equivalent to the US, and do not require Canadian physicians to go through ECFMG certification or even take the USMLE. You will, however, need an employer in the US to sponsor your visa.

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Your friends at BeMo

BeMo Academic Consulting

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