What are the residency programs that don’t require ECFMG certification in the US or Canada? If you have this question, you’re in the right place. ECFMG or the Educational Commission for Foreign Medical Graduates certification is required to apply to residency programs in the US. It is only a requirement for international medical graduates (IMGs), a term used for students who have completed their medical education outside of the US or Canada.
So, if you are an IMG and have done your research on IMG friendly residency programs, this article will help you with the next steps in your application process. Read on, as we will discuss what ECFMG certification is, how to get certified, and what process is followed in the US and Canada for IMGs.
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What Is ECFMG Certification?
ECFMG certification is a standard for evaluating the qualifications of international medical graduates (IMGs) looking to practice medicine in the US health care system. Before we proceed with details about the ECFMG certification, we first need to understand what an IMG is in the US.
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An international medical graduate or IMG is a student who has completed their medical education at a medical school outside of the US or Canada. This shows that a student’s place of birth or citizenship/residency doesn’t make them an IMG. It only depends on where the medical school they graduated from is located. Thus, US or Canadian citizens who have completed their medical education outside the country will be considered IMGs in their own country.
ECFMG certification is necessary for IMGs to enter ACGME-accredited residency or fellowship programs in the US. It is also one of the eligibility requirements for IMGs to be able to take Step 3 of the United States Medical Licensing Examination (USMLE Step 3).
How Does Residency Matching with ECFMG Work?
Note that you do not have to be ECFMG-certified to participate in the Match and Supplemental Offer and Acceptance Program (SOAP), but you do need to be verified by the ECFMG, which involves completing the medical science examination and demonstrating your clinical and communication skills, which are the requirements for ECFMG certification.
Residency matching is carried out by the National Resident Matching Program (NRMP) in the US and the Canadian Resident Matching Service (CaRMS) in Canada. For IMGs applying to a US medical school for residency, the NRMP sends a list of IMGs who have registered for the Match to the ECFMG after the Match opens for registration. The ECFMG will then assess if the candidate has completed the necessary requirements for ECFMG certification and send the information back to the NRMP. This process needs to be completed by the residency rank order list (ROL) deadline for IMG applicants. Most institutions in the United States use the Electronic Residency Application System (ERAS) to screen residency applicants.
Along with the ECFMG certification, applicants need to fulfill US state medical board requirements, specific residency program requirements, and US visa requirements.
US State Medical Board Requirements
The Federation of State Medical Boards (FSMB) publishes US state-specific requirements for medical licensure. These requirements broadly include the minimum postgraduate training required, the number of attempts at the licensing examination allowed, and the time limits for completion of the licensing examination sequence needed for license eligibility. Make sure to check the FSMB website before you apply to avoid applying in states that limit training permits or recognize fewer international medical schools. You can also look at some of the IMG friendly residency programs or IMG friendly hospitals in different US states.
Residency Program Requirements
Descriptions for US residency programs can be found on the official individual program websites, so make sure to review all the requirements before you apply. Most of the information can be found on the Fellowship and Residency Electronic Interactive Database Access (FREIDA), Accreditation Council on Graduate Medical Education (ACGME), and American Academy of Family Physicians (AAFP).
US Visa Requirements
The two most common visas are the H1-B (Temporary Worker) and the J-1 (Exchange Visitor). Some institutions will sponsor the visa for residents in the residency program, so make sure you review those individual program details. The ECFMG itself can sponsor foreign national physicians for the J-1 visa, as it is authorized by the US Department of State.
We’ll talk about how matching operates for IMGs in Canada a little later, but let’s first look at the requirements for ECFMG certification.
Requirements for ECFMG Certification
IMGs need to make sure they satisfy a number of requirements to be eligible for ECFMG certification. These include:
- Medical science examination requirement
- Clinical skills requirement
- Communication skills requirement
- Medical education credential requirements
IMGs looking to get ECFMG certification first need to make sure the medical school they have attended is listed in the World Directory of Medical Schools (World Directory), along with an ECFMG statement that the school meets the eligibility requirements for its students and graduates to be able to apply for ECFMG certification and examination. The note should also mention the graduation years for which the school meets these requirements.
Applicants will need to submit an Application for ECFMG Certification, which includes an online application and the Certification of Identification Form (Form 186), which should be notarized after completion.
For the medical science examination requirement, applicants must have passed the United States Medical Licensing Examination or USMLE Step 1 and USMLE Step 2 CK (Clinical Knowledge).
As for clinical and communication skills, IMGs must complete an ECFMG Pathway – explained below – which includes getting a satisfactory score on the Occupational English Test (OET) Medicine, or having a passing performance on the USMLE Step 2 CS exam.
The medical education credential requirements include at least four academic years for which credit has been given toward completion of the curriculum by a medical school listed in the World Directory. Another requirement of ECFMG certification is submission of a final medical diploma for verification, which means IMGs need to have graduated to be able to apply for the certification.
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ECFMG Pathways
Source: ECFMG Certification requirements – The Pathways
ECFMG pathways can be used by eligible IMGs who plan on participating in the NRMP Main Residency Match to meet the clinical and communication skills requirements for ECFMG certification. As part of the pathway, applicants must get a satisfactory score on the Occupational English Test (OET) Medicine to satisfy the communication skills requirement for ECFMG certification. These pathways include:
Pathways 2, 3, and 4 are for those students who do not meet the requirements of the first pathway. To apply for these pathways, applicants must have graduated after a certain date, an authorized official of their medical school must attest to the applicant’s clinical skills, and they must not have failed the USMLE Step 2 Clinical Skills (CS) component one or more times. Those who have failed one or more times must apply via Pathway 6.
It should be noted that ECFMG certification issued to candidates through a Pathway expires after a certain amount of time. To find out the exact timeline of when your ECFMG certification might expire, review the official ECFMG website. The expiry date becomes inconsequential once the applicant completes the first year of their training in a US GME training program accredited by the ACGME. However, if the candidate does not enter an ACGME-accredited program within that window, their ECFMG certification will expire, and they will have to revalidate their certification by meeting the clinical and communication skills requirements in place at that time. This essentially means you have a limited amount of time between when you get your EFCMG certification (via Pathways) and your acceptance into a residency program.
General Eligibility for All Pathways
Since these pathways are designed to help students meet the clinical and communication skills requirements for ECFMG certification, those who have already met the requirements cannot apply. This means that if students have a valid passing performance on Step 2 CS or if they have a previously approved Pathways application, they cannot apply to these Pathways.
Additionally, applicants must not be barred from pursuing ECFMG certification. They must have submitted an Application for ECFMG Certification. Lastly, applicants must have previously registered for a USMLE Step or Step Component. In case they have not, they will need to first register for a USMLE exam before they can put in their application for ECFMG.
Furthermore, IMGs and non-IMGs can start the certification process and apply for the required exams as soon as they meet the eligibility requirements for examination. Applicants should first confirm if their medical schools meet ECFMG requirements. Students or graduates of medical schools that meet ECFMG requirements can apply to ECFMG for certification and may request a USMLE/ECFMG Identification Number through the Interactive Web Applications (IWA).
Here's an overview of the ECFMG Certification steps:
Residency Programs That Don’t Require ECFMG Certification in the US
In the US, there are no residency programs that accept candidates without an ECFMG certification. If you have completed your medical education in the US or Canada and are applying for residency in the US, you do not need the ECFMG certification. But, if you are an IMG applying to residency in the US, you will need to be ECFMG-verified to be able to participate in the Match and SOAP and ECFMG-certified to start your residency program.
Certification for IMGs Applying to Canadian Medical Schools
The process of getting into a residency program in Canada for IMGs is a little different. First, to be able to apply for residency in Canada following the CaRMS timeline, applicants must be Canadian citizens or permanent residents. Any Canadian citizen who graduated from an international medical school, including Canadian-friendly US med schools, is considered an IMG.
There is no ECFMG certification per se, but IMGs looking to apply for residency in Canadian medical schools need to meet the criteria provided by the Medical Council of Canada (MCC). The ECFMG, however, is contracted by the MCC to verify international medical credentials for IMGs to become practicing physicians in Canada.
Requirements for IMGs Applying to Canadian Residency Programs
Applicants must be Canadian citizens or permanent residents of Canada and have their Medical Identification Number for Canada (MINC). Visa holders are not considered eligible.
Applicants must be current students or graduates from a medical school listed in the World Directory of Medical Schools or their medical school must be accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS) or Liaison Committee on Medical Education (LCME) in the US, or by a US School of Osteopathic Medicine.
Applicants must have written and passed or be scheduled to write the National Assessment Collaboration (NAC OSCE) examination.
Applicants must have written and passed or be scheduled to write the Medical Council of Canada Qualifying Exam Part I (MCCQE Part I). This examination analyzes whether the critical medical knowledge and clinical decision-making ability of a candidate is at a level that is expected of a medical student completing their medical degree in Canada.
There is no fixed order in which these exams need to be taken but make sure you follow important timelines for your application cycle, which you can find on the MCC website. Note that USMLE scores cannot replace any of the aforementioned exams.
Provincial Requirements
Besides the requirements for IMGs mentioned above, there are some provincial requirements that applicants need to meet to be able to participate in the CaRMS matching process. A province may ask the IMG to verify their medical degree, complete additional examinations, or enter into a service agreement that commits them to practice medicine in a particular area for a specific amount of time. The official CaRMS website lists all the provincial requirements, so make sure you review them before starting your application process.
Final Thoughts
While there are no medical schools that accept IMG candidates into their residency programs without ECFMG certification, it is a good idea to understand what the certification entails and how it affects residency programs in both the US and Canada. The certification ensures that international medical graduates have the right skills and knowledge to practice medicine in the country where they are applying.
FAQs
1. Are there any medical schools in the US that don’t require ECFMG certification for residency from IMGs?
No, all medical schools in the US require ECFMG certification from IMGs.
2. I graduated from a Canadian medical school; will I be considered an IMG in the US?
No, graduates from Canadian medical schools are not considered IMGs in the US.
3. Is USMLE a requirement for ECFMG certification?
Yes, applicants must have passed Step 1 and Step 2 Clinical Knowledge (CK) of the United States Medical Licensing Examination (USMLE).
4. What are the requirements for ECFMG certification?
There are four main requirements for ECFMG certification: medical science examination, clinical skills, communication skills, and medical education credential requirements. The medical school you attended must be listed in the World Directory of Medical Schools (World Directory). You will need to submit an Application for ECFMG Certification, which includes an online application and the Certification of Identification Form (Form 186), which should be notarized after completion.
5. Does ECFMG certification expire?
If you have been granted an ECFMG certification through a Pathway, it will expire after a certain amount of time; you can check on the official website for exact expiration timelines.
6. Is there an ECFMG requirement for IMGs applying to Canadian residency programs?
There is no ECFMG certification per se, but IMGs applying to residency in a Canadian medical school need to meet the criteria provided by the Medical Council of Canada (MCC).
7. How many times can I take the MCCQE Part I?
You can take the MCCQE Part I a maximum of four times. If you have a pass result, you cannot retake the exam. You will need to wait for one year between your third and fourth attempts. In case you are not satisfied with your performance on your fourth attempt, you can ask the Central Examination Committee for special permission to make a fifth attempt. This is only allowed in the case of exceptional personal circumstances.
8. As an IMG, can I apply for residency in Canada?
International medical graduates can apply to residency programs in Canada if they are either Canadian citizens or have permanent residency status. IMGs who don’t fall into these categories can only apply if they have the appropriate sponsorship through the Postgraduate Medical Education Office in Canada.
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