According to the US Department of Education, the Educational Commission for Foreign Medical Graduates (ECFMG) is "the authorized credential evaluation and guidance agency for non-U.S. physicians and graduates of non-U.S. medical schools who seek to practice in the United States or apply for a U.S. medical residency program. It provides comprehensive information and resources on licensure, the U.S. Medical Licensure Examination (USMLE), residencies, and recognition." [1]
Through its program of certification, the ECFMG assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).
ECFMG acts as the registration and score-reporting agency for the USMLE for foreign medical students/ graduates, or in short, it acts as the designated Dean's office for International Medical Graduates (IMGs) in contrast to the American Medical Graduates (AMGs).
Medical schools in Canada that award the M.D. are not assessed by ECFMG, because the Liaison Committee on Medical Education historically accredited M.D.-granting institutions in both the U.S. and Canada (today, Canada has its own accrediting body that generally follows U.S. standards). M.D. graduates of American and Canadian institutions are not considered IMGs in either country.
ECFMG was founded in 1956, in response to the increase need for the evaluation of the readiness of international medical graduates entering the physician workforce during the 1950 expansion of US healthcare system. Its initial name was Evaluation Service for Foreign Medical Graduates (ESFMG). [2] Later that year, it was renamed Educational Council for Foreign Medical Graduates. In conjunction with NBME, it created what became known as the ECFMG certification which included examinations and assessments of English language proficiency.[ citation needed ] In 1974, it merged with the Commission on Foreign Medical Graduates and changed its name to its current name Educational Commission for Foreign Medical Graduates. [3]
The main pathway for international medical graduates who wish to be licensed as a physician in the United States is to complete a U.S. residency hospital program. The general method to apply for residency programs is through the National Resident Matching Program (abbreviated NRMP, but also called "the Match"). To participate in the NRMP, an IMG is required to have an ECFMG certification [4] by the "rank order list certification deadline" time (usually in February of the year of the match). [5]
To acquire an ECFMG certification, the candidate must meet these requirements: [6]
In comparison, regular graduates from medical schools in the United States need to complete USMLE Steps 1 and 2 as well, but can participate in the NRMP while still doing their final year of medical school before acquiring their medical diplomas. [8] In effect, taking regular administrative delays into account, and with residency programs starting around July, there is a gap of at least half a year for IMGs between graduation from medical school and beginning of a residency program.
The COVID-19 global pandemic has brought some changes to the ECFMG certification process. First as AAMC suspended temporarily and later eliminated the Step 2 CS examination, [9] ECFMG moved to a pathways model for verification of clinical skills. [10] IMGs who have already taken Step 2 CS may still use it to fulfill this requirement. All other IMGs will need:
Pathway | Description | Notes |
---|---|---|
Pathway 1 | Already Licensed to Practice Medicine in Another Country | Intended for applicants who currently hold or have recently held a license/registration to practice medicine without supervision (unless they failed Step 2 CS) |
Pathway 2 | Already Passed a Standardized Clinical Skills Exam for Medical Licensure | Intended for applicants who do not currently hold, or have not recently held, a license/registration to practice medicine without supervision (Pathway 1), but who successfully completed a secure, standardized clinical skills exam as a requirement for medical licensure or registration in a country other than the United States. |
Pathway 3 | Medical School Accredited by Agency Recognized by World Federation for Medical Education (WFME) | Intended for applicants who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1) and who have not already passed an acceptable standardized clinical skills exam for medical licensure (Pathway 2). An applicant to Pathway 3, 4, or 5 must be a student or a recent graduate of a medical school that meets eligibility requirements established by ECFMG. |
Pathway 4 | Medical School Accredited by Agency that Has Received a Determination of Comparability by National Committee on Foreign Medical Education and Accreditation (NCFMEA) | Intended for applicants who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1) and who have not already passed an acceptable standardized clinical skills exam for medical licensure (Pathway 2). These applicants must be students or recent graduates and must meet eligibility requirements established by ECFMG. |
Pathway 5 | Medical School Issues Degree Jointly with a U.S. Medical School Accredited by Liaison Committee on Medical Education (LCME) | Intended for applicants who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1) and who have not already passed an acceptable standardized clinical skills exam for medical licensure (Pathway 2). These applicants must be students or recent graduates and must meet eligibility requirements established by ECFMG. |
Pathway 6 | Evaluation of Clinical Patient Encounters by Licensed Physicians | Intended for applicants who do not meet the eligibility requirements for Pathway 1, 2, 3, 4, and 5 and/or have failed Step 2 CS one or more times. To meet the requirements for Pathway 6, the applicant's clinical skills must be evaluated by licensed physicians using ECFMG's Mini-Clinical Evaluation Exercise (Mini-CEX). |
As of April 2021, ECFMG certifications obtained by fulfilling the clinical and communication skills requirements through a pathway will expire in 2022 if the applicant does not enter an ACGME-accredited training program in 2021 or 2022. If the applicant enters a training program they become permanent after one year of residency. [7]
A pilot project was started in 2012 for an electronic verification system of medical credentials from international medical schools, with participation from approximately 20 international medical schools. [11] After completion of this pilot project, ECFMG now allows all medical schools to register for free. [12]
Expected to be implemented in late 2024, a notable development is anticipated in medical education application procedures. ECFMG Status Reports will be integrated into Electronic Residency Application Service (ERAS) submissions, offering vital information for institutions assessing applicants. These reports will specifically indicate whether the candidate's medical school meets the Recognized Accreditation Policy, determined by accreditation from agencies recognized by the World Federation for Medical Education or the National Committee on Foreign Medical Education and Accreditation. This enhancement aims to streamline the evaluation of medical school credentials, enhancing transparency and efficiency in the residency application process. However, IMGs will still be able to pursue ECFMG Certification even if their medical school doesn't meet the Recognized Accreditation Policy, as long as their school meets ECFMG's current requirements. [13] The accrediting agencies that are WFME recognized are:
Agency | Country | Recognized until |
---|---|---|
The Association for Evaluation and Accreditation of Medical Education Programs (TEPDAD) | Turkey, State of Palestine, Oman, Qatar, Kuwait, Lebanon | July 2023 |
Committee on Accreditation of Canadian Medical Schools (in cooperation with LCME) | Canada | April 2024 |
Liaison Committee on Medical Education (LCME) | United States of America | April 2024 |
Korean Institute of Medical Education and Evaluation (KIMEE) | Republic of Korea | September 2026 |
Accreditation Commission on Colleges of Medicine (ACCM) | Selected Caribbean countries: Anguilla, Aruba, Cayman, Islands, Curaçao, Dominica, Saint Kitts and Nevis, Sint Maarten, St. Vincent & the Grenadines, University of Jordan Faculty of Medicine - Jordan | December 2026 |
Japan Accreditation Council for Medical Education (JACME) | Japan | March 2027 |
Australian Medical Council (AMC) | Australia and New Zealand | January 2028 |
Independent Agency for Accreditation and Rating (IAAR) | Kazakhstan, Kyrgyz Republic, Republic of Moldova, Russian Federation, Tajikistan, Ukraine, Romania, Belarus | January 2028 |
Sudan Medical Council (SMC) | Sudan | June 2028 |
National Center for Educational Quality Enhancement (NCEQE) | Georgia | October 2028 |
Institute for Medical Education Accreditation (IMEAc) | Thailand | October 2028 |
Indonesian Accreditation Agency for Higher Education in Health (Lembaga Akreditasi Mandiri Perguruan Tinggi Kesehatan) (IAAHEH/LAM-PTKes) | Indonesia | October 2028 |
Accreditation Organisation of the Netherlands and Flanders (Nederlands-Vlaamse Accreditatieorganisatie) (NVAO) | Netherlands and Flanders | November 2028 |
Mexican Board for Accreditation of Medical Education (Consejo Mexicano para la Acreditación de la Educación Médica (COMAEM) | Mexico, Costa Rica | April 2029 |
National Authority for Quality Assurance and Accreditation of Education (NAQAAE) | Egypt | April 2029 |
System of Accreditation of Medical Schools/Sistema de Acreditação de Escolas Médicas (SAEME) | Brazil | April 2029 |
Taiwan Medical Accreditation Council (TMAC) | Taiwan | April 2029 |
Secretariat of the Council for Undergraduate Medical Education (SCUME) | Iran | June 2029 |
Commission for Academic Accreditation (CAA) | United Arab Emirates | June 2029 |
Cyprus Agency of Quality Assurance and Accreditation in Higher Education (CYQAA) | Cyprus | February 2030 |
Working Committee for the Accreditation of Medical Education, Ministry of Education (WCAME) | China | June 2030 |
Medical Council of Ireland (MCI) | Ireland, Royal College of Surgeons in Ireland, Medical University of Bahrain - Bahrain | June 2030 |
Accreditation and Quality Assurance Commission for Higher Education Institutions (AQACHEI) | Jordan, Iraq, Palestine, and Syria | September 2031 |
Quality Assurance Agency for Higher Education (AQU) | Catalonia, Spain | October 2031 |
Agency for Accreditation of Educational Programs and Organizations (AAEPO) | Kyrgyzstan | March 2032 |
Hungarian Accreditation Committee (MAB) | Hungary | March 2032 |
National Center for Academic Accreditations (NCAAA) | Saudi Arabia | April 2032 |
American Osteopathic Association, Commission on Osteopathic College Accreditation (AOA COCA) | United States of America | August 2032 |
Grenada Medical and Dental Council (GMDC) | Grenada | September 2032 |
National Agency for Quality Assessment and Accreditation of Spain (ANECA) | Spain | October 2032 |
Eurasian Centre for Accreditation and Quality Assurance in Higher Education and Health care (ECAQA) | Kazakhstan and Uzbekistan | October 2032 |
Education & Training Quality Authority (BQA) | Bahrain | November 2032 |
Sri Lanka Medical Council (SLMC) | Sri Lanka | March 2033 |
Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU) | The Philippines | April 2033 |
Malaysian Medical Council (MMC) | Malaysia | April 2033 |
Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM-HP) | Countries of the Caribbean Community (CARICOM), Dominican Republic | May 2033 |
Consejo Nacional de Acreditación (CNA) | Colombia | June 2033 |
International medical schools can send Medical Student Performance Evaluations (MSPEs) and medical school transcripts on behalf of their students and graduates to ECFMG through digital documents by the ECFMG Medical School Web Portal (EMSWP) [15]
The United States Medical Licensing Examination (USMLE) is a three-step examination program for medical licensure in the United States sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Physicians with a Doctor of Medicine (MD) degree are required to pass the USMLE for medical licensure. However, those with a Doctor of Osteopathic Medicine degree (DO) are required to take the COMLEX-USA (COMLEX) exams but may also sit for the USMLE as well.
Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, veterinarian, dentist, podiatrist (DPM) or pharmacist (PharmD) who practices medicine or surgery, veterinary medicine, dentistry, podiatry, or clinical pharmacy, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant.
Step 2 Clinical Skills of the United States Medical Licensing Examination (USMLE) was an exam administered to medical students/graduates who wish to become licensed physicians in the U.S. It is similar to the COMLEX-USA Level 2-PE exam, taken by osteopathic medical students/graduates who seek licensure as physicians in the U.S. For US medical students, the exam fee is $1,300. For medical students at non-US medical schools, the tests cost is higher—currently $1,535. These fees do not include costs associated with travel and lodging to take the test. Historically, US students have taken Step 2 CS late in their senior year, prior to graduation. However, now that more residency programs require students to record a passing score, many US medical schools recommend students take Step 2 CS in the fall of their senior year.
The United States Medical Licensing Examination (USMLE) Step 1 is a standardized test that assesses a medical student's knowledge of basic science concepts and their application to clinical medicine. The exam is one of three components required for medical licensure in the United States and is typically taken by students after their second year of medical school.
USMLE Step 2 CK is a nine-hour-long exam that represents the second part of the United States Medical Licensure Examination. It assesses clinical knowledge through a traditional, multiple-choice examination divided into eight 60-minute blocks, each containing up to 40 questions, as well as an hour of break time. In contrast to USMLE Step 1, which prioritizes knowledge of basic sciences, the focus of Step 2 is on clinical application of medical knowledge, and requires the examinee to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision. The USMLE Step 2 is generally taken during the third or fourth year of medical school by U.S. medical students. Step 2 results are reported numerically on a scale between 1 and 300; this is in contrast to Step 1, which is pass/fail only.
The Foundation for Advancement of International Medical Education and Research (FAIMER) is a nonprofit organization whose mission is to "support the Educational Commission for Foreign Medical Graduates (ECFMG) as it promotes international health professions education through programmatic and research activities." These activities include:
Medical University of the Americas (MUA) is a private for-profit offshore medical school in Charlestown, Nevis. It is owned by R3 Education, Inc. which also owns St. Matthew's University and Saba University School of Medicine MUA confers upon its graduates the Doctor of Medicine (MD) degree.
An international medical graduate (IMG), earlier known as a foreign medical graduate (FMG), is a physician who has graduated from a medical school outside of the country where he or she intends to practice. The term non-local medical graduate may be similarly used in countries with distinct licensing regions within them. Generally, the medical school of graduation is one listed in the World Directory of Medical Schools (WDOM) as accredited by the Foundation for Advancement of International Medical Education and Research or the World Health Organization.
Medical school in the United States is a graduate program with the purpose of educating physicians in the undifferentiated field of medicine. Such schools provide a major part of the medical education in the United States. Most medical schools in the US confer upon graduates a Doctor of Medicine (MD) degree, while some confer a Doctor of Osteopathic Medicine (DO) degree. Most schools follow a similar pattern of education, with two years of classroom and laboratory based education, followed by two years of clinical rotations in a teaching hospital where students see patients in a variety of specialties. After completion, graduates must complete a residency before becoming licensed to practice medicine.
Most physicians in the United States hold either the Doctor of Medicine degree (MD) or the Doctor of Osteopathic Medicine degree (DO). Institutions awarding the MD are accredited by the Liaison Committee on Medical Education (LCME). Institutions awarding the DO are accredited by the Commission on Osteopathic College Accreditation (COCA). The World Directory of Medical Schools lists both LCME accredited MD programs and COCA accredited DO programs as US medical schools. Foreign-trained osteopaths do not hold DO degrees and are not recognized as physicians in the United States or in other jurisdictions.
The American Medical Association (AMA) Physician Masterfile includes current and historical data on all physicians, including AMA members and nonmembers, and graduates of foreign medical schools who reside in the United States and who have met the educational and credentialing requirements necessary for recognition as physicians. A Masterfile record is created and ME number assigned when entering medical school or through the ECFMG. For medical students, there are two primary methods to create the initial record - the Student Outreach Program and the annual freshman matriculation file received from the Association of American Medical Colleges (AAMC).
Ross University School of Medicine (RUSM) is a private, for-profit medical school. Its main campus is in Barbados, and its administrative offices are in Miramar, Florida. Until 2019, the university's main campus was in Portsmouth, Dominica. RUSM is owned by Adtalem Global Education Inc.
Doctor of Osteopathic Medicine is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licensed as a physician or surgeon and thus have full medical and surgical practicing rights in all 50 US states. As of 2023, there were 186,871 osteopathic physicians and medical students in DO programs across the United States.Osteopathic medicine emerged historically from the quasi-medical practice of osteopathy, but has become a distinct and proper medical profession.
The American University of Integrative Sciences (AUIS), is a private for-profit offshore medical school with a single campus located in Barbados. Founded in 1999, it was formerly known as the University of Sint Eustatius School of Medicine (USESOM). For a period, the school was based in Sint Maarten, where it was taken over by IEMR LLC, a US-based company. Since October 2017, AUIS has operated in Barbados, and it is currently a candidate for accreditation by the Caribbean Accreditation Authority for Education in Medicine and other Health Professions (CAAM-HP).
The UCLA International Medical Graduate (IMG) Program is a non-profit educational program for Hispanic International Medical Graduates who are residing in the US legally. Housed in the Dept of Family Medicine of the David Geffen School of Medicine at UCLA in Los Angeles, California the IMG Program was created to train immigrant physicians who could address the linguistic and cultural barriers to care faced by California's largely underserved Hispanic population.
The National Resident Matching Program (NRMP), also called The Match, is a United States-based private non-profit non-governmental organization created in 1952 to place U.S. medical school students into residency training programs located in United States teaching hospitals. Its mission has since expanded to include the placement of U.S. citizen and non-U.S. citizen international medical school students and graduates into residency and fellowship training programs. In addition to the annual Main Residency Match that in 2021 encompassed more than 48,000 applicants and 38,000 positions, the NRMP conducts Fellowship Matches for more than 60 subspecialties through its Specialties Matching Service (SMS). The NRMP is sponsored by a board of directors that includes medical school deans, teaching hospital executives, graduate medical education program directors, medical students and residents, and one public member.
The Caribbean Accreditation Authority for Education in Medicine and other Health Professions (CAAM-HP) is an accrediting body for the education programmes and schools of medicine, dentistry, veterinary medicine, nursing and other health professions in the 15 member nations of the Caribbean Community (CARICOM). CAAM-HP was established in 2003 and is headquartered in Kingston, Jamaica.
Avalon University School of Medicine (AUSOM) is a private medical school located in Willemstad, Curaçao, in the Caribbean. AUSOM confers upon its graduates the Doctor of Medicine (MD) degree. Administrative offices for the university are located in Youngstown, Ohio.
An offshore medical school is a medical school that caters "primarily to foreign students, wishing to practice medicine in the US and Canada" according to the World Bank, compared to local schools that focus on their home nation. Such schools are chiefly located in the Caribbean basin, but also includes schools in other locations, such as Mexico and Australia, which run programs that target American students.
World Federation for Medical Education (WFME) is a non-governmental organisation concerned with education and training of medical doctors worldwide. WFME's main objective is to "enhance the quality of medical education worldwide, with promotion of the highest scientific and ethical standards in medical education". The organisation develops standards for medical education and promotes accreditation of medical schools. It also co-manages the World Directory of Medical Schools.