Foreign medical education programs for physicians are accredited by the Educational Commission for Foreign Medical Graduates (ECFMG). The ECFMG evaluates medical schools around the world to ensure that they meet the same standards as medical schools in the United States. The accreditation process includes an evaluation of the medical school’s curriculum, faculty, and resources. The ECFMG also assesses the medical school’s ability to prepare its graduates to practice medicine in the United States. The ECFMG also evaluates the medical school’s graduates to ensure that they are competent to practice medicine in the United States. After a medical school is accredited, its graduates may apply for licensure in the United States.

Educational Commission for Foreign Medical Graduates

According to the US Department of Education, the Educational Commission for Foreign Medical Graduates 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.”

Through its program of certification, the Educational Commission for Foreign Medical Graduates (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.

History

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). 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. 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.

Certification

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 by the “rank order list certification deadline” time (usually in February of the year of the match).

To acquire an ECFMG certification, the candidate must meet these requirements:

  • Examination Requirement: Completion of USMLE Step 1 and USMLE Step 2 Clinical Knowledge
  • Meet the clinical and communication skills requirements (see section)
  • Medical education credential requirements: A medical diploma of medical education taken at an institution registered in the World Directory of Medical Schools (WDOM). The official source to confirm that a medical school meets ECFMG’s requirements, is the World Directory at www.wdoms.org. Schools that meet the requirements will have an ECFMG note stating this in the schools’ World Directory listing.

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. 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.

Clinical and communication skills requirements

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, ECFMG moved to a pathways model for verification of clinical skills. IMGs who have already taken Step 2 CS may still use it to fulfill this requirement. All other IMGs will need:

  • Assessment of communication skills, including English language proficiency through the Occupational English Test Medicine exam
  • Meet the requirements for one of the pathways below:
Pathways for ECFMG certification (2022)
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).

Certification expiration

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.

Projects

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. After completion of this pilot project, ECFMG now allows all medical schools to register for free.

Effective in 2024, the ECFMG will restrict eligibility to USMLE and employment as a doctor in the United States to graduates from medical schools accredited by an agency which is recognized by the World Federation for Medical Education or to an equivalent standard. The accrediting agencies that meet these requirements are:

Agencies with recognition status
Agency Country Recognized until
Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM-HP) Countries of the Caribbean Community (CARICOM), Dominican Republic May 2022
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, Curacao, 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

Communication

International medical schools can send Medical Student Performance Evaluations (MSPEs), medical school transcripts, and letters of recommendation (LoRs) on behalf of their students and graduates to ECFMG by means of mail[citation needed], or through digital documents by the ECFMG Medical School Web Portal (EMSWP).

References

External links

General
National libraries


Source: Educational Commission for Foreign Medical Graduates
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