ECFMG Certification: Requirements and How It Works

ECFMG Certification is the credential that tells US residency programs an international medical graduate (IMG) has met a common standard in medical education and exams. If you graduated from a medical school outside the US and Canada, you need it to enter an ACGME-accredited residency. ECFMG (now part of Intealth) issues it.

This page is the map. The detail for each requirement is in the linked guides.

What certification is and is not #

The ECFMG Certificate shows that you satisfy ECFMG's requirements. It is not a license to practice. State medical boards issue licenses, and they set their own rules (Step 3 is required in most states).

It is also not the same as applying for residency. You apply through ERAS, and ECFMG supports that process by issuing your ERAS token (see the ERAS token guide).

The requirements at a glance #

The current ECFMG Information Booklet groups the requirements into these parts.

Step by step #

1. Create your account. Everything runs through your MyIntealth account. See the MyIntealth guide.
2. Confirm your school is eligible. Look up your school and graduation year in the World Directory before you spend money on anything else.
3. Apply for ECFMG Certification and submit credentials. ECFMG verifies your diploma and transcript with your school. This is often the slowest part.
4. Take the exams. Step 1 and Step 2 CK are passed through the USMLE program. Since January 2026, FSMB provides USMLE registration and related Step services to IMGs, so check the current USMLE and ECFMG pages for who to contact about what.
5. Meet the clinical and communication skills requirement through a Pathway.
6. Receive your certificate once everything is complete and accepted.

The Pathways #

Step 2 CS has been discontinued and is no longer offered. ECFMG now offers Pathways that let you meet the clinical skills and communication skills requirements in other ways. Which Pathway you can use depends on factors such as your graduation date and your school's status. Some Pathways also involve the Occupational English Test (OET).

Because the Pathway rules are detailed and have changed, read the Pathways section of the current Information Booklet rather than relying on summaries. If your certificate is earned through a Pathway, it can be subject to expiration unless you meet the conditions for it to be valid indefinitely.

What is different for IMGs #

Everything on this page is specific to IMGs. US and Canadian medical school graduates do not go through ECFMG. One recent wrinkle: ECFMG states that individuals who graduate from Canadian medical schools on or after July 1, 2025 are considered IMGs for entry into US GME programs, because accreditation of Canadian programs is now handled differently. If that applies to you, check the booklet.

Fees #

ECFMG and USMLE fees change and depend on your situation. Do not budget from a forum post. Use the official ECFMG fee page and the USMLE fee information for current amounts.

Common mistakes #

• Starting with the exam, not the school. If your school or graduation year is not eligible, exams will not fix it. Check the World Directory first.
• Letting credential verification sit. Verification depends on your school responding. Start early and follow up.
• Name mismatches. Your name must match your passport across every system. Fix problems at the start.
• Relying on a past year's rules. The booklet is reissued yearly. Always read the edition for the year you apply.

What comes next #

Once your account is created, the next step is confirming school eligibility, then credentials. Read the MyIntealth account guide first, then the World Directory guide.