The Occupational English Test (OET) for IMGs

The Occupational English Test (OET) Medicine is now part of how most international medical graduates (IMGs) satisfy ECFMG's clinical and communication skills requirement. If you do not hold a valid, passing Step 2 CS result, you complete an ECFMG Pathway, and ECFMG's Pathways pages state that a satisfactory OET Medicine result is part of it. This page explains what that means, how to book, and how to avoid timing problems.

The short answer #

• What it is: an English-language test for healthcare professionals, run by OET, with a Medicine version built around clinical communication.
• Who needs it for ECFMG: IMGs who meet the clinical and communication skills requirement through a Pathway. ECFMG states that all Pathways applicants must satisfy it, with no exceptions for native language, language of instruction or citizenship.
• Who does not: applicants who already hold a passing former Step 2 CS result that is still valid for ECFMG certification. ECFMG says such applicants cannot use a Pathway. Applicants who failed Step 2 CS at least once are directed by ECFMG to a specific Pathway, so read the Pathways rules rather than assuming.

What it replaced #

Until 2020, USMLE Step 2 CS (Clinical Skills) was the in-person exam that covered clinical and communication skills for IMGs. The USMLE program discontinued it, and ECFMG introduced Pathways as the replacement route. The OET is how ECFMG now checks English and communication ability within those Pathways. The remaining Pathway evidence (for example, how your school assessed clinical skills) depends on which Pathway you qualify for.

See the certification overview for where this requirement sits among the others.

What ECFMG says about scores and rules #

ECFMG's pages describe these elements:

1. All four sub-tests count. Listening, Reading, Writing and Speaking each need a satisfactory result.
2. A minimum test date. The result must come from a test taken on or after a cutoff ECFMG states on its page (for the 2026 Pathways it was January 1, 2024). Cutoffs can change by season.
3. Results must reach ECFMG. OET releases results to ECFMG using your MyIntealth ID, and ECFMG issued a notice in May 2026 about the ID being required at release. Errors here delay your application, see common ECFMG delays.
4. Timing for the next Match. For the 2027 Match, ECFMG advised taking OET Medicine on or before the last scheduled test date in December 2026, and warned that later results may not arrive in time to decide your Pathway outcome before the Match.

How to book #

1. Create or check your MyIntealth account so you know your MyIntealth ID.
2. On OET's website, choose the Medicine profession (not another profession), then a venue or at-home option offered in your country, and a date.
3. Provide your MyIntealth ID so results can be sent to ECFMG, and follow ECFMG's instructions for release.
4. Pay OET's fee to OET. This is separate from ECFMG fees and varies by country and format, so check OET's booking page for the current price.
5. Watch for your result and confirm in MyIntealth that ECFMG has received it.

Planning and timing #

Costs #

There are at least two separate payments: the OET fee, paid to OET, and the Pathways application fee, paid to ECFMG (see ECFMG fees). A retake means paying OET again. Test-center travel, if your country has few venues, is a cost people forget.

What is different for IMGs #

This is IMG-only. US and Canadian-accredited graduates do not go through ECFMG, although ECFMG treats some Canadian graduates after a stated date as IMGs, so check your status if that applies.