The ECFMG has just announced 5 alternative Step 2CS pathways for International Medical Graduates (IMGs) seeking eligibility for the 2021 Match Cycle. Ordinarily, for IMGs to become ECFMG Certified (and therefore allowed to begin residency in the United States), they must first pass USMLE Step 1, Step 2CK, and 2CS.

However, the USMLE recently announced that Step 2CS would be delayed anywhere from 12-18 months, due to COVID-19 related concerns. As such, the ECFMG committed itself to providing alternative Step 2CS pathways for IMGs to satisfy this clinical skills portion of ECFMG Certification.

The following is taken directly from the ECFMG, based on their June 17, 2020 announcements.

Alternative Step 2CS Pathways for ECFMG Certification – 2021 Match Cycle

According to the ECFMG:

“English Language Proficiency Assessment

Applicants who pursue one of the following pathways will be required to attain a satisfactory score on an English proficiency assessment. All applicants, regardless of citizenship, will be required to satisfy this requirement. Details regarding this requirement also will be announced very soon.

Obtaining Permanent ECFMG Certification

ECFMG Certificates based on one of the clinical skills pathways listed below will expire if the applicant does not enter an ACGME-accredited GME program for the 2021-2022 academic year. Once the applicant successfully completes the first year of ACGME-accredited training, the certificate is no longer subject to expiration.

Eligibility for All Pathways

Applicants who are eligible to pursue ECFMG Certification based on one of the pathways include those who:

• Have not already passed Step 2 CS.
• Are not barred by ECFMG from pursuing certification.
• Are not barred by USMLE from taking a Step or Step Component from August 1, 2020 to January 31, 2021.
• Have not failed a USMLE Step or Step Component (Step 1, Step 2 CK, or Step 2 CS) two or more times.
• Have taken or been registered for any USMLE Step or Step Component since January 1, 2018.”

The 5 Alternative Step 2CS Pathways

(Quoted directly from the ECFMG as of June 17, 2020)

Pathway 1: Already Licensed to Practice Medicine in Another Country

• The applicant has held a full, unrestricted license or registration to practice medicine in any country at any time on or after January 1, 2015. The license does not need to be currently valid.
• The license or registration has not been subject to disciplinary action.

Pathway 2: Already Passed a Standardized Clinical Skills Exam for Medical Licensure

• The applicant has successfully completed a secure, standardized clinical skills exam in English as a requirement for medical licensure or registration in another country, which is deemed acceptable by ECFMG. This includes such exams as:
  • – General Medical Council: Professional and Linguistic Assessment Board (PLAB) Part 2
  • – Australian Medical Council: Clinical Examination Part 2
  • – Medical Council of Canada: Qualifying Examination Part 2, National Assessment Collaboration Examination
  • – Medical Council of New Zealand: NZREX Clinical
  • – Medical Council of Ireland: Pre-Registration Examination System (PRES), Level 3
• The date of the examination must be on or after July 1, 2018.

Pathway 3: Medical School Accredited by Agency Recognized by the World Federation for Medical Education (WFME)

• Applicant’s medical school is currently accredited by an agency recognized by WFME.
• The date of graduation must be on or after January 1, 2018.
• An authorized school official must attest to the applicant’s clinical skills.

Pathway 4: Medical School Participates in U.S. Federal Student Loan Program

• Applicant’s medical school currently participates in the U.S. Federal Student Loan Program.
• The date of graduation must be on or after January 1, 2018.
• An authorized school official must attest to the applicant’s clinical skills.

Pathway 5: Medical School Issues Degree Jointly with a U.S. Medical School Accredited by the Liaison Committee on Medical Education (LCME)

• The applicant is a student or graduate of a medical school that grants an MD degree issued jointly with a U.S. medical school accredited by LCME. Currently, these include:
  • Weill-Cornell Medicine – Qatar
  • Duke University – National University of Singapore Medical School
• The date of graduation must be on or after January 1, 2018.
• An authorized school official must attest to the applicant’s clinical skills.”

What Does This Mean for Applicants?

A formal application process and instructions for completing the alternative Step 2CS pathways are being developed by the ECFMG. If you plan to utilize one of these pathways, you MUST get your ERAS token from the ECFMG and register with the AAMC’s MyERAS.

Also, remember that if you become ECFMG Certified based on an alternative pathway, and do NOT enter a residency program for the 2021-2022 academic year, your Certification will become void. At this time, you CANNOT use the alternative Step 2CS pathways to become ECFMG Certified for any other application cycle.

Additionally, ALL applicants will be required to complete the English Language Proficiency requirements, even if it is your native language. More details regarding this aspect of eligibility are expected to be released soon.

Important Notes Regarding Ineligibility

• Applicants who have been barred by the ECFMG from pursuing Certification are ineligible for the pathways.
• Applicants are ineligible if the ECFMG has suspended or revoked their ECFMG Certificate.
• Applicants are ineligible if the USMLE has barred them from taking a USMLE exam between August 1st, 2020, and January 31st, 2021.
• Applicants must have taken or registered for a USMLE exam sometime after January 1st, 2018.
• Any applicant who has failed any USMLE Step or Component two or more times is ineligible.

For more information, view the ECFMG’s Alternative Pathway FAQ Section.

These 5 alternative Step 2CS pathways are sure to raise many questions. Visit the ECFMG’s website for the most up to date information. Make sure to contact the ECFMG directly if you have specific questions or clarifications regarding these requirements.