ECFMG Pathways

ECFMG Pathways for IMG Certification in 2022 Residency Match

There are 6 ECFMG Pathways for International Medical Graduates (IMGs) seeking eligibility for the 2022 Match Cycle. As most residency candidates already know, the USMLE Step 2CS exam has been permanently discontinued. Accordingly, the ECFMG committed itself to providing alternative Step 2CS Pathways for IMGs to satisfy this clinical skills portion of ECFMG Certification. If you successfully completed a Pathway in 2021, you won’t have to resubmit for the 2022 Match (however, you should take the time to contact the ECFMG to verify your status).

The following is taken directly from the ECFMG (Requirements for ECFMG Certification for 2022 Match): 

Alternative Step 2CS Pathways for ECFMG Certification – 2022 Match Cycle

According to the ECFMG:


Assessment of Communication Skills, Including English Language Proficiency 

Applicants who pursue one of the Pathways are required to attain a satisfactory score on the Occupational English Test (OET) Medicine to satisfy the communication skills requirement for ECFMG Certification. All Pathway applicants, regardless of citizenship or native language, must satisfy this requirement.

Information on Expiration of the ECFMG Certificate for the Purpose of Entering GME 

ECFMG Certificates issued to applicants who satisfy the clinical and communication skills requirements for ECFMG Certification through a Pathway will be valid for entry to positions beginning in 2021 and 2022 at U.S. GME programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Once the applicant successfully completes the first year of ACGME-accredited training, the ECFMG Certificate will no longer be subject to expiration for the purpose of entering GME.

If you do not enter an ACGME-accredited training program in 2021 or 2022, your ECFMG Certificate will expire for the purpose of entering GME. Should you wish to enter a GME program in the future, you will be required to meet the clinical and communication skills requirements for ECFMG Certification in place at that time in order to revalidate your ECFMG Certificate.

If you were certified by ECFMG based on a 2021 Pathway and your ECFMG Certificate lists an expiration date in 2021, this expiration date has been extended through December 31, 2022.

General Eligibility for All Pathways

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

  • Have not already met the clinical and communication skills requirements for ECFMG Certification. (If you have a passing performance on Step 2 CS that is valid for ECFMG Certification or your Pathways application for the 2021 Match was approved, you have already met the clinical and communication skills requirements for ECFMG Certification and are not currently eligible to pursue a Pathway.)
  • Are not barred by ECFMG from pursuing certification.
  • Have completed an Application for ECFMG Certification.
  • Have previously been registered for a USMLE Step or Step Component.

Applicants who failed Step 2 CS one or more times must apply to Pathway 6 in order to meet the clinical and communication skills requirements for ECFMG Certification, regardless of whether they meet the eligibility requirements for other Pathways.

Alternative Step 2CS Pathways

Please keep in mind, this information was last updated by the ECFMG on April 17, 2021 and is subject to change. Be sure to contact the ECFMG directly with any questions you may have about these alternative Step 2CS pathways.

(Quoted directly from the ECFMG as of April 17, 2021)

  • Pathway 1: Already Licensed to Practice Medicine in Another Country

    Pathway 1 is intended for applicants who currently hold or have recently held a license/registration to practice medicine without supervision. Applicants who meet the eligibility requirements for Pathway 1 must apply to Pathway 1 in order to meet the clinical and communication skills requirements for ECFMG Certification, unless they failed Step 2 CS; see Important Note.

    See the Pathway 1 page for more information.

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

    This Pathway is 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.

    See the Pathway 2 page for more information.

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

  • Pathway 4: Medical School Accredited by Agency that Has Received a Determination of Comparability by National Committee on Foreign Medical Education and Accreditation (NCFMEA)

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

    Pathways 3, 4, and 5 are 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.

    See the page for Pathways 3, 4, and 5 for more information.

  • Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians

Pathway 6 is 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).

Applying to the Pathways

To meet the clinical and communication skills requirements for ECFMG Certification through one of the Pathways:

  • Determine your eligibility to apply to a Pathway by reviewing all information on [the ECFMG] website carefully.
  • If you believe you are eligible to apply to a Pathway, complete and submit your Application for Pathways for ECFMG Certification for 2022 Match. You will receive an e-mail confirming that your application has been submitted. Your application must be submitted by December 15, 2021.
    • You can apply to Pathways 1-5 now.
    • The on-line application process for Pathway 6 is expected to open in July 2021. Please monitor this website for the steps that you can take to prepare for Pathway 6 before July.
  • Meet the communication skills requirement by attaining a satisfactory score on each of the four sub-tests (Listening, Reading, Writing, and Speaking) of the OET Medicine test. You must take OET Medicine on or before the last available test date in December 2021.
  • Release your OET Medicine scores to ECFMG. See Assessment of Communication Skills, Including English Language Proficiency for instructions. ECFMG must receive your scores directly from OET by January 15, 2022.
  • Ensure that all required documentation in support of your Pathway application is received by ECFMG. See the detailed instructions for the Pathway to which you are applying for complete information on required documentation and deadlines. It is your responsibility to ensure that ECFMG receives all required documentation.
  • Monitor the status of your application by logging into the Application for Pathways for ECFMG Certification for 2022 Match. You will be notified by e-mail when processing of your application is complete.

If you submitted an Application for Pathways for ECFMG Certification for 2021 Match, please see here for important information based on the status of your 2021 application and to determine what steps you may need to take if you wish to participate in the 2022 Match.


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.

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