ECFMG Pathways & OET Updates for 2022-23

There are 6 ECFMG Pathways for International Medical Graduates (IMGs) applying for the 2023 Match Cycle. As most candidates already know, the USMLE Step 2CS exam has been permanently discontinued. As a result, the ECFMG created alternative Step 2CS Pathways for IMGs. These Pathways satisfy the clinical skills portion of ECFMG Certification. If you successfully completed one of the Pathways in 2022, you won’t have to resubmit for the 2023 Match. However, make sure to contact the ECFMG to verify your status. Now, let’s learn about updates to the ECFMG Pathways and OET requirements for 2023 below.

Keep in mind, this information was last updated by the ECFMG on February 17, 2022 and is subject to change. Contact ECFMG directly with any questions you may have about these ECFMG pathways.

So, here are the Pathway updates for 2023, taken from ECFMG:

Using the ECFMG Pathways for the 2023 Match

Who Should Use the Pathways?

  • IMGs who need to meet the clinical and communication skills requirements for ECFMG Certification and who plan to apply for the 2023 Match.
  • IMGs who applied to the 2021 or 2022 Pathways whose application was rejected will be able to reapply to the 2023 Pathways.

What’s New for the OET requirement for 2023?

All IMGs who pursue one of the six Pathways will be required to achieve a satisfactory score on the Occupational English Test (OET) Medicine to meet the communication skills requirement. Remember, all Pathways applicants, regardless of citizenship or native language, must satisfy this requirement.

  • Note, applicants to the 2023 Pathways must have attained a satisfactory score on OET Medicine on or after January 1, 2021.
  • Also, if you took the exam before April 1, 2022 you need a minimum score of 350 on each of the four measured sub-tests of OET Medicine (Listening, Reading, Writing, and Speaking) in one test administration.
  • Additionally, if you take the exam on or after April 1, 2022, you need a minimum score of 350 on the Listening, Reading, and Speaking sub-tests. You also need a minimum score of 300 on the Writing sub-test. Both need to be taken together.

Alternative Step 2CS Pathways

As in 2022, the 2023 Pathways will offer six Pathways.

Pathway 1: Already Licensed to Practice Medicine in Another Country

First, this is for applicants who currently hold or have recently held a license/registration to practice medicine without supervision. The license/registration must have been valid on or after January 1, 2018.

Pathway 2: Already Passed an Objective Structured Clinical Examination (OSCE) for Medical Licensure Administered by an Acceptable Medical School

Next, applicants who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1), but who attend or have graduated from a medical school that administers an OSCE specifically required for medical licensure by the medical regulatory authority (MRA) in that country can apply to Pathway 2. Additionally, the medical school must meet certain ECFMG requirements and the applicant must successfully complete the OSCE.

  • Note, ECFMG does not accept passing results on OSCEs not administered by an acceptable medical school. 
  • Also, applicants to Pathway 2 must have a medical school graduation date on or after January 1, 2021.

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

See ECFMG.org for more information.

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

See ECFMG.org for more information.

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

In summary, students or recent graduates of medical schools that meet eligibility requirements established by ECFMG and who have not yet obtained a license/registration to practice medicine without supervision (Pathway 1) qualify for Pathways 3, 4, and 5. An authorized official of the medical school must attest to the applicant’s clinical skills.

  • Applicants to Pathways 3, 4, and 5 must have a medical school graduation date on or after January 1, 2021.

Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians

Finally, this last pathway is for applicants who don’t meet the requirements for the other Pathways and/or have failed the former USMLE Step 2 CS exam. For this, licensed physicians in six real, in-person clinical encounters must observe and evaluate the applicant’s clinical skills using the ECFMG Mini-Clinical Evaluation Exercise (Mini-CEX) for Pathway 6.

  • For 2023, each physician evaluator will be able to submit evaluations for no more than 10  applicants.
  • Note, there will be some changes to the processes that physician evaluators must follow to complete Mini-CEX evaluations for Pathway 6 applicants. See details on these changes as they become available.

ECFMG Pathways Application Fee

Please note, the fee to apply to the 2023 Pathways will be $925.

Expiration of the ECFMG Certificate

Remember, ECFMG Certificates issued to applicants through a Pathway can expire. However, once you complete the first year of U.S. GME training in an accredited program, the Certificate will no longer be subject to expire. 

So, that means that if you don’t complete the first year of training before the expiration date, the ECFMG Certificate will expire. If so, you’ll need to re-validate the Certificate by meeting requirements in place at that time in order to enter another GME program in the future.

In addition, ECFMG Certificates issued through the 2021 or 2022 Pathways will be valid through December 31, 2024.

Finally, Certificates issued based on the 2023 Pathways will be valid through December 31, 2024.

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Visit the ECFMG’s website for the most up to date information. 

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