ECFMG Pathways & OET Updates for 2023-24

There are 6 ECFMG Pathways for International Medical Graduates (IMGs) applying for the 2024 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. Now, let’s learn about updates to the ECFMG Pathways and OET requirements for 2024 below.

Keep in mind, this information was last updated by the ECFMG on March 8, 2023 and is subject to change. Contact ECFMG directly with any questions you may have about these ECFMG pathways.

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 2024 Match.

Incomplete 2023 Pathways Applications

All 2023 Pathways applications that are incomplete by the time the 2024 Pathways application opens will be rejected. You can reapply to the 2024 Pathways when the application opens in the second quarter of 2023.

Assessment of Communication Skills, Including English Language Proficiency

All IMGs must achieve a satisfactory score on the Occupational English Test (OET) Medicine to pursue a Pathway. All Pathways applicants, regardless of citizenship or native language, must satisfy this requirement.

  • Change to eligible testing dates: Applicants must have attained a satisfactory score on OET Medicine on or after January 1, 2022.

What’s Changing for the 2024 Pathways?

This year, ECFMG will offer Six Pathways for 2024, just as in 2023. Changes for 2024 are listed below.

Pathway 1: Already Licensed to Practice Medicine in Another Country

Change to eligible licensure dates: For 2024, applicants to Pathway 1 must currently hold, or have held, a full, unrestricted license to practice medicine issued at any time on or after January 1, 2019. The date of initial licensure/registration may be prior to January 1, 2019, but the license/registration still must have been valid on or after January 1, 2019.

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

  • Change to eligible graduation date: Applicants to Pathway 2 must have a medical school graduation date on or after January 1, 2022.

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

See ECFMG for details.

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 for details.

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

See ECFMG for details.

In summary, students or recent graduates of medical schools who have not yet obtained a license/registration to practice medicine without supervision qualify for Pathways 3, 4, and 5. Here, an authorized official of the medical school must attest to your clinical skills.

  • Change to eligible graduation date: For the 2024 Pathways, applicants to Pathways 3, 4, and 5 must have a medical school graduation date on or after January 1, 2022.

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. Physicians will use the ECFMG Mini-Clinical Evaluation Exercise (Mini-CEX).

  • Changes to evaluator processes: For the 2024 Pathways, there will be minor changes to the processes that physician evaluators must follow to complete Mini-CEX evaluations.

ECFMG Pathways Application Fee

Please note, the fee to apply to the 2024 Pathways will be $925.


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








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