ECFMG 2023 Pathways

IMPORTANT- ECFMG will not be accepting further 2022 Pathway applications. Furthermore moving ahead, the ECFMG will not determine the outcome of a Pathways application until all required supporting documentation has been received.

Assessment of English Fluency and other Communication Skills

A satisfactory score on the Occupational English Test (OET) Medicine is mandatory for all IMGs, regardless of citizenship, in order to be eligible for pursuing one of the six 2023 ECFMG Pathways. 

What is a satisfactory score for the OET for ECFMG applicants? –

Applicants must obtain  a minimum score of 350 (Grade B) on each of the four sub-tests  (Listening, Reading, Writing, and Speaking)

2023 Eligible Testing Date Changes:

For 2023 Applicants, A satisfactory score on the OET Medicine must have been attained on or after January 1, 2021, for qualifying for the 2023 ECFMG Pathways.

Pathway 1: Applicant Has Obtained a License to Practice Medicine

A license or registration to practice medicine without supervision is required to qualify for Pathway 1.  Demonstration of licensure or registration attainment without a record of disciplinary action must be proven.

2023 Pathway 1 Changes:

A full, unrestricted license to practice medicine issued on or after January 1, 2018, must be provided by applicants.

Only a license or registration that has been valid on or after January 1, 2018, is permitted.

Pathway 2: Applicant Has Passed an Objective Structured Clinical Examination (OSCE) for Licensure Granted by an Accredited Medical School

Completion and passing of the OSCE and attendance of or graduation from an ECFMG standardized medical school are required to qualify for Pathway 2 of the 2023 ECFMG Pathways.  The medical school must also provide an OSCE approved by the medical regulatory authority (MRA) in that country.

2023 Pathway 2 Changes:

For acceptance, passing results on OSCEs must be administered only by an accredited medical school. 

A medical school graduation date on or after January 1, 2021, must be provided by applicants.

Pathway 3: Applicant Has Attended or Graduated From a World Federation for Medical Education (WFME) Accredited Medical School

Pathway 4: Applicant Has Attended or Graduated From a Determination of Comparability Awarded and Accredited Medical School

Pathway 5: Applicant Has Obtained a Joint Degree With an Accredited U.S. Medical School

Attendance of and/or graduation from an ECFMG accredited medical school is required to qualify for Pathways 3, 4, and 5.  Applicants must undergo a clinical skills test administered by an authorized official of the medical school. 

2023 Pathway 3, 4, and 5 Changes:

On or after January 1, 2021, a medical school graduation date must be provided by applicants.

Pathway 6: Applicant Passes Evaluation Standards Set by Licensed Physicians

Evaluation and observation of clinical skills during six in-person sessions administered by licensed physicians is required to qualify for Pathway 6.  The ECFMG Mini-Clinical Evaluation Exercise (Mini-CEX) will be used during these sessions. 

2023 Pathway 6 Changes: 

An individual physician evaluator may submit evaluations to no more than 10 applicants. 

The processes that physician evaluators must follow to complete Mini-CEX evaluations is undergoing alterations.  More details to come on these changes as they become available. 

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Written by Nina Madjer, MD

Now that the ERAS application has opened up for the 2023 match, many international medical students are trying to navigate their way through not only ERAS, but also the ECFMG certification process via “Pathways”. 

The Pathways for ECFMG certification are how IMGs can meet clinical and communication skills requirements if they plan to participate in the NRMP Match cycle. Regardless of which pathway criteria you may fit into, you must meet the clinical and communication skills requirements. 

I have sifted through the latest available information on the ECFMG website to break down the General Eligibility Requirements, Pathway 1-6 criteria, and important upcoming dates that may make understanding this process a little bit easier. 

However, the “Pathways” is how to fulfill clinical and communication skills requirements UNLESS you fit into one of these three categories, so be sure that these exceptions do not apply to you before applying. 

1. You have passed USMLE Step 2 CS

2. You are already certified by ECFMG

3. You have an approved Pathways application from 2021 or 2022

General Eligibility

To be eligible to apply to an ECFMG certification pathway, you must meet each of the following criteria:

1. You must not have 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 if you have a previously approved Pathways application, you have already met the clinical and communication skills requirements for ECFMG Certification and are not currently eligible to pursue a Pathway.)

2. You must not be barred by ECFMG from pursuing certification.

3. You must not have already submitted an Application for ECFMG Certification.

4. You must not have previously been registered for a USMLE Step or Step Component. This means that, if you have never been registered to take a USMLE Step or Step Component, you must apply for and be registered for a USMLE exam before you can submit a Pathways application.

5. You must fulfill the Medical Science Examination Requirement.

   1. Passed USMLE Step 1 and Step 2 CK

6. You must fulfill the Clinical Skills Requirement.

   1. Apply to Pathways https://pathways.ecfmg.org/Prepare yourself for the application fee which is $925

7. You must fulfill the Communication Skills Requirement.

   1. Apply to Pathways https://pathways.ecfmg.org/

      1. Prepare yourself for the application fee which is $925

   2. Attain a satisfactory score on each of the four sub-tests of the Occupational English Test (OET). These four sub-tests include: Listening, Reading, Writing, and Speaking.

   3. Release your OET scores to ECFMG

If after reading the above criteria, you find that you are eligible to apply for ECFMG certification via one of the pathways, you need to find out which pathway you are eligible to apply for. Below are the criteria for applying to Pathways 1-6. 

Pathway 1: Already Licensed to Practice Medicine in Another Country

This pathway is for applicants who currently hold a license to practice medicine without supervision. 

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

This pathway is for applicants who do not meet the criteria for Pathway 1, but who have graduated from a medical school that administers an OSCE that is approved by the medical regulatory authority in that country. 

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)

The following requirements apply to all applicants applying to Pathways 3, 4, and 5.

1. The date of your medical school graduation must be on or after January 1, 2021.

2. An authorized official of your medical school must attest to the applicant’s clinical skills.

3. The applicant has not failed the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination® (USMLE®) one or more times. Applicants who failed Step 2 CS one or more times must apply to Pathway 6 to meet the clinical and communication skills requirements for ECFMG Certification.

To find out if your school fits the criteria for Pathways 2, 3, 4, or 5, check out this link: https://www.ecfmg.org/certification-requirements-2023-match/pathway-schools.php 

Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians

This pathway is for applicants that do not meet the requirements for Pathways 1-5. The one differing requirement for Pathway 6 is that the applicant’s clinical skills must be evaluated by licensed physicians using ECFMG’s Mini-Clinical Evaluation Exercise (Mini-CEX). To get a blank copy of this form follow this link, although the real form must be submitted electronically: https://www.ecfmg.org/certification-requirements-2023-match/minicex-p6.pdf 

Important Upcoming Dates:

To ensure that your application is processed on time and that it fits the time frame for applying to the NRMP Match 2023 cycle, please keep the following dates in mind. 

1. Take OET before December 2022.

2. Release OET scores to ECFMG before January 31st, 2023.

3. Submit Pathway application before January 31st, 2023.

***All of this information was obtained directly from the ECFMG website and is current as of May 12th, 2022. ***

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