Copied from AMA site

To enter into an Accreditation Council for Graduate Medical Education (ACGME)-accredited residency or fellowship program in the U.S., International Medical Graduates (IMGs) must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). IMGs must also be certified by ECFMG in order to take Step 3 of the three-step United States Medical Licensing Examination (USMLE).

To obtain ECFMG certification, IMGs must pass a series of exams and provide the ECFMG with copies of medical education credentials, which ECFMG will verify directly with the medical school. The certification process begins with the first application for examination to ECFMG. At this time IMGs will get assigned an ECFMG identification number to use throughout the certification process.

ECFMG applications must:
1. Meet a medical science examination requirement and clinical skills requirement
2. Meet a medical education credential requirement
3. Meet English Language proficiency requirement

1. Medical science and clinical skills examination requirements
Step 1 and Step 2 Clinical Knowledge (CK) of the USMLE meet the medical science examination requirement. Step 2 Clinical Skills (CS) satisfies the clinical skills requirement. For more information, the USMLE Web site has detailed information on all examination requirements. Step 1 and Step 2 CK must be passed within a specific period of time. Specific time limits for passing Step 2 CS for ECFMG certification may apply.

There are five testing centers in the U.S. Tests and test dates vary by location. Be sure to check available tests and dates far in advance. Test availablity varies by location. The Clinical Skills Evaluation Centers are in Atlanta, Chicago, Houston, Los Angeles, and Philadelphia. Refer to the ECFMG Website for information on exam eligibility, fees, application, scheduling, test centers, preparation, and sample test materials.

2. Meet a medical education credential requirement - The medical school and year of graduation must be listed in the International Medical Education Directory (IMED). IMGs must have at least four credit years in attendance at a medical school listed in IMED. IMED is maintained by the Foundation for the Advancement of International Medical Education and Research (FAIMER). IMED contains information supplied by countries about their medical schools.

For EFMG Certification, applicants must provide the required medical education credentials, which include the final medical diploma and final medical school transcript. ECFMG verifies every applicant's medical school diploma with the appropriate officials of the medical school that issued the diploma. ECFMG also will request from the applicant's medical school the final medical school transcript when the school returns the verification of medical diploma.

All medical credentials provided to the ECFMG are subject to verification. Applicants should always use the same name under which you originally registered with the ECFMG. Applicants also receive an ECFMG identification number, which should be included in any communications.

Standard ECFMG Certificate is issued when applicants meet all of the aforementioned examination and medical education credential requirements. Applicants must also pay any outstanding fees before certificates are issued. The Standard ECFMG Certificate includes:
* name of the applicant
* applicant's USMLE/ECFMG Identification Number
* dates examination requirements were met
* date certificate was issued
* if applicable, dates through which the passing performances on certain exams remain valid for the purpose of entry into graduate medical education

3. English Examinations for Language Proficiency

Passing performances on the English language proficiency test (such as the TOEFL exam or the former ECFMG English Test) are not subject to expiration for the purpose of entering graduate medical education programs, regardless of the date passed. If certified by the ECFMG and Standard ECFMG Certificate lists a "valid through" date for an English language proficiency test, a request can be made for a permanent validation sticker online using the ECFMG's Online Applicant Status and Information System (OASIS).

Once these requirements are met, an applicant receives a Standard ECFMG Certificate that is valid for two years from the date of passage of the English test and which can be used for entry into an ACGME-accredited GME program. Once the holder of an ECFMG Certificate enters GME, the Certificate is no longer subject to expiration. If the Certificate expires before entering GME, an applicant may pass the ECFMG English test or TOEFL to revalidate the ECFMG Certificate for two additional years.

The ECFMG Reporter is a free e-mail newsletter for IMGs interested in ECFMG Certification. Subscribe at www.efmg.org/reporter. ECFMG representatives can also answer questions by e-mail: info@ecfmg.org or by calling (215) 386-5900 from 9:00 a.m. - 5:00 p.m., Eastern time, Monday through Friday.

Fifth Pathway Program

The Fifth Pathway Program was developed by the American Medical Association (AMA) in 1971 for U.S. citizens or permanent residents who wish to return to the U.S. for GME after attending a foreign medical school, generally in Mexico. This program is available to those who completed their premedical work in a U.S.-accredited college, studied medicine in a foreign medical school listed in the World Directory of Medical Schools and have completed all requirements for admission to practice medicine except internship and/or social service in the foreign country. IMGs who meet these criteria are then able to substitute the Fifth Pathway program for internship and/or social service in the foreign country. After receiving a Fifth Pathway certificate from an accredited U.S. medical school, an IMG may then apply for the first year of GME in the U.S. It is important to note there is no eligibility for the Fifth Pathway after graduating from medical school.


Original AMA article located here