Upcoming ECFMG changes & the impact on International Medical Graduates

Tomáš Petras - Nov 27, 2023
Three young doctors in conversation

As a prospective International Medical Graduate (IMG) who would like to practice medicine in the United States, you have likely come across the term “ECFMG Certification.” In this article, we’ll look at who the ECFMG are and what they do. We’ll also look at the recent ECFMG developments that may impact IMGs wishing to sit the United States Medical Licensing Examination (USMLE®) Step 3 exam and complete their residency in the US and address any misconceptions about these changes. 

Are you ready? Let’s go! 

Who are the ECFMG, and what do they do?

The Educational Commission for Foreign Medical Graduates (ECFMG) was established in 1956. It “is a world leader in promoting quality healthcare — serving physicians, members of the medical education and regulatory communities, healthcare consumers, and those researching issues in medical education and health workforce planning.” 

According to the AMA, almost one-fourth of the US physician workforce consists of International Medical Graduates (IMGs) and other foreign graduates. The benchmark for assessing these doctors' credentials before entry into US graduate medical education (GME), where they undertake supervised patient care, is certification by the ECFMG.

IMGs must have ECFMG Certification to sit the USMLE Step 3 exam and be granted a license to exercise and practice medicine in the US.

To promote healthcare for all, ECFMG, along with other members of Inhealth, pool their knowledge and resources to advance the standard of healthcare education globally. You can visit their website if you're interested in learning more about Inhealth and ECFMG.

How to obtain ECFMG Certification as an International Medical Graduate

There are several prerequisites for IMGs to be aware of to be eligible for ECFMG Certification and subsequently to take Step 3 of the USMLEs:

  • Medical school requirements: The medical school must adhere to the standards set by the ECFMG. Schools that fully comply with the standards will be listed in the World Directory of Medical Schools with a comment from the ECFMG indicating the institution is eligible for its graduates and students to apply to the ECFMG for ECFMG Certification and examination. Graduates and students must pass their exams within the allotted period. 

  • Clinical skills and communication skills requirement: Students must complete an ECFMG Pathway, which involves passing the previous Step 2 CS component of the USMLE or receiving a passing score on the Occupational English Test (OET) Medicine. Please note that in January 2021, the Step 2 CS test was discontinued.
  • Medical Science Examination Requirement: Applicants must pass USMLE Steps 1 and 2 to be certified by ECFMG.

  • Medical education credential requirements: The ECFMG remark in the medical school's listing in the World Directory of Medical Schools must provide the person's graduation year. IMGs must have received credit from a qualified medical school that is recognized in the World Directory for at least four academic years. As stated by the ECFMG, “There are restrictions on credits transferred to the medical school that awards an applicant’s medical degree that can be used to meet this requirement.”

After all these requirements are fulfilled, you will be eligible for ECFMG Certification.

Did you know?
You do NOT need to be ECFMG Certified by the time you apply for residency. However, you must complete the ECFMG Certification before the start of your residency.

The upcoming changes to the ECFMG Certification

As a result of a decision made by the ECFMG in July 2010, physicians applying for ECFMG Certification must have graduated from a medical school that has received the recognized accreditation by 2023. (This date was pushed back until the beginning of 2024 because of the COVID-19 pandemic.) For this requirement to be met, a candidate's medical school must be officially accredited using standards comparable to those set for US medical schools by the Liaison Committee on Medical Education (LCME) or other widely recognized standards, such as those proposed by the World Federation for Medical Education (WFME) or the National Committee on Foreign Medical Education and Accreditation (NCFMEA). Previously, the Recognized Accreditation Policy said that only medical graduates who attended medical schools that have received accreditation from accrediting bodies that have been recognized by organizations such as the World Federation for Medical Education (WFME) or the National Committee on Foreign Medical Education and Accreditation (NCFMEA) are eligible to register for the ECFMG. This was changed recently.

The Recognized Accreditation Policy will be initially implemented in 2024. The recognized accreditation status of a medical school will be reported as part of the first deployment. This reporting is simply done for informational purposes and won't prevent someone from being eligible for ECFMG Certification. ECFMG will inform well in advance if they are considering updating the Recognised Accreditation Policy in a way that might impede the IMGs' eligibility for ECFMG Certification. As such, there is no need to worry!

Did you know?
Beginning in 2024, medical schools will report their status of recognized accreditation. This will not impede IMGs’ eligibility for ECFMG Certification, even if their medical school is not accredited by a recognized accreditation agency.


Phew! There is still time in case you have been scratching your head and stressing whether your medical school will fulfill the medical school requirements of the ECFMG Certification. However, as mentioned, 2024 is fast approaching and recognition of accreditation is a lengthy process. Let’s take a look at what you can do as a medical student to fulfill medical school requirements.

What can you do to be eligible for ECFMG Certification?

At this point, you might be asking yourself: “Okay, what should I do to support myself and prevent other medical students from worrying about the ECFMG Certification?” First of all, let’s take a look at the status quo.

As a first step, you need to check whether your medical school is accredited by an accrediting body which is recognized by the World Federation for Medical Education (WFME) or the National Committee on Foreign Medical Education and Accreditation (NCFMEA). You can find this information on the websites of the WFME and NCFMEA. The WFME has a helpful map with the recognition status of certain countries.

Did you know?
It is still important to check whether the accreditation agency recognized by the WFME which is serving in your country actually accredits your medical school. You can search the WFME interactive map to find the website for the agency where the list of accredited medical schools is kept and regularly updated.


NCFMEA: Comparability decisions. Here, you can find a list of countries and the names of accrediting bodies that have standards that are comparable to those used to accredit medical schools in the United States.

Now, let’s take a look at the different possibilities you may encounter: 

1. My medical school is accredited by a recognized accreditation agency.

Hurray! This means that your medical school will fulfill the medical school requirements for ECFMG Certification even during the 2024 initial implementation period (and most likely after as well — do check the dates when the recognition is valid!). This means that you will be eligible for the ECFMG Certification if you fulfill the other requirements. You can take a deep breath and study for your USMLE exams!

2. My medical school is accredited by an accreditation agency that is in the process of being recognized.

That’s also great information! The accreditation agency is working hard to obtain the WFME recognition status. Check the website of the accreditation agency as well as the WFME list of the countries served by recognized agencies regularly.

3. My medical school is not accredited by a recognized accreditation agency. 

If you find yourself in this situation, do not worry. As previously mentioned, ECFMG states that starting in 2024, only the initial implementation of the Recognized Accreditation Policy will take place. This means that the medical faculties need to report to the ECFMG on their recognized accreditation status (whether or not they are accredited by a recognized accreditation agency). As ECFMG states on their website, this initial implementation will not impede IMGs’ eligibility to apply for ECFMG Certification.

What can you do, as a medical student, to advocate for recognized accreditation and be sure that even if the Recognized Accreditation Policy changes in the future, you will not lose your eligibility for ECFMG Certification? Let's look at some examples:

  • Bring the conversation to your faculty board: As a medical student, you are more than just a receiver of medical education. You should be a full-fledged stakeholder in the advancement of your own education as well as the quality of your medical school. As such, you can mobilize the student voice in your medical faculty, either as an interested group of students or by reaching out to the student representatives of your faculty and bringing this discussion to the decision-makers. In return, your faculty can look for solutions.

Tip: Be careful how you structure your arguments in front of your faculty board. Will your faculty be happy to invest effort in a process that will result in you practicing medicine in the United States? Instead, focus on the positives, such as that obtaining recognized accreditation means that the education in your medical education system is of a remarkable quality. 

  • Engage in a discussion with your accreditation agency: As a student, you have a huge say in the accreditation process of your medical school. Many accreditation agencies across the world value meaningful student engagement, so much so, that student representatives sit on the board of the accreditation agencies. Since recognized accreditation is done through the efforts of the accreditation agencies, they are one of the main stakeholders to reach out to.

  • Create a campaign to raise awareness: Sometimes, you can see resilience in medical education systems in terms of these processes. As a student, you can create a campaign that would bring awareness to this issue, which in return can put a little bit of pressure on the faculty to answer to the student's needs. 

No matter which category you find yourself in, your eligibility to obtain ECFMG Certification will not be compromised in 2024. It is important to note that ECFMG will announce any changes to the Recognized Accreditation Policy which might result in individuals' eligibility for ECFMG Certification well in advance. As such, it is still important to advocate for recognized accreditation as it improves the quality of medical education. Advocating for recognized accreditation also means that if there is a change to the Recognized Accreditation Policy in the future, one will be sure that their medical school fulfills the medical school requirements and they are eligible for ECFMG Certification.


Preparing for the USMLEs? Get ready with AMBOSS' high-yield study plans, exam-style questions, & Anki add-on. Start your free trial today! 

Start free trial