ECFMG Certification and Residency in the U.S.

The ECFMG Certification

Because of the considerable differences in the educational standards and curricula used by medical schools outside the United States and Canada, ECFMG Certification is designed to assess the readiness of a foreign medical graduate to enter a residency and fellowship program in the U.S. that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).

For one to be certified by ECFMG, he must provide the Commission with copies of his medical education credentials sent directly by one's medical school as well as pass a a series of exams.

What  are the benefits  of being ECFMG certified?

First, it is a requirement for any international medical graduate who seeks to enter an ACGME-accredited residency or fellowship program in the U.S.

Second, before one can sit for the Step 3 in the United States Medical Licensing Examination (USMLE).

Third, ECFMG Certification is also one of the requirements to obtain an unrestricted license to practice medicine in the United States.

The Road Map to a Medical Career in the U.S.

ECFMG Certification

- submission of credentials

- pass Step 1, Step 2 CK and CS

Apply for Residency

- ERAS

- Matching

- Scramble

Residency Training

Pass Step 3 (may also be taken prior to Residency in some states)

Full Unrestricted MD Licence

The Application Essentials

a. eligibility

b. documents

If you have already finished medical school when you submit your first exam application, your medical education credentials such as transcript of record, diploma, and clinical experience must be submitted with this initial exam application.

If you are a medical school student when you submit your first exam application, you must send your medical education credentials as soon as you graduate and receive them.

If you have transferred credits to the medical school that awarded or will award your medical degree, you must document these credits when you apply for examination, regardless of whether you are a student or a graduate.

You may not submit your credentials to ECFMG until you apply for an exam. If you send credentials to ECFMG before you apply for an exam, they will not be processed.

The eligibility requirements for examination differ depending on whether you are a medical school student or a medical school graduate.

Medical Student

• must be officially enrolled in a medical school located outside the United States and Canada that is listed in IMED available on the ECFMG website, both at the time that you apply and at the time you take the exam.

• the “Graduation Years” in IMED for your medical school must be listed as “Current” at the time you apply and at the time you take the exam. Your Medical School Dean, Vice Dean, or Registrar must certify your current enrollment status

• must have completed at least two years of medical school. This eligibility requirement means that you must have completed the basic medical science component of the medical school curriculum by the beginning of your eligibility period.

Medical School Graduate

• must be a graduate of a medical school located outside the United States and Canada that is listed in IMED

• graduation year must be included in the medical school’s IMED listing.

• must have had at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) in attendance at a medical school that is listed in IMED

Applying for the Examination

To apply for ECFMG exam, you have to use ECFMG's Interactive Web Application (IWA). What comprises a complete application?

• On-line application part

• Certification of Identification Form (Form 186)

• Certification Statement (Form 183)

• other required documents

Please review carefully the instructions before starting your application. Answer questions completely and be ready with the dates as well as the names of the department heads during your clinical rotation.

Review all items before submission. There are items in the application that require advance planning. These may include photographs, official signatures, and additional documents, such as copies of your medical diploma if you are a medical school graduate. If your application is not complete, it will be rejected. As soon as ECFMG receives your application, you will be notified through email. By using the ECFMG's OASIS service, you can check the status of your exam application.

Typically, ECFMG processes applications within 3 wks of receipt of the complete application.A request for verification will be sent to your medical school and depending on how fast your school responds to the verification request, the time needed to complete the processing of your papers is dependent on this. A notice will be sent by ECFMG once your application has been processed and your eligibility has been determined. It will then issue important information about scheduling and taking the exams to eligible applicants.

How to start the certification process?

1. Access IWA and obtain ECFMG Identification Number.

2. Use the number sent by ECFMG to your personal email to apply for exam.

3. Submit the online applications part and pay the required fees.

4. Complete the Certification of Identification Form (Form 186), Certification Statement (Form 183) and other required documents as outlined in IWA

5. Wait for the notice of approval/complete additional requirements needed.

6. Once notice of eligibility is obtained, schedule the exam.

Is there any particular order to take the exam required for ECFMG Certification? No. You can take the exams in any order. There is no age limit and no minimum number of years that you have to practice Medicine before you can apply for the certification.

Exam Preparation

The ECFMG website contains information on preparing for the exams as well as orientation and practice materials. Additional information can be downloaded at USMLE and the National Board of Medical Examiners websites.

Testing Centers for Step 1 and 2

Step 1 and Step 2 (CK and CS) are offered continuously throughout the year. Applicants registered for these exams are assigned a 3-month eligibility period during which they must take the exam. In the Philippines, it is given by Prometric Philippines located at the Ateneo de Manila University. There is a 100 dollar+ surcharge fee if test is taken outside the U.S. and Canada.

Step 2 CS (the practical part) can only be taken in the U.S. A few cities with test centers for this exam are L.A., Chicago, Houston, and Philadelphia in the United States. Please check complete listing by visiting the ECFMG website.

Although you cannot cancel your registration for the exam, there are options that provide flexibility. Registered applicants can change their test date and/or test center, subject to availability. If you are unable to take Step 1/Step 2 CK during your assigned eligibility period, you can request an extension of your eligibility period for a fee. If you are unable to obtain the appropriate visa to enter the United States to take Step 2 CS, you may request a full refund of the exam fee. To avoid a rescheduling fee, you must cancel or reschedule more than 14 days before your scheduled testing appointment

Test Limit

For ECFMG Certification, there is no limit on the number of times you can take a Step or Step Component you have not passed. If you fail or do not complete a Step or Step Component, you may retake it, but you must reapply and pay the appropriate fee. Certain restrictions apply when retaking the same Step or Step Component. Once you pass a Step or Step Component, you may not repeat it, and you will have seven years to pass the other Step(s) or Step Component(s) required for ECFMG Certification.

For the purpose of medical licensure, the USMLE program recommends to state medical licensing authorities that they require applicants to pass the full USMLE sequence (including Step 3, which is not required for ECFMG Certification) within a seven-year period. The USMLE program also recommends to state medical licensing authorities a limit on the number of attempts allowed to pass each Step or Step Component.. Some state medical licensing authorities accept the USMLE-recommended limits, but others do not. You should contact the FMSB for general information and the medical licensing authority of the jurisdiction where you plan to apply for licensure for definitive information, since licensure requirements vary among states.

Fees (Feb 2009)

Step 1 $710

Step 2 $710

Step 3 $1,200

International Test Delivery Surcharges Step 1 $130 Step 2 $145

Extension of Eligibility Period Step 1/Step 2 CK $50

Step 2 CSRescheduling Fee $0 - $400 (depending on date of cancellation)

The fee for the 2009 Step 3 is $690 for all state medical boards with the exception of those boards listed below

• Iowa $740

• South Dakota $840

• Vermont $725

Applying for Residency

As soon as one is ready to apply for a residency position ( you need at least Step 1 passing or Step 2 CK, the Clinical Skills can be taken anytime ideally before interview), the applicant will register through the Electronic Residency Application Service (ERAS) .  ERAS  transmits applications, letters of recommendation (LoRs), Medical Student Performance Evaluations (MSPEs), medical school transcripts, USMLE transcripts, COMLEX transcripts, and other supporting credentials from you and your designated dean's office to program directors of the different hospitals using the Internet. ERAS consists of MyERAS (the Web site where you create your application), the Dean's Office Workstation (DWS), the Program Director's Workstation (PDWS), and the ERAS PostOffice. The processing fees are as follows:


Number of Programs Per Specialty      AAMC Fees
Up to 10                                              $60
11-20                                                  $8 each
21-30                                                 $15 each
31 or more                                          $25 each


An additional of 60 USD is charged for the ECFMG Transcript Fee. Helpful steps to guide the applicant in navigating through the complexity of  using the ERAS.

Step 1: Research Programs and Contact them for information.

Step 2: Get Your Electronic Token

Step 3: Register on MyERAS.

Step 4: Create Your Profile.

Step 5: Create Your MyERAS Application.

Step 6: Work with Your Documents.

Step 7: Select Programs.

Step 8: Assign Documents to Programs.

Step 9: Apply to Programs.

Step 10: Check the Status of Your Application - Applicant Document Tracking System (ADTS) and Monitor the Message Center for Information from Programs.

Step 11: Add Programs/Update Your Documents and Track Assignments.

Step 12: Keep Your Profile Up-to-Date.

Step 13: Register for the  Match through NRMP. 

Payment of the $40.00 registration fee  must be made at the time of registration. Applicants who complete their registrations after November 30th must pay an additional $50 late registration fee. All registration fees are non-refundable.

Matching

Getting into a residency program is a very competitive process.   After the applicant registers with ERAS and  apply to programs, the program director/selection committee review applications and invite selected candidates for interviews held between October and February. After the interview period is over, students submit a "rank-order list" to a centralized matching service (the National Residency Matching Program). The  residency programs will also be submitting  a list of their preferred applicants in rank order to this same service. The process is blinded, so neither applicant nor program will see each other's list. The two parties' lists are combined by an NRMP computer, which creates optimal matches of residents to programs using an an algorithm. On the third Thursday of March each year ("Match Day") these results are announced and made available online at the the NRMP website. By entering the Match system, applicants are contractually obligated to go to the residency program at the institution to which they were matched. The same applies to the programs; they are obligated to take the applicants who matched into them.

On the Monday prior to Match Day, candidates will log in to their NRMP account to find out  if they matched or not. If they have matched, they must wait until the Match Day (Thursday) to find out the facility and the program they have been matched with. . If they have not secured a position through the Match, the locations of remaining unfilled residency positions are released to unmatched applicants the following day. These applicants are given the opportunity to contact the programs about the open positions. This is what is known as "The Scramble."

Because the scramble aims to to fill those unfilled slots in all specialties joining the match, one may have to choose a different program or another state and hospital outside his original match list and can be a very stressful day for the applicant.  Statistically, IMG’s comprise the majority of the medical graduates going for the scramble and the chances of getting into a residency program becomes even more slim compared to the original matching process.

According to the NRMP website, in 2008,  4,214 programs enrolled in the Match, which altogether offered 25,066 positions. A total of 35,956 applicants participated in the Match. Of those, 15,692 were 2008 graduates of accredited U.S. medical schools and 20,264 were independent applicants including the IMG’s.