ECFMG and Intealth: ECFMG Certification for IMGs Explained

If you studied medicine outside the United States and want to train there, ECFMG Certification is the status that opens the door to US graduate medical education. ECFMG (Educational Commission for Foreign Medical Graduates) is the organisation that grants it. Since 2021 ECFMG and its sister organisation FAIMER operate under a shared umbrella called Intealth.

This page explains what ECFMG and Intealth do, what ECFMG Certification requires in 2026, how the Pathways and OET Medicine work, and how the World Directory and EPIC fit in. For licensing after residency, see our guide to the FSMB and US state medical boards.

Key facts

What Intealth and ECFMG do

Intealth is a private nonprofit working to advance quality in health care education worldwide. ECFMG and FAIMER continue as divisions of Intealth. In practical terms for doctors:

• ECFMG certifies international medical graduates for entry into US graduate medical education and runs EPIC, a primary-source verification service for physician credentials.
• FAIMER co-runs the World Directory of Medical Schools with the World Federation for Medical Education (WFME).
• USMLE link. ECFMG members sit on the USMLE governing committee, and the USMLE Steps are part of the certification requirements.

ECFMG does not grant licences. Licensing happens at state level after residency.

Requirements for ECFMG Certification

For 2026 you need:

Step 2 CS used to cover the clinical and communication skills requirement. It was discontinued by the USMLE program, and Pathways replaced it.

Pathways explained

ECFMG assigns Pathways by applicant situation:

• Pathway 1 covers applicants already licensed to practise medicine in another country.
• Pathways 3, 4 and 5 cover students or recent graduates of eligible schools who aren't Pathway 1 applicants.
• Pathway 6 is the route for everyone else, and it is mandatory for anyone who failed Step 2 CS one or more times.

Important dates for the 2027 cycle:

• Take the OET Medicine on or before the last available test date in December 2026, or your results may not arrive in time for the 2027 Match.
• Submit your 2027 Pathways application by January 31, 2027, or you will not meet eligibility requirements for the 2027 Match.

An accepted Pathway can expire, so watch the validity dates.

World Directory and sponsor notes

The World Directory of Medical Schools combines FAIMER's former IMED data with WFME's Avicenna Directory. ECFMG uses sponsor notes in the World Directory to show whether students and graduates of a school are eligible for ECFMG Certification. A school's listing alone isn't the deciding factor; read the ECFMG sponsor note for your school and your graduation year.

Graduates of Canadian medical schools who graduated before July 1, 2025 are not considered international medical graduates and are not eligible for ECFMG Certification.

EPIC

EPIC is ECFMG's primary-source verification service. Physicians build a portfolio of verified credentials and can send reports to organisations such as regulators. Medical school credentials in an EPIC portfolio don't need to come from a school listed in the World Directory, but a receiving organisation may still require that. EPIC verification is separate from ECFMG Certification.

Step-by-step for IMGs

1. Check the sponsor note for your school in the World Directory.
2. Register for USMLE Step 1. IMGs apply through the FSMB. See the USMLE Step 1 guide.
3. Pass Step 2 CK. See the USMLE Step 2 CK guide.
4. Take the OET Medicine in time for your target Match.
5. Apply for your Pathway before the deadline.
6. Complete credential verification of your diploma and related documents.
7. Receive ECFMG Certification and enter residency. Step 3 and the state licence follow later.

Step 1 is usually the longest preparation phase. The MediFlow USMLE Step 1 course has free test questions to start with.

Typical mistakes

• Missing the Pathways deadline. January 31, 2027 for the 2027 Match.
• Taking the OET too late. Results after the last December 2026 test date may arrive too late.
• Choosing the wrong Pathway after a Step 2 CS fail. Pathway 6 is mandatory in that case.
• Confusing EPIC with Certification. EPIC verifies credentials; it doesn't certify you.
• Forgetting the Pathway can expire.

Contact and official links

• ECFMG Certification: ecfmg.org/certification
• 2026 Information Booklet: ecfmg.org/2026ib
• Pathways: ecfmg.org/certification-pathways
• EPIC: ecfmg.org/psv
• Intealth: intealth.org