What is ECFMG?

Educational Commission for Foreign Medical Graduates. This is the body that determines whether students are equipped to enter residency in the U.S. The ECFMG certificate is complete once all documents from your medical school are verified and you have passed the first 3 USMLE examinations (Step 1, Step 2 CK, Step 2 CS). This certificate is like a stamp of approval for a Program Director when reviewing your application. With this certificate, they cannot question the quality of medical school, your fundamental knowledge of medicine, or your clinical skills, as you have completed the required steps to begin residency in the U.S. Without this certificate, you are still in the process of certification and this is a huge factor in the application process. While some PDs may not mind the fact that you are not certified by the time of application, most do. When comparing two applicants, one certified and the other not, it plays a huge factor as to who gets the interview and who doesn’t.

Why September 1st?

Every IMG should make it their goal to get their credentials verified and complete the first 3 USMLEs (Step 1, Step 2 CK, Step 2 CS) by early August so that they are ECFMG Certified by September 1st. Why September 1st? This is the day registration opens for ERAS, meaning the day you can begin applying to residency programs. The earlier your application goes out, the higher chances you have of getting an interview. Some may argue against this statement, but in general you want all of your applications out in the month of September. Consider how many applications every program gets; thousands upon thousands of applications for what, 10 spots? Sometimes 20, maybe 50 max. On average, most programs interview 10x the number of spots available. Of those 10, only 1 gets the seat. Meaning the chance that you match at a program you interviewed is 10%.

Here is an example:

Residency Program A received 2000 applications.
They are interviewing 200 applicants.
They have 20 spots available in the Match.
Thus the chance of you matching to a program you apply to is ~1%. Slim, but be hopeful!

So looking at the competition, one needs to be ahead of the game. A complete application, with full ECFMG certification, fresh LORs, U.S. clinical experience, research publications, all ready on September 1st is sure to impress a Program Director. Receiving the same application in October or November will not hold its weight because either the program has already given out all of its interview dates or they have already stopped looking at applications. Just think, out of thousands of applications a Program Director receives, how must he/she filter through them. Which ones are granted interviews, which are held for re-examination, which are incomplete or thrown out. Not having one of your USMLE test scores on the application is big. Some programs will hold your application until they receive the score. When it gets there, it might be too late, or your score might not be what they were looking for. Having everything ready when the initial application goes out makes it easier for a PD to decide whether you fit into their criteria or not. If an application is incomplete, who knows if they will ever come back to it. Competitive programs do not need to filter through applications to find top candidates. Many of their applicants are already AMGs or top IMG candidates. There is a very strict criterion for every program. Remember there is a shortage of residency spots to applicants. If you look at NRMP Match statistics, more than 50% of IMGs fail to match each year. It is getting more and more competitive every year as more US medical schools are opening, more Caribbean schools are expanding, and residency programs are the still same size. This means those IMGs, in particular ones who need visas, have the hardest time matching into residency in the U.S.

ECFMG Certification Step by Step Guide:

1. Begin ECFMG registration at http://www.ecfmg.org/

Goto IWA and click on first-time user. Please read the instructions as what is mentioned here is summarized and may miss crucial updates on their registration process.

Tip: Make sure you use your full legal name (as on a passport and your medical school degree)

Complete the information required and wait to receive your ECFMG ID number by email. You may want to memorize this number as you will be using it a lot.

2. You can now apply for your Step 1, Step 2 CK, or Step 2 CS by completing an application on IWA and paying the fee. You get to choose 3 month blocks for which you can take the exam (any available day in that block). Schedule appropriately as it costs a fee to extend your block. You can change dates with no fee within your block as long as it is done 31 days before the scheduled test date.

3. Medical school verification (credential) process. This is quite daunting and takes a lot of patience. Some get it done in one go, others struggle back and forth with ECFGM for some mistake or missing document / signature. Medical school verification is different for medical students and medical graduates.

A: Medical Students (have not graduated yet)

Begin by printing Form 186 – Certification of Identification Form from IWA. Complete it with attached passport photo.

Tip: write your name and ECFMG number on the back of photo
Tip: make sure medical school seal is stamped on part of photo
Tip: if you have graduated but have not been issued your degree yet, do not say graduated (as it will reject your application since you cannot provide a copy of your degree)

Once complete, send via courier to ECFMG. They will email you once it is received, and it will take 3 weeks to process the document. This is why you want to get this done ASAP as ECFMG always takes weeks to months to process documents, especially as dates get closer to September 1st. You can view the status of your application / documents on OASIS.

B. Medical Graduates (with diploma in hand)

Since you have your degree and transcripts available to you, you can send a complete package to ECFMG with all the medical school verification documents. They include:

1.      Form 344
2.      Form 345 (2 copies)
3.      Form 186 (read 3A for details)
4.      Form 187
5.      Final Medical Diploma (2 photocopies)
6.      Final Transcript
7.      Passport Size Photo (not sure how many copies are needed)

Tip: Write your ECFMG ID number on the top right of all documents being sent.

There are instructions if your documents are not in English, if you have transferred credits, etc. Please check the ECFMG site for more details as there maybe new requirements after this is written.

4. Pray that your medical school did their part right and all the documents were signed, stamped, and sealed properly. Make sure you do your part in organizing all the documents and making sure everything is complete before mailing. If this is not their first time doing ECFMG verification for a student, they probably know more than you and you should be fine!

5. Your medical school will receive a Form 327A: Verification of Medical Education Form. It will require some signatures and most likely copies of your transcript and diploma once again. Leave this to your medical school to complete.

Tip: Make sure they put the school seal on the form (my school forgot to, took another month or 2 to mail and resubmit it).

6. Now you can easily apply for your remaining USMLEs through IWA. You will receive your ECFGM certificate once your medical school verification is complete and you have passed all 3 exams.

Fees (as of May 2011)
Step 1:   $780
Step 2 CK: $780
Step 2 CS: $1355
Extension of eligibility: $65 (For Step 1 and Step 2 CK)


Step 4: Research and Clinical Experience