Medical Education Credentials
An international medical graduate 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 the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER). 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. See Transfer Credits. The physician’s graduation year must be included in the medical school’s IMED listing. The FAIMER IMED contains information supplied by countries about their medical schools. FAIMER is not an accrediting agency.
Note Regarding Ineligible Practitioners: Graduates not eligible for admission to the exams or for ECFMG Certification include, but are not limited to: Graduates licensed only in stomatology, ayurvedic or homeopathic medicine, or those awarded only the diploma of Physician-Epidemiologist-Hygienist, Physician-Biochemist, Physician-Cyberneticist, Physician-Biophysicist, Licensed Medical Practitioner, or Assistant Medical Practitioner.
Applicants for ECFMG Certification must document the completion of all requirements for, and receipt of, the final medical diploma. ECFMG verifies every applicant’s final medical diploma with the appropriate officials of the medical school that issued the diploma. When ECFMG sends your medical diploma to your medical school for verification, ECFMG will request the medical school to include your final medical school transcript when the school returns the verification of your medical diploma to ECFMG. Verification by ECFMG with the issuing school may also be required for transcripts that are submitted by applicants to document transferred credits. An applicant’s credentials are not considered complete until ECFMG receives verification of the final medical diploma, final medical school transcript, and, if required, transfer credit transcript(s) directly from the issuing school(s).
Please do not send any credentials not required by ECFMG (such as licenses, certificates of full registration, high school diplomas, academic awards, etc.). Submission of unnecessary documents can delay the processing of your application.
Transfer Credits
Transfer credits are credits earned for a course taken at one institution (such as a medical school) that are accepted by another medical school toward meeting its degree requirements. For example, a student attends a medical school for one year and earns credits for 12 courses. The student transfers to another medical school, which accepts the credits for those 12 courses toward meeting its degree requirements. The credits for those 12 courses are then referred to as transfer credits.
For the purpose of ECFMG Certification, credits earned on or after January 1, 2008 that are transferred to the medical school that awarded or will award an applicant’s medical degree must meet all of the following criteria:
- Credits must be transferred from one IMED-listed medical school to another IMED-listed medical school.
- Credits must be for courses taken at one medical school within seven years of the date of graduation at the medical school that accepts the transferred courses.
- Credits must be for courses that were passed at the medical school at which the course was taken.
All applicants who have transferred credits to the medical school that awarded or will award their medical degree must document these credits when they apply to ECFMG for examination, regardless of when the credits were earned. See Credentials for Exam Registration.
Applicants whose transferred credits do not comply with the policy outlined above will not meet the requirements to be registered by ECFMG for examination or the requirements for ECFMG Certification. Applicants whose transferred credits do not meet all the criteria listed above may request an exception from the ECFMG Medical Education Credentials Committee.
Provision of Credentials and Translations
Credentials for ECFMG Certification
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.
If you are a medical school graduate when you submit your first exam application, your medical education credentials must be submitted with this initial exam application.
If you are a medical school student when you submit your first exam application, send your medical education credentials as soon as you graduate and receive them.
You must include your full name and USMLE/ECFMG Identification Number on the front of all credentials and the back of photographs before sending them to ECFMG. See Credentials for Exam Registration.
After you have applied for an exam, if you need to send credentials to ECFMG separately from an exam application, you must send the credentials to the following address:
Educational Commission for Foreign Medical Graduates (ECFMG)
Attn: Registration and Credentials Services
3624 Market St., 4th Floor
Philadelphia, PA 19104-2685
USA
ECFMG will not accept letters or other deliveries that arrive with postage or other fees due.
When your credentials have been processed, ECFMG will notify you. You can also check the status of your credentials by accessing OASIS.
Final Medical Diploma
ECFMG requires all medical school graduates to submit copies of their final medical diploma.
You must send two photocopies of your final medical diploma to ECFMG. Do not send an original diploma. The exact name of the final medical diploma you must provide is listed in the Reference Guide for Medical Education Credentials. The Reference Guide lists these medical credential qualifications by country of medical school. Although this Reference Guide is based upon information that was current at the time of publication, this information is subject to change.
The photocopies of your medical diploma must be 216 mm x 279 mm (8½ in x 11 in). If these documents are larger than 216 mm x 279 mm (8½ in x 11 in), you must send reduced photocopies that are 216 mm x 279 mm (8½ in x 11 in). You must send the copies of your diploma to ECFMG by mail or courier service. ECFMG does not accept these documents by fax or e-mail. You must send one full-face, passport-sized, color photograph with the copies of your medical diploma. The photograph that you send must be current; it must have been taken within six months of the date that you send it. A photocopy of a photograph is not acceptable.
You must submit the copies of the final medical diploma in the original language, containing the issue date and all of the appropriate signatures of the medical school and/or university officials. Documents that are not in English must be accompanied by an official English translation. ECFMG will not accept copies of a medical diploma that is not in English without an official English translation. Likewise, ECFMG will not accept an English translation of a diploma without copies of the original language document from which the English translation was prepared. (See English Translations.)
Do not submit professional evaluations of your final medical diploma. ECFMG does not accept such evaluations in lieu of your final medical diploma.
You must also complete and submit with your medical diploma the ECFMG Medical Education Credentials Submission Form (Form 344) and two copies of the Medical School Release Request (Form 345). These forms are available on the Publications page of this website and from ECFMG, upon request. If you are submitting your medical diploma with an exam application, follow the instructions for additional documents in Applying for Examination.
Final Medical School Transcript
When ECFMG sends your medical diploma to your medical school for verification, ECFMG will request the medical school to include your final medical school transcript when the school returns the verification of your medical diploma to ECFMG.
If ECFMG is unable to obtain your final medical school transcript directly from your medical school, ECFMG will contact you and request that you submit to ECFMG copies of your final medical school transcript. If ECFMG has previously verified your medical diploma with your medical school but not the final medical school transcript, you must send copies of the final medical school transcript to ECFMG. ECFMG will then send a copy of the final medical school transcript to the medical school for verification. In such cases, you must send two photocopies of your final medical school transcript to ECFMG. The photocopies of your medical school transcript must be 216 mm x 279 mm (8½ in x 11 in). If these documents are larger than 216 mm x 279 mm (8½ in x 11 in), you must send reduced photocopies that are 216 mm x 279 mm (8½ in x 11 in). You must send the copies of your transcript to ECFMG by mail or courier service. ECFMG does not accept these documents by fax or e-mail.
You must send one full-face, passport-sized, color photograph with the copies of your final medical school transcript. The photograph that you send must be current; it must have been taken within six months of the date that you send it. A photocopy of a photograph is not acceptable.
You must submit the copies of the final medical school transcript in the original language. Documents that are not in English must be accompanied by an official English translation. ECFMG will not accept copies of a medical school transcript that is not in English without an official English translation. Likewise, ECFMG will not accept an English translation of a transcript without copies of the original language document from which the English translation was prepared. (See English Translations.)
Do not submit professional evaluations of your final medical school transcript. ECFMG does not accept such evaluations in lieu of your final medical school transcript.
Transcript(s) to Document Transferred Credits
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 when the credits were earned. You must send to ECFMG two photocopies of an official transcript issued by the school or institution at which the course was taken. The photocopies must be 216 mm x 279 mm (8½ in x 11 in). If these documents are larger than 216 mm x 279 mm (8½ in x 11 in), you must send reduced photocopies that are 216 mm x 279 mm (8½ in x 11 in).
You must submit the copies of the transcript in the original language. Documents that are not in English must be accompanied by an official English translation. ECFMG will not accept copies of a transcript that is not in English without an official English translation. Likewise, ECFMG will not accept an English translation of a transcript without copies of the original language document from which the English translation was prepared. (See English Translations.)
Do not submit professional evaluations of your transcript. ECFMG does not accept such evaluations in lieu of your transcript.
You must also complete and submit with your transcript(s) the ECFMG Medical Education Credentials Submission Form (Form 344). Form 344 is available on the Publications page of this website and from ECFMG, upon request. To submit the transcript to ECFMG, follow the instructions for additional documents in Applying for Examination.
Name on Medical Diploma and Transcript(s)
The name on your medical diploma and transcript(s) must match exactly the name in your ECFMG record. If the names do not match exactly, you must submit legal documentation that verifies the name on your medical diploma/transcript(s) is (or was) your name. The legal documentation must show your name exactly as it appears on your medical diploma/transcript(s). (See Name of Applicant and Changing or Verifying Your Name.)
An example of a discrepancy between the name in your ECFMG record and the name on your medical diploma/transcript(s) would be if your ECFMG record lists your married name, but your medical diploma/transcript(s) lists your maiden name.
Other examples of a discrepancy include, but are not limited to, the following:
- Use of initials for the first name or last name (surname) on the medical diploma/transcript(s)
Example: “Mary Smith” in your ECFMG record, but “M. Smith” or “Mary S.” on your medical diploma/transcript(s).
- Difference in the sequence of names
Example: “John James Clark” in your ECFMG record, but “James John Clark” or “Clark James John” on your medical diploma/transcript(s).
- Hyphenations and separations in names
Example: “Alice Al Quigley” in your ECFMG record, but “Alice Al-Quigley” or “Alice Alquigley” on your medical diploma/transcript(s).
Credentials for Exam Registration
If you are a medical school graduate, the two copies of your medical diploma and the current color photograph must be sent with your application for examination (if your diploma and photograph have not been submitted to ECFMG previously). If you have graduated and met all requirements for your medical diploma but your medical diploma has not yet been issued, a current, full-face, passport-sized, color photograph and a letter signed by your Medical School Dean, Vice Dean, or Registrar must be submitted with your exam application. The letter must be written on your medical school’s letterhead and must include the following statement:
This is to confirm that [applicant name] has graduated and completed all requirements to receive the [degree title] degree from [medical school/university name]. The degree will be issued [month and year].
To submit these items to ECFMG, follow the instructions for additional documents in Applying for Examination.
You must then send the photocopies of your diploma to ECFMG as soon as the diploma is issued. You must also complete and submit with your medical diploma the ECFMG Medical Education Credentials Submission Form (Form 344) and two copies of the Medical School Release Request (Form 345). These forms are available on the Publications page of this website and from ECFMG, upon request. See Credentials for ECFMG Certification.
If you graduated from medical school and do not submit your medical diploma or a letter from your medical school, as described above, and these documents have not been received previously by ECFMG, your application will be rejected.
If the name on your diploma does not match the name in your ECFMG record and you do not submit acceptable legal documentation that verifies the name on your diploma, your application will be rejected. (See Name of Applicant and Changing or Verifying Your Name.)
If you are a medical school student, you should send the copies of your medical diploma and current, full-face, passport-sized, color photograph to ECFMG as soon as you graduate and receive the diploma. See Credentials for ECFMG Certification.
Students and graduates who have transferred credits to the medical school that awarded or will award their medical degree must submit a transcript to document these credits when they apply for examination, regardless of when the credits were earned. Failure to provide appropriate documentation of transfer credits will prevent exam registration. See Credentials for ECFMG Certification. To submit these items to ECFMG, follow the instructions for additional documents in Applying for Examination.
If your credentials are complete, you are generally not required to resend these documents when you apply for subsequent exams. After receiving your medical diploma, ECFMG will notify you and advise if additional credentials are required.
If you have questions or concerns about your credentials, you can contact ECFMG by e-mail at credentials@ecfmg.org or by telephone or fax (see General Inquiries).
English Translations
Any document submitted to ECFMG that is not in English must be accompanied by an English translation, prepared by and certified to be correct by a government official (for example, a Consular Officer), medical school official (for example, a Dean or Registrar), or a professional translation service.
The translation must appear on letterhead and must bear the original signature and title of the government or medical school official or representative of the translation service. If the translation service is a private company, the letterhead must identify the company as a translation service. The translation must be a word-for-word translation of the original language document. An abstract or summary translation of the document is not acceptable. The translation must be prepared from the original document or a photocopy of the original document. ECFMG will not accept a translation prepared from a transcription (transcribed version) of the document.
An English language certificate issued by the medical school that is not a word-for-word English language version of the degree, transcript, or other document in the original language is not acceptable as a translation. English translations that do not meet the requirements above will not be accepted. Examples of unacceptable translations include, but are not limited to:
- translations prepared by a notary who is not a government or medical school official or representative of a professional translation service,
- a translation that was not signed by the translator or official or representative of the translation service, and
- a translation that is not a word-for-word translation of the original language document.
Additionally, applicants are not permitted to translate their own documents.
ECFMG does not endorse or recommend individual translation services. However, you can locate a translation service by consulting the website of the American Translators Association.
Verification of Credentials
ECFMG verifies every applicant’s final medical diploma with the appropriate officials of the medical school that issued the diploma and requests the medical school to include the final medical school transcript when the school returns the verification of the medical diploma to ECFMG. Verification by ECFMG with the issuing school may also be required for transcripts that are submitted by applicants to document transferred credits. You will not fulfill the ECFMG medical education credential requirements until verification of your final medical diploma, final medical school transcript, and, if required, transfer credit transcript(s) is received directly from the issuing school(s) and accepted by ECFMG.
In some instances, the verification process can be lengthy due to the processing time required by the institutions and prevailing postal conditions. ECFMG will notify you to advise when your diploma is sent to your medical school for verification. If ECFMG does not receive a response from your medical school within the anticipated time period, ECFMG will send subsequent verification requests to your medical school. ECFMG will notify you when it sends these subsequent requests. ECFMG will also notify you after receiving and evaluating the verification from your medical school. You can check the status of these medical education credentials on-line using OASIS.
Important Note: Applicants are responsible for any fees associated with the verification of the final medical diploma, final medical school transcript, and transcript(s) to document transferred credits. If your medical school charges a fee for the verification of your diploma and/or transcript, ECFMG will advise you to contact your medical school directly regarding the fee and the method of payment. If the final medical school transcript provided by your medical school is not in English, ECFMG will have the transcript translated into English by an independent translation service, will charge your ECFMG financial account for the translation, and will notify you of the charge. The current translation fee is $205. See Payment for information on how to make a payment to your ECFMG financial account.
Irregular Behavior
The ECFMG Medical Education Credentials Committee reviews allegations of irregular behavior. As defined by ECFMG, irregular behavior includes, “all actions or attempted actions on the part of applicants, examinees, potential applicants, others when solicited by an applicant and/or examinee, or any other person that would or could subvert the examination, certification or other processes of the ECFMG.” Examples of irregular behavior include, but are not limited to, submission of any falsified or altered document to ECFMG; submission of any falsified or altered ECFMG document to other entities or individuals; falsification of information on applications or through other means; and failing to comply with a USMLE or ECFMG policy, procedure, and/or rule.
A finding of irregular behavior by ECFMG may be sufficient cause for ECFMG to bar you from an exam, to terminate your participation in an exam, to withhold and/or invalidate the results of your exam, to withhold a certificate, revoke a certificate, or to take other appropriate action. ECFMG will report findings of irregular behavior to the FSMB Board Action Databank, state medical licensing authorities, and directors of graduate medical education programs, among others. ECFMG may also report such findings to the USMLE Committee on Irregular Behavior and Score Validity and to any other organization or individual who, in the judgment of ECFMG, has a legitimate interest in such information.
In all cases when the ECFMG Medical Education Credentials Committee has made a finding of irregular behavior, a permanent annotation will be included in the individual’s ECFMG Status Report and ECFMG Certification Verification Service (CVS) Report. If there is a finding of irregular behavior made on or after August 31, 2006, regardless of the date of the conduct or activity that gave rise to the finding, additional information explaining the basis for the finding of irregular behavior and the resulting action will accompany every ECFMG Status Report and CVS Report. This additional information may also be provided to legitimately interested entities.
Representative Examples of Irregular Behavior
Representative examples of allegations of irregular behavior and actions taken by the ECFMG Medical Education Credentials Committee include:
- Altering or Fabricating Letters of Recommendation
The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in connection with an individual who altered a Letter of Recommendation prior to submitting it to ERAS Support Services at ECFMG.
Following review, the ECFMG Medical Education Credentials Committee determined the individual had engaged in irregular behavior and took action to permanently revoke the individual’s Standard ECFMG Certificate.
- Forging a Standard ECFMG Certificate
The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in connection with an individual who submitted to a residency program a document that purported to be a Standard ECFMG Certificate. The individual involved had not met the requirements for ECFMG Certification, and no Standard ECFMG Certificate had ever been issued to him.
Following review, the ECFMG Medical Education Credentials Committee determined the individual had engaged in irregular behavior and took action to bar the individual from admission to all ECFMG examinations and from ECFMG Certification.
The Fifth Pathway Program
The Fifth Pathway, created by the American Medical Association (AMA) in 1971, allows certain students who have attended four years at an international medical school to complete their supervised clinical work at a U.S. medical school, to become eligible for entry to U.S. residency training, and ultimately to obtain a license to practice in the United States. This pathway is available only to individuals who satisfy specific criteria; these criteria are outlined on the AMA website.
Individuals who pursue the Fifth Pathway complete the four-year didactic curriculum at the international medical school, but they do not complete the internship and/or social service requirement for graduation. Instead, they complete a Fifth Pathway program, which is one year of supervised clinical work at a U.S. medical school. Since they do not complete the internship and/or social service requirement, they do not receive the final medical diploma and, therefore, are not graduates of the international medical school.
Important Notes:
The AMA’s Council on Medical Education has announced that it will no longer support the Fifth Pathway as a mechanism for eligibility to enter the first year of ACGME-accredited graduate medical education programs. The last Fifth Pathway program class to be supported is the January 2009 entering class, which ends in December 2009. The full report of the Council is available on the AMA website.
Additionally, the USMLE program will cease acceptance of Fifth Pathway certificates issued after December 31, 2009 for the purpose of meeting Step 3 eligibility requirements. For valid Fifth Pathway certificates issued through December 31, 2009, the USMLE program has not yet determined whether they will be accepted indefinitely for purposes of meeting Step 3 eligibility criteria or whether a cut-off date will be imposed. Individuals holding Fifth Pathway certificates that are not accepted by the USMLE program for purposes of meeting Step 3 eligibility will be required to obtain ECFMG Certification in order to be eligible for Step 3. Monitor the USMLE website for additional information.
Participants in Fifth Pathway programs who have not completed the internship and/or social service required for graduation at the international medical school and for receipt of the final medical diploma are not eligible for ECFMG Certification. However, these individuals may apply to ECFMG for examination, provided that they
- hold a Fifth Pathway certificate issued on or before December 31, 2009 or are enrolled in a Fifth Pathway program that will result in issuance of a Fifth Pathway certificate on or before December 31, 2009; or
- meet the examination eligibility requirements for medical school students, including the requirement that their international medical school certify their current enrollment status. See Eligibility for Examination.