ECFMG Certification — A Brief Guide
Mindy Hung, Medical Writer
Introduction
ECFMG Certification — What Is It?
Graduates of foreign medical schools commit to a multistep process costing upwards of $2500 US when they decide to pursue a residence program or fellowship in the United States.
Aside from investigating schools and narrowing down specialties, candidates must obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG), the body that determines whether prospective students are equipped to enter American programs.
ECFMG assesses a candidate’s eligibility through a battery of tests and credentials checks, including the following:
copies of medical school diploma
United States Medical Licensing Exams (USMLE) Step 1 AND Step 2
Test of English as a Foreign Language (TOEFL)
ECFMG Clinical Skills Assessment (CSA)
Collecting these documents to seek approval from the ECFMG is also often a prerequisite to obtaining a license to practice medicine in the United States.
While the requirements might sound daunting, planning well before the final year of medical school provides the candidate with the best chance of getting into the right program at the right time. Studying for exams and gathering the needed applications and certifications will make the process move more smoothly. Moreover, factoring in the price of test preparation books, CD-ROMs, photocopying and postage, and the time and expense involved in travel to test centers will help ensure a smoother, less stressful passage.
Credentials — Diploma and Documentation
On applying to the ECFMG for those first United States Medical Licensing Exams (USMLEs), medical students and graduates will be asked for 2 recent full-face photographs and official credentials from one’s medical school.
Students will need their applications certified by the medical school dean, vice dean, or registrar in order to confirm official enrollment. Recent graduates who have not yet received their diplomas require a certificate from the dean, vice dean, or registrar confirming graduation from medical school, stating that all of the requirements to receive the diploma have been met, and the date on which it will be issued. Students and graduates must send ECFMG copies of the diploma once they have been conferred.
Medical school graduates who present copies of their diploma and photos right away, thus completing their credentials requirement, will not be asked to resubmit these documents when they apply for subsequent exams.
The Boards — USMLE Step 1 and Step 2
Submitting the first application for the USMLE Step 1 or Step 2 — also known as the Boards — marks the beginning of the certification process. The ECFMG is in charge of receiving and tracking all foreign applications (Form 104S [.pdf]), issuing each person an identification number that should be used in subsequent correspondence.
To qualify to take the USMLE, candidates must supply the aforementioned diplomas and pictures, and one’s medical school must be listed in the current edition of the World Directory of Medical Schools. (Medical school libraries often carry the publication.)
Although the boards can be taken in any order, students must be within 12 months of completing the full didactic curriculum at their medical school in order to take Step 2 while those who have had 2 years of medical school may take Step 1.
After confirming eligibility, the National Board of Medical Examiners will then send a scheduling permit that will allow the applicant to make an appointment to take the test. Applicants must take the exam within 3 months of receiving the permit.
Taking the Boards
Step 1 and Step 2 are computer-based multiple-choice exams, which must be taken at Prometric exam centers located around the world. For 2001, each Step costs $615 US in addition to an international test delivery surcharge.
Step 1 tests applicants on the basic mechanisms and principles of medicine (for example, anatomy and biochemistry, identifying specimens). Composed of about 350 test items, the exam takes place during an 8-hour testing session, divided into 30- to 60-minute blocks with about 45 minutes break time. Step 2 is divided into 30- to 60-minute blocks, administered in a 9-hour testing session with a 45-minute break. It focuses on clinical diagnosis and disease pathogenesis (mental and physical disorders, applying principles of management). Examples of questions from USMLE Step 1 and 2 can be found in Medscape Med Student’s Test Center. Candidates should answer 55% to 65% of items correctly to achieve a passing score.
Familiarity with the format of the exam and the subject matter is key. Visiting the USMLE Web site will give applicants a good overview of the depth and breadth of the test but CD-ROMs or prep books are necessary investments. The Boards are long and grueling, and these study-aids will help test-takers familiarize themselves with the format and subject matter.
English-Language Proficiency — TOEFL
ECFMG also requires that candidates demonstrate that they can read and understand North American English by achieving a minimum overall score of 213 on the Test of English as a Foreign Language (TOEFL). All foreign candidates must take this exam, a fact that might prove galling to natives of the United Kingdom, New Zealand, and Australia.
The fee through July 2001 is $110 US. The TOEFL is usually computer-based (there are a few exceptions) and is administered at Sylvan Learning Centers in 180 countries around the world; however, due to the high demand, temporary exam venues are often set up at universities and in schools.
The TOEFL is about 4 hours long and consists of 4 sections. The first is a listening test (40-60 minutes) in which the candidate must demonstrate an ability to read and understand North American English. The testing center will supply headphones for this section. The second section, on structure (15-20 minutes), measures the candidate’s ability to recognize language appropriate for standard, written English — formal English. The reading section (70-90 minutes) tests comprehension on passages from standard North American textbooks. The final section is a writing test (30 minutes) in which the candidate is given a topic and asked to present an organized and coherent essay.
Clinical Skills Assessment
The Clinical Skills Assessment (CSA), administered by the ECFMG, can be scheduled after the candidate has completed the full didactic curriculum (or is within 12 months of finishing) and passed Step 1 and the TOEFL.
The CSA consists of 11 simulations of patient encounters, which measure a candidate’s competence in patient communication and gathering and interpretation of clinical data. Candidates must go to each station where a lay person, portraying a patient, will respond to questions and react appropriately to physical maneuvers. Evaluators will score 10 of the 11 simulations, weighing the candidate’s ability to obtain a relevant medical history, carry out a focused physical exam in the 15 allotted minutes, and effectively record the patient encounter in the 10 minutes afterwards. Including orientation and breaks, the test lasts 8 hours.
Due to the unique format of the CSA, candidates must travel to the ECFMG’s secure testing center in Philadelphia, Pennsylvania. It is the only facility that offers the exam; therefore, candidates must factor in travel, visa, and accommodation in addition to the $1200 US (year 2001) fee.
More information on the test can be found at: http://www.ecfmg.org/csahome.htm
Applications and Implications
As can be seen, obtaining ECFMG certification takes a long time. However, those committed to furthering their studies through a residence program or fellowship in the United States will find it easier if they keep these points in mind:
Begin thinking and planning well before the final year of medical school
Set aside time for study and at least $2500 US
Become familiar with the structure and subject of tests
Write to ECFMG for updated information, or visit their Web site (http://www.ecfmg.org).
addresses
Educational Commission for Foreign Medical Graduates (ECFMG)
ECFMG3624 Market Street, Third FloorPhiladelphia, PA 19104-2685 USAhttp://www.ecfmg.org/
Clinical Skills Assessment (CSA)
ECFMG Clinical Skills Assessment Center3624 Market Street, Third FloorPhiladelphia, PA 19104-2685 USAhttp://www.ecfmg.org/csahome.htm
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