PUPOSE:
The ECFMG (Educational Commission for Foreign Medical Graduates), through a program of certification, assesses the readiness of graduates of international medical schools to enter ACGME accredited residencies or fellowships in the United States. ECFMG certification provides assurance to program directors that graduates of international medical schools have met minimum standards of eligibility required to enter such programs. ECFMG certification is a requirement for entry into a residency program (Canadian graduates are exempt from this requirement) and is also a prerequisite for licensure in most states.

POLICY:
To earn the ECFMG Certificate, IMGs are required to

• Pass Step 1 and Step 2CK of the United States Medical Licensing Exams (NOTE: Some combinations of formerly administered medical science exams, such as FLEX or FMGEMS may be acceptable for purposes of obtaining ECFMG certification. However, they are no longer accepted as prerequisites for USMLE Step 3 and so are not valid for licensure. All medical science exams must have been taken within 7 years of first exam application.)
• Pass the ECFMG Clinical Skills Assessment exam or the USMLE Step 2CS exam. This exam tests both clinical proficiency and spoken English language proficiency. It is a one-day exam administered at various testing centers located in Philadelphia, Atlanta, Los Angeles, Chicago, and Houston. The Clinical Skills exam or Step 2CS can be applied for at any time after meeting the previous exam requirements. Details for eligibility, application, and scheduling are available on the ECFMG web site at www.ecfmg.org.
• Document completion of requirements for, and receipt of final medical diploma from a medical school that is listed in the World Directory of Medical Schools.
• NOTE: Although not a requirement for ECFMG certificate, residents
  entering at PGY2 level or above must also provide documentation that they have passed USMLE Step 3.

Only those with an ECFMG certificate (except Canadian graduates) are eligible to apply for graduate medical education training in the United States.

Fee information for the USMLE examinations is available through ECFMG. Fees are paid by the applicant and are not reimbursed by the University. Examination fees will not be credited to a future examination nor refunded if applicants do not take the examination. Scores for examinations take approximately six weeks, and are mailed directly to the applicant.

The USMLE Step 1CK, Step 2CK, and Step 2CS for international medical graduates are offered through the ECFMG. The exams are computer based, are offered in selected test centers throughout the world, and may be applied for at any time through ECFMG.
To learn about eligibility requirements for any of the above exams, read information bulletins published on the ECFMG web site at www.ecfmg.org. Also consult this web site for information regarding re-taking tests, scheduling tests, scoring tests, and any other information regarding these tests.

VISA REQUIREMENTS
ECFMG is authorized by the United State Information Agency (USIA) to sponsor international physicians as Exchange Visitors (J-1 Clinical Visa) in graduate medical education programs which lead toward American Board Certification and which are affiliated with accredited medical schools in the United States. The duration of stay of the Exchange Visitor is limited to the time typically required to complete such programs. To be eligible for sponsorship, foreign nationals must hold a valid ECFMG certificate (except Canadian graduates), have a houseofficer agreement (contract) in a program accredited by the ACGME, and complete an application for sponsorship.

Information regarding Initial Sponsorship or Continuation of Sponsorship is available on the ECFMG web site (www.ecfmg.org). The Training Program Liaison (TPL) in the Graduate Medical Education Office will assist the applicant with submitting the required documentation to ECFMG for processing The Certificate of Eligibility for Exchange Visitor Status will be sent to the institution providing the education or training, to be forwarded to the foreign national physician. The Form DS-2019 (Certificate of Eligibility for Exchange Visitor Status) is used to obtain a J-1 Clinical visa to enter the United States. All non-US-citizen medical graduates who train in an ACGME-accredited program at the University of Utah Affiliated Hospitals must obtain a J-1 Clinical visa.
Research fellows not providing any patient care, and whose status is not that of "housestaff," may work through the International Student Office at the University of Utah, and do not need to go through the ECFMG. However, it should be noted that if an international medical graduate enters this country to do research, it is a complicated process (and not guaranteed) to switch to a clinical program later on.

The University of Utah Affiliated Hospitals does not accept H-1 visas for residencies or fellowships.

If an applicant is a "Permanent Resident" or has a "Green Card," there is no visa requirement. If an applicant is in the process of obtaining a "Green Card" or "Permanent Resident Work Authorization," the requirement for J-1 Clinical visa may be waived by the Director of Graduate Medical Education on the condition that the applicant provides documentation of a valid Employment Authorization Card (EAC). A valid EAC may take the place of a Green Card temporarily. The Green Card must be presented to the GME Office as soon as it is received. In the event that the Green Card is denied, the resident will be released from his/her contract. In such event, the resident may reapply for entry to the program after establishing eligibility for a J-1 Clinical visa.

ELIGIBILITY FOR RESIDENCY OR FELLOWSHIP POSITIONS
Applicants must be qualified for a residency or fellowship program according to the same criteria used for all applicants to the program. In addition, they must have a valid ECFMG certificate (except Canadian graduates) before they can be considered. A J-1 Visa (or citizenship or permanent residency or valid EAC) is required for all non-US citizens in a training program who provide patient care. This visa can be obtained by working through the ECFMG Training Program Liaison, by the process explained above.

MEDICAL LICENSURE REQUIREMENTS
The Graduate Medical Education Committee of the University of Utah Affiliated Hospitals requires that all housestaff apply for a Utah medical license by July 31st, or within 30 days of hire, of their second year of training. Many international medical school graduates will not have the required United States training in order to be eligible for a Utah medical license. As a result, all program directors must obtain approval from the Graduate Medical Education Committee to hire any international medical graduate who may need an exemption from the licensure requirement. This approval for a licensure exemption must be granted by the Graduate Medical Education Committee before an offer of training can be extended to the physician. Please see Medical License Policy (GME 1.3).
COMPLETION OF TRAINING
Upon successful completion of training the GME Office will provide a Certificate of Completion. The Certificate of Completion will reflect the actual degree or credential received by the trainee from the medical school from which he/she graduated. No other degree or credential may be printed on the Certificate of Completion.
 

RESTRICTIONS

• Residents with J-1 Clinical visas may not hold faculty appointments
• Residents with J-1 Clinical visas may not bill independently for any services
• Residents with J-1 Clinical visas may not moonlight
   

CONTACTING ECFMG
The ECFMG may be contacted through its web site at www.ecfmg.org. The web site contains detailed and specific information about all ECFMG functions. The web site contains complete informational bulletins on all exams and has downloadable application forms for all exams. It also contains downloadable application forms for all certification and sponsorships. International medical graduates inquiring about residency positions, and applicants to residency positions, are encouraged to visit the ECFMG web site to answer any questions and obtain information. The Office of Graduate Medical Education is also available to answer questions and provide assistance