At the end of May, the Federation of State Medical Boards and the National Board of Medical Examiners, two groups who sponsor the United States Medical License Examination (USMLE) elected to suspend the clinical skills portion of the USMLE Step 2 for at least 12 months.

This decision was a difficult one to make and announce as international medical graduates (IMGs) must pass the USMLE Step 2 CS to apply for certification with the Educational Commission for Foreign Medical Graduates (ECFMG). U.S. medical graduates are also required to pass this portion of the USMLE should they wish to apply to medical residency programs.

The decision to postpone the exam was made with respect to the health and safety of those taking and administering the exam. The USMLE Step 2 CS is hands-on and requires patient-physician scenarios. Maintaining sanitary testing sites that also respect social distancing guidelines would be difficult.

ECFMG is now accepting one of five alternative educational experiences or certifications in lieu of the USMLE Step 2. Those who meet one of the following requirements are eligible to apply for certification. Here are the five pathways as outlined by ECFMG:


    1. Licensed to practice medicine in another country
    2. Passed a standardized clinical skills exam elsewhere (in English)
    3. Graduated from a medical school recognized by the World Federation for Medical Education (WFME)
    4. Graduated from a medical school participating in the U.S. federal student loan program
    5. Graduated from a medical school providing joint U.S. medical school degrees accredited by the Liaison Committee on Medical Education (LCME)


Above is simply an overview of the five pathways. Each pathway has certain stipulations. Those looking to apply to the 2021 Match should be sure such conditions do not affect them. It is also important to note that not all individuals who meet one of the above pathways can obtain their ECFMG certification without the USMLE Step 2CS. Those who have failed any of the USMLE Steps a total of two or more times and those who have not taken any Steps since 2018 are not eligible to be considered for one of the pathways. Information on pathway details, stipulations, and frequently asked questions relating to such topics can be found on ECFMG’s website.


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