If you’re in your clinical years of medical school or a recent graduate looking to match into a US Residency Program, you probably know that the USMLE decided to discontinue the Step 2 Clinical Skills (CS) exam.

While many students celebrated not having to study for another board exam, many international students and IMGS suddenly found out that their intended pathway to ECFMG certification was no longer available.

Recognizing this issue, the ECFMG developed Pathway 6, a new pathway for IMGs to receive ECFMG certification and thereby become eligible for the Match.


Who is eligible for Pathway 6?

Pathway 6 is open to IMGs who meet the following criteria:

  • Do not have a passing score on USMLE Step 2 CS that is valid for ECFMG Certification, and
  • are not already certified by the ECFMG, and
  • plan to enter a U.S. Residency Program in 2021 or 2022.


How do I complete pathway 6? – the Mini-CEX

Well, beyond passing USMLE Step 1 and Step 2 CK, you must also complete a new in-person evaluation called the Mini-CEX.

The Mini-CEX, or Mini-Clinical Evaluation Exercise, is what the ECFMG describes as a “workplace-based assessment tool used to evaluate an individual’s clinical skills in a variety of clinical settings”. In plain English – it is a standardized evaluation completed by a US physician preceptor during a US clinical experience such as a clerkship, an elective, observership, or externship in a generalist specialty (IM, FM, Pediatrics, OBGYN).


Can I obtain a Mini-CEX evaluation during an AMO Clinical Experience?

Yes! The great news is that AMO’s in-person clinical experience preceptors and teaching hospitals can provide this evaluation so you can get certified.


If I book an AMO Clinical Experience, Can You Guarantee It?

Many other providers are “guaranteeing” a Mini-CEX evaluation if you book one of their programs. But watch out! You should be wary of these guarantees!

Look closely at the physician evaluator criteria:

  • Currently hold a full, unrestricted license to practice medicine without supervision.
  • Have held a full, unrestricted license to practice medicine without supervision for a minimum of five years.
  • Be authorized to perform the Mini-CEX in the jurisdiction where the clinical encounter will take place.
  • Give the applicant approval to share your name and e-mail address with ECFMG.
  • Not be a relative of the applicant.
  • Receive no compensation to evaluate the applicant.

As you see above: US Preceptors and Teaching Hospitals cannot receive compensation based on completing the Mini-CEX. If your complete your clinical experience with a provider that says all of their preceptors must complete a Mini-CEX in order to receive students, you could void your Mini-CEX exam and your ECFMG certification!


Don’t worry, we can still help:

When you book a program through AMO, you can work with our advisor team to find a program that is willing to complete a Mini-CEX upon request. Ethically, the decision of whether to complete the evaluation, like the decision to write a letter of recommendation, is always at the discretion of the preceptor.

However, when you work with AMO’s advisor team, we can make sure you book a rotation that is willing and excited to help IMGs obtain ECFMG certification in an ethical and transparent way. Search our programs and speak with an AMO advisor today to get started with the Mini-CEX process.