Pathway 3: Medical School Accredited by Agency Recognized by World Federation
for Medical Education (WFME)
Pathway 4: Medical School Accredited by Agency that Has Received a
Determination of Comparability by National Committee on Foreign Medical
Education and Accreditation (NCFMEA)
Pathway 5: Medical School Issues Degree Jointly with a U.S. Medical School
Accredited by Liaison Committee on Medical Education (LCME)
Who Should Apply
Pathways 3, 4, and 5 are for applicants who do not meet the eligibility requirements for Pathway 1 and are students or recent graduates of a medical school that meets eligibility requirements established by ECFMG for Pathway 3, 4, or 5.
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Eligibility Requirements
Requirements for
all applicants to Pathways 3, 4, and 5:
-
Date of medical school graduation must be on or after January 1,
2023.
-
An authorized official of your medical school must attest to the applicant’s clinical skills.
- Applicant has not failed the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination® (USMLE®) one or more times. Applicants who failed Step 2 CS one or more times must apply to Pathway 6 in order to meet the clinical and communication skills requirements for ECFMG Certification. For information on applying to Pathway 6, see the Pathway 6 page.
Pathway-specific medical school requirements:
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Pathway 3. Applicant’s medical school is currently accredited by an agency recognized by the World Federation for Medical Education (WFME).
-
Pathway 4. Applicant’s medical school is
currently accredited by an agency that has received a
determination of comparability by the National Committee on
Foreign Medical Education and Accreditation (NCFMEA).
-
Pathway 5. Applicant’s medical school grants an
MD degree issued jointly with a U.S. medical school accredited by
the Liaison Committee on Medical Education (LCME).
To determine whether a medical school’s students and recent
graduates are eligible to apply to Pathway 3, 4, or 5, search the
list of Medical Schools Eligible for 2026 Pathways. Please note: Schools that meet the eligibility
requirements for both Pathways 3 and 4 will be listed as eligible
for Pathway 3 only, and applicants from that school will be required
to apply to Pathway 3.
If ECFMG determines that additional medical schools meet the
requirements for Pathway 3, 4, or 5, they will be added to the list
accordingly.
If you believe your medical school meets the requirements listed
above and is not included on the list of eligible schools, please
contact ECFMG.
In addition to the requirements listed above, the applicant must
meet the requirements in
General Eligibility for All Pathways
and
Assessment of Communication Skills, Including English Language
Proficiency, as well as all other eligibility requirements for ECFMG
Certification.
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Application Timing
If you meet the eligibility requirements for Pathway 3, 4, or 5, you
may apply using the on-line
Application for 2026 Pathways for ECFMG Certification and Pathways Revalidation.
Your application must be submitted no later than January 31, 2026, Eastern Time (ET) in the United States. If you need to meet the clinical and communication skills requirements for ECFMG Certification through the Pathways and you do not submit a 2026 Pathways application by January 31, 2026, you will not meet eligibility requirements for the 2026 Match.
In order for you to participate in the 2026 Match, ECFMG must determine the outcome of your Pathways application; determine your overall eligibility for the 2026 Match, including verifying your passing performance on USMLE Step 1 and Step 2 Clinical Knowledge (CK); then report your eligibility status to the National Resident Matching Program® (NRMP®) by the NRMP Rank Order List Certification deadline. ECFMG will not determine the outcome of your Pathways application until all required supporting documentation and/or verification(s) have been received. Therefore, the time needed to complete the processing of your application is contingent upon receipt of all supporting documentation and verifications, including the Clinical Skills Attestation by your medical school. See Applicant Instructions below for more information and deadlines.
If you have not met all requirements for your Pathways application when the current application season ends, your application will be rejected and you will be required to reapply and pay any and all required application fee(s) in a future application season in order to meet the clinical and communication skills requirements for ECFMG Certification.
Please plan the timing of your application accordingly.
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Application Instructions
-
Access the Application for 2026 Pathways for ECFMG Certification and Pathways Revalidation and determine general eligibility.
- To begin the application, you will need to log in using your MyIntealth Account. Once you begin the application, you will have five days to complete and submit it. If the application is not submitted within five days, it will be deleted, and you will need to begin a new application if you wish to apply to a Pathway.
- After you log in, the application will indicate whether you meet the eligibility requirements that pertain to all Pathways.
- If you have failed Step 2 CS one or more times, the application will indicate that you will be required to apply to Pathway 6. For information on applying to Pathway 6, see the Pathway 6 page.
-
If you meet the general eligibility requirements, you will
proceed to questions regarding your eligibility for the
specific Pathways.
If you do not meet the eligibility requirements for Pathway 1, the system will automatically determine your eligibility to apply to Pathway 2, 3, 4, or 5, based on the information in your ECFMG record.
-
If you are eligible to apply to Pathway 3, 4, or 5, your
medical school will be required to attest to your clinical
skills, as described in
Clinical Skills Attestation by Medical School below.
-
If the application indicates that you are not eligible for
Pathway 3, 4, or 5, you will be required to apply to Pathway
6. For information on applying to Pathway 6, see the
Pathway 6 page.
-
If the application indicates you are ineligible for Pathway 3,
4, or 5 and you believe your ECFMG record is incorrect, please
contact us for assistance.
-
Complete and submit the application. After your
eligibility to apply to Pathway 3, 4, or 5 is confirmed, you will
be asked to certify your application, provide payment, and submit
your application to ECFMG.
Once your application is received, ECFMG will evaluate it. A case
manager will contact you if there are any issues with your
application or if we require additional information.
Clinical Skills Attestation by Medical School
In order to meet the requirements for Pathway 3, 4, or 5, your medical school must attest to your clinical skills. After you submit your Pathways application, the Application Summary will indicate the method your school must use to attest to your clinical skills.
If your medical school participates in using the
MyIntealth Entity Portal:
-
Your medical school must attest to your clinical skills through
the Clinical Skills Evaluation and Attestation Portal, following
the steps outlined in
Information and Instructions for Medical Schools that Meet
Eligibility Requirements for Pathway 3, 4, or 5
on the Information for Medical Schools page. A request to complete
the attestation will be automatically posted to your school
through the Clinical Skills Evaluation and Attestation Portal when
you submit your Pathways application.
-
Please note that it is your responsibility to ensure that your
medical school completes the electronic Clinical Skills
Attestation in support of your application; your application
cannot be approved until the completed attestation is received
and accepted by ECFMG. The electronic attestation must be
received by ECFMG no later than February 15, 2026.
-
Submission of the electronic Clinical Skills Attestation does not
guarantee that it will be accepted by ECFMG.
If your medical school does not participate in using the MyIntealth Entity Portal:
-
Your medical school must attest to your clinical skills using the
Clinical Skills Attestation form, following the steps outlined in
Information and Instructions for Medical Schools that Meet
Eligibility Requirements for Pathway 3, 4, or 5
on the Information for Medical Schools page. You will be able to
download the form from the Application Summary screen after you
submit your Pathways application.
-
The form must be completed by an authorized official of your
medical school and sent directly to ECFMG by the medical school.
Instructions for completing and submitting the form are included
with the form.
-
Please note that it is your responsibility to ensure that your
medical school completes a Clinical Skills Attestation form in
support of your application; your application cannot be approved
until the completed attestation is received and accepted by
ECFMG. The form must be received by ECFMG no later than January 31, 2026.
-
Submission of the Clinical Skills Attestation form does not
guarantee that it will be accepted by ECFMG.
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Important Information on Documentation Submitted in Support of Your
Application
-
The name on your document. If the name on your document does not match the name in your ECFMG record, ECFMG may contact you to request documentation to confirm your name as it appears on your document.
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Fees and Payment
The fee for applying to a Pathway is $925. Full payment is due when
you submit your application.
If the application is not submitted within five days of when you
begin, it will be deleted, and you will need to begin a new
application if you wish to apply to a Pathway.
You must use a Visa, MasterCard, Discover, or American Express
credit card with a security code; credit available in your ECFMG
Financial Account cannot be used to pay for a Pathways application.
Fees related to your application are not refundable. If you submit a
Pathways application and ECFMG determines that you are ineligible for
the Pathway, your application will be rejected, and the fee will not
be refunded. In addition, if ECFMG does not receive all required
documentation in support of your application, as well as any
required verifications of submitted documentation from the issuing
authority, your application will not be complete, and the
application fee will not be refunded.
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Application Processing Time
Once your application has been submitted, you can use the on-line Application for 2026 Pathways for ECFMG Certification and Pathways Revalidation to check the status of your application. The following guidelines
may be helpful:
-
Please allow five business days after submission of your
application for a case manager to begin reviewing your
application.
-
If any documentation is required for your Pathways application,
such as a Clinical Skills Attestation from your medical school,
please allow five business days for the submitted document to be
added to your previously submitted application.
-
Once your eligibility review has been completed, ECFMG will
conduct a final review of your application. Please allow five
business days for this final review.
The time needed to complete the processing of your application is
contingent upon receipt of all supporting documentation and
verifications.
The preceding information is current as of August 18, 2025 and
is subject to change. Please visit the ECFMG website frequently
for updates regarding these requirements.
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