1. Educational Commission for Foreign Medical Graduates: An Overview

2. New Logo for ECFMG
ECFMG is introducing a redesigned logo in conjunction with the 50th Anniversary.
ECFMG’s Standard ECFMG Certificate and other ECFMG documents will be redesigned to reflect ECFMG’s new logo.
Individuals who review documents related to ECFMG Certification can access more information on these changes on the ECFMG website:
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

3. ECFMG Private, Non-profit Organization
Organizational Members
American Board of Medical Specialties (ABMS)
American Medical Association (AMA)
Association of American Medical Colleges (AAMC)
Association for Hospital Medical Education (AHME)
Federation of State Medical Boards of the United States, Inc (FSMB)
National Medical Association (NMA)
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

4. ECFMG Services ECFMG Certification - Credentials
Certification Verification Service (CVS)
Electronic Residency Application Service (ERAS)
Exchange Visitor Sponsorship Program (EVSP)
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

5. “IMG” Definition
An International Medical Graduate (IMG) is any physician who received his/her basic medical degree or qualification from a medical school outside of the U.S. or Canada, regardless of citizenship
This includes any U.S. citizen who received a medical degree from a school outside of the U.S. or Canada
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

6. ECFMG Certification
ECFMG Certification assures residency program directors and the U.S. public that the international medical graduate (IMG) has met minimum standards to enter U.S. residency programs
ECFMG Certification is required for:
IMG entry into ACGME-accredited GME
Taking USMLE Step 3
State licensure
J-1 visa sponsorship / ECFMG
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

7. Medical Education Credential Requirements for ECFMG Certification
Completion of a medical school curriculum of at least four academic years
Medical school and graduation year listed in the International Medical Education Directory (IMED) See
Documented completion of all requirements for and receipt of final medical diploma
Primary source verification of medical diploma and transcript by ECFMG
GW. Need to mention WHO in second bullet?
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

8. Examination Requirements for ECFMG Certification
Spoken English Proficiency (SEP) is part of the USMLE Step 2 CS
English language proficiency test (TOEFL)
USMLE Step 2 CS
Clinical Skills
ECFMG Clinical Skills Assessment (CSA)
USMLE Step 2 CK Clinical Knowledge
USMLE Step 2 Clinical Science
USMLE Step 1 Basic Science
Current Requirements
Prior Requirements*
*A valid ECFMG Certificate may be based on previously-administered examinations.
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

9. ECFMG Certification Resources
General Certification
ECFMG Certification Fact
Permanent Validation Sticker
Form 246:
Form 295:
E-Newsletter: The ECFMG Reporter
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

10. Certification Verification Service (CVS)
ECFMG's Certification Verification Service (CVS) provides prompt, primary source confirmation of an IMG’s ECFMG certification status. This information is provided to residency programs, state medical boards and other organizations, such as hospitals and HMOs.
Satisfies JCAHO requirement for primary-source verification of IMG’s medical school completion
No charge for GME programs
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

11. CVS Online
Web-based requests for confirmation of ECFMG Certification status
Confirmations sent via postal mail
Establish an account for your program by sending to
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

12. Electronic Residency Application Service (ERAS)
Most residency/fellowship programs require application through ERAS
Developed by the AAMC and administered by ECFMG for IMGs, ERAS transmits the following to program directors through the Internet:
residency applications
letters of recommendation
deans’ letters/ MSPEs
transcripts
other support documentation
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

13. Exchange Visitor Sponsorship Program (EVSP)
Administers J-1 programs -“alien physician” per Federal Regulations 22CFR§62.27(b)
Interfaces with DOS/DHS in tracking of J-1 physicians in SEVIS database
Collaborates with HHS, Academic Medicine and the Legal Community on broad IMG issues
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

14. Immigration Options for Foreign National Physicians

15. *Foreign national = non-U.S. citizen or permanent resident
Who Needs a Visa?
All foreign national* physicians need appropriate visas to participate in U.S. graduate medical education (GME).
Foreign national physicians may be U.S. medical school graduates or IMGs; all foreign national physicians need visas to train in U.S. GME
All IMGs, regardless of citizenship, need ECFMG Certification for U.S. GME, not all IMGs need visas
*Foreign national = non-U.S. citizen or permanent resident
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

16. Immigration Terms
“Visa” - A permit stamped or affixed in a passport to request entry to the U.S. Only needed at time of entry into the U.S.
“Visa Status” -Legal classification reflecting physician’s authorized activity while in the U.S., i.e. B-1, J-1, H-1B
U.S.C.I.S. - U.S. Citizenship and Immigration Services, formerly the “I.N.S.”
U.S. Consulate – Branch of U.S. Embassy that issues visas. Part of the U.S. Department of State. Only located outside U.S.
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

17. Foreign National Physicians and IMGS
Entry into U.S. GME
Foreign National Physicians and IMGS
Complete ECFMG Certification (if IMG)
Meet examination and credentialing requirements
Apply for U.S. Residency Training Position
Apply to ERAS
Interview with programs
Enroll in the NRMP Match
Secure a contract/letter of offer
Seek Appropriate U.S. Training Visa/Status
(if foreign national physician)
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

18. Most Common Visas Types for Foreign National Physicians in U.S. GME
J-1 “Alien Physician”
ECFMG is the only sponsor for clinical training in the “alien physician” category
H1-B “Specialty Occupation Worker”
J-2 “Dependent”
J-2 is defined as the spouse or minor child of J-1 visa holder
F-1 “Student”
Optional practical training – one year of training
O-1 of “Extraordinary Merit”
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

19. Visa Considerations Hospital policies
Does the hospital require a specific visa classification for GME, or is it decided by the physician or by the program?
Physician’s long term goals and plans
Physician’s immigration history in U.S.
Physician’s personal/family ties in the U.S.
Assess the facts, ask questions
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

20. Considerations Specific to IMGs in General Surgery
Preliminary Years
Research Before/During Training
Subspecialty Training
Give IMGs competitive edge
Requires advance to categorical
Extends overall duration
Prior to residency requires change of category
During residency extends overall duration; visa timeframe considerations
Requires careful planning
Must change visa status or petition for an exceptional extension if not completed within allowed visa status maximum
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

21. J-1 Exchange Visitor Visa
vs.
H-1B Temporary Worker
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

22. J-1 Visa Status Educational & cultural exchange “Non-immigrant intent”
ECFMG sole sponsor
USMLE Steps 1, 2CK, 2CS
Valid ECFMG certification
Funding – hospital, home government or personal
7 year maximum
Two-year home residency requirement (*waiver)
J-2 dependents eligible for work authorization
4 - 6 weeks processing
Fee = $200
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

23. H-1B Visa Status Temporary Worker in a Specialty Occupation
“Dual Intent”
Employer sponsored
USMLE Steps 1, 2CK, 2CS, 3
Funding – hospital salary
6 year maximum
No home residency requirement
H-4 dependents not eligible to work
weeks
Fees - DHS, DOL & Attorney
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

24. Immigration Steps
Determine most appropriate visa classification for physician and program
Program applies for visa documentation from either ECFMG or USCIS/DOL
Physician applies for a “visa” at a U.S. Consulate abroad and enters US
If already in US in alternate “visa status,” physician applies for a change of status through government service center
Training can not begin until physician has obtained appropriate visa status
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

25. Visa Application Process
Physician must schedule visa appointment at U.S. Consulate in the home country via web or phone
Possible delays due to security clearances
Arrival in U.S. in appropriate visa status authorizing medical training
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

26. J-1 Physician + TPL = Complete Application
ECFMG J-1 Sponsorship
J-1 Physician + TPL = Complete Application
Sponsorship Available for Participation in:
ACGME Accredited Residency Training
ACGME Accredited Subspecialty Training
Non-Standard Programs (advanced cutting edge fellowships)
Extension for Board Examinations
Sponsorship Application Materials
Online Application Payment and Status updates through OASIS
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

27. 6 Steps of the J-1 Visa Sponsorship Process
1. TPL and Physician Complete Application, Submit to ECFMG
2. ECFMG Regional Advisor Evaluates Application
TPL is notified of application deficiencies
If all requirements are met, application is approved
Electronic SEVIS record is created
SEVIS Form DS-2019 is issued
3. SEVIS Form DS-2019 is mailed to TPL
TPL makes copy for hospital records
TPL forwards SEVIS Form DS-2019 to the physician
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

28. 6 Steps of the J-1 Visa Sponsorship Process (continued)
4. Physician Applies for J-1 Visa Status
U.S. Embassy or Consulate abroad, or USCIS Regional Service Center in the US
Requires electronic SEVIS Record and Form DS-2019
For detailed instructions see:
Option 1: Apply at U.S. Embassy or Consulate Abroad
Option 2: Apply for Change of Visa Status in the US
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

29. 6 Steps of the J-1 Visa Sponsorship Process (continued)
5. J-1 Physician Reports for Training
The foreign national physician must present the TPL with evidence of approved J-1 visa status in order to begin the GME program. Documentation includes:
J-1 Visa Stamp in Passport
J-1 D/S (Duration of Status) on I-94 Arrival/Departure Record
6. TPL Must Report Arrival / Delay to ECFMG within Thirty Days of the Training Start Date
Failure to report inactivates the SEVIS record
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

30. Required J-1 Reporting by Host Institutions & TPLs
Arrival / Delays – within 30 days of contract start date
Any Change in the Approved Training Plan
Remediation
Leave of absence/maternity leave
Licensure delay
Proposed off-site rotations
Proposed early advancements
Resignation
Contract termination
Legal Concerns /Allegations, Internal Hearings, etc.
* H-1B Reporting also required
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

31. INTERNATIONAL TRAVEL IS DISCOURAGED DURING TRAINING PROGRAMS
Why?
If the J-1 physician departs the U.S. with an expired visa stamp in the passport, visa renewal will be required to
re-enter. The visa application process may involve lengthy security clearances, etc. and J-1 renewal cannot be guaranteed.
If the J-1 Physician MUST Travel:
Discuss contract conditions - delay, failure to return, etc.
Refer to
Request travel documents from ECFMG
Endorsed SEVIS Form DS-2019
“Letter of Good Standing”
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

32. Maintaining Visa Status
Strict Adherence to J-1 Regulations (22CFR§62)
Compliance With All U.S Immigration Laws
Reporting of U.S. Address
Valid Documentation for J-1
Uninterrupted ECFMG Sponsorship / Valid SEVIS Form DS-2019
Valid Form I-94
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

33. Continuation of J-1 Visa Sponsorship
Available when progressing in a full-time
GME training program
Requires approved contract - usually annual
Continuation Applications
Online Application Payment and Status updates through OASIS
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

34. Special Appeals to the U.S. Department of State
Changes in J-1 Visa Category
Exceptional Extensions of Stay Beyond Seven Years
Advisory Opinions in Special or Unusual Circumstances
Reviewed on case-by-case basis;
contact EVSP for further information.
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

35. Considerations Specific to IMGs in General Surgery
Preliminary Years
Research Before/During Training
Subspecialty Training
Give IMGs competitive edge
Requires advance to categorical
Extends overall duration
Prior to residency requires change of category
During residency extends overall duration; visa timeframe considerations
Requires careful planning
Must change visa status or petition for an exceptional extension if not completed within allowed visa status maximum
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

36. EVSP Resources Review
EVSP for access to:
EVSP Reference Guide
EVSP Fact Sheet
Application Materials
Updates and Memoranda
U.S. Department of State Exchange Visitor
U.S. Citizenship and Immigration
U.S. Department of Homeland
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

37. Exchange Visitor Sponsorship Program
Questions?
Exchange Visitor Sponsorship Program
Tel: (215)
Fax: (215)
Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.