Road Map to US Residency:A Post-Pandemic Guide for Filipino IMGs
Updated: Aug 24, 2021
PART 1: ECFMG Certification
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What is the ECFMG (Educational Commission for Foreign Medical Graduates)?
The first major hurdle for any Filipino medical student or graduate in securing a residency spot in the United States is getting certified by the ECFMG. . This is the agency that certifies whether international medical graduates have the adequate medical knowledge and language proficiency to enter residency or fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). ECFMG certification is also a requisite to the final step of the USMLE (Step 3).
While each resident-hopeful’s journey would be unique, we aim to help you create timeline by walking you through the steps needed to get certified by ECFMG, from signing up to getting your certificate, including the nuances brought about by the COVID-19 pandemic.
Getting Started
Create an ECFMG account through the Interactive Web Applications (IWA). Both students and graduates can apply for an account. This means that the first step may start before or after graduation. The earliest would be two years into medical school and the latest would be a few months before your target match year starts. Any later would be risky, given the fact that each step in the process may be prone to unexpected delays.
Once you have applied for an account, the form on the website will ask for your biographic, medical school, and contact information. Remember that that the name you put in should exactly match the ones in your identification documents (i.e. passport or green card), to save you from the hassle of having to change names. The email address that you will provide will be ECFMG’s main mode of correspondence with you hereon. Once your email address has been verified you will receive an eight-digit identification number and you’re set for the next step, which is applying for ECFMG certification on the IWA. The online part will cost you $145, and you will be asked to download your Certification of Identification Form (CIF or Form 186). This form will have to be filled and notarized through a NotaryCam webcam conference. This is usually scheduled within the day so be ready with your identification document. Once ECFMG receives your CIF, they will need to process it within two weeks. With this done, you can now apply for the exams! Applying and Scheduling USMLEs The exams required for ECFMG certification are USMLE Step 1, Step 2 CK, and the Occupational English Test. Step 1 covers the basic sciences while Step 2 CK covers the clinical sciences. Although given the name “steps”, the order in which you can take them is rather inconsequential (Step 1 before Step 2 CK and vice versa), and depends on your level or readiness.
Applying for either step for the first time requires you to fill-in an extensive 23-itemform online. During this part, graduates will have to upload a copy of their diploma with its English translation, most commonly through the my ECFMG app. With each exam application you will be asked to pick your eligibility period. This is the three-month period within which you have to take your exam. Upon completion you will have to pay$965 for each exam.
ECFMG then requests verification of your status from your medical school. Schools can either verify online via the ECFMG Medical School Web Portal (EMSWP) or on paper via Certification Statement Form 183. The latter would require you to print and fill out the form, have the dean sign and stamp, and send it to ECFMG in Philadelphia. Luckily, most Philippine schools verify through the EMSWP. Once your medical school completes status verification, you will be notified of your eligibility period and asked to wait for a scheduling permit. This permit usually arrives within a week and provides you with a scheduling number and a candidate ID number (CIN) which you will use to set a site and date for your exam on the Prometric website. Preparing for the USMLEs For the USMLE Step 1, the widely recommended minimum material to master is the First Aid and UWorld. For Step 2 CK, UWorld still is the most popular question bank, followed by NBME. This is not to discount the fact that there are tons of other materials you could choose to study for both exams, and it depends on even a lot more factors, which this post will unfortunately not cover. What is important is that you take the exam when you feel ready. The question banks attempt to gauge your readiness by giving you a predicted score. Your target will depend on the competitiveness of your chosen specialty. Most would advise international medical graduates to aim for a Step 1 score of at least 230 or 250. Nothing is really certain because some residency programs do not indicate or even require scores. Also, starting January2022, Step 1 scores will be a thing of the past, as Step 1 would simply be a pass-or-fail exam. The soonest time you absolutely feel unready for the exams, you can consider moving your eligibility period or even your exam date, but this would come at a price. Before the exam date, check your Prometric site and be aware of test center policies, especially their COVID-19 precautions. There is a sample exam offered by Prometric that helps you understand the testing interface and may help those with test anxiety feel more at ease. This can serve as a simulation of the test. Taking and Passing the USMLEs On the day itself, come half an hour early to your Prometric site and prepare to sit for hours on end, staring at a computer screen, answering multiple choice type questions.
The USMLE Step 1 has seven blocks of 40 questions each, and Step 2 CK has eight. You will be given an hour to answer each block and an hour for break including an optional 15-minute tutorial. You can divide your break time as you please but can only take breaks in between blocks. Checking in and out of the room will be part of the break time, so always be mindful of your remaining time. After finishing the question blocks, you will answer a survey, receive a dry-sealed proof of completion, and go home to rest your eyes.
The waiting game usually lasts for two to three weeks but can be as long as eight weeks, barring announced delays. Be sure to regularly check the USMLE website for delays that may affect you. The anxiety reaches its peak the moment you receive an email that tells you that your score report is ready. On the IWA, you can access a pdf of your score report, indicating your score, where you fall on the curve, and how well you performed in each subset. With the pass/fail change in Step 1,we wonder how the classic look of the score report will change. Ultimately, we hope you get that passing score report and move on to the next steps. Occupational English Test With the suspension of the Step 2 CS in 2020, and the unsuccessful attempt to bring it back the following year, the ECFMG started to require IMGs to take the Occupational English Test (OET) instead. The OET is a language test specifically designed for medical professionals in order to assess their English skills in listening, reading, writing, and speaking, corresponding to the four subtests of the exam. Fortunately, since Philippine medical schools run on English as a medium of instruction, the OET preparation for Filipino students and graduates would be less of a feat than the USMLEs. At the minimum, familiarizing yourself with the format of the tests would suffice. Try the free practice materials available at the OET preparation portal website to give you an idea of how ready you are. Chances are, you would already be confident to register.
Registering for the OET is independent from the USMLEs, and starts with creating an account with myOET to receive a 9-digit candidate number. You will have to upload a passport photo, and the you will be able to book for either a paper or a computer exam. The paper exams are given twice a month at specific test locations. Pick the date that best fits your timeline and pay AU$587 (Yes, OET is based in Australia). Two weeks before your schedule, your test site will notify you of the timetable of the subtests, among other important information. Days before the schedule, be sure to checkout the two-part OET Ultimate Guideto Test Day Part 1 and 2. Arrive at the test site at least 30 minutes before the first subtest on your timetable. In my experience, the speaking part was done individually in the morning, and in the afternoon, all test takers will check in to take the listening, reading, and writing parts together, in that order. The scores will be posted on your myOET dashboard after three weeks. The satisfactory mark is a B- level or score of 350 on ALL subsets. The emphasis on ALL means that if you fail to get 350 on any subtest, ECFMG will require you to retake all four. Hopefully our English education would not allow you to get to that point. In order for ECFMG to receive your scores, you will have to allow them to view your scores on the OET dashboard and fill up an online form provided on the email notification. This form allows OET to link your scores with your ECFMG ID number. Applying to the Pathways Also, since the suspension of Step 2 CS, ECFMG introduced the pathways to certification. There are currently six pathways. The simplest and probably the most recommended for Filipino IMGs is Pathway 1. This pathway is for those already licensed to practice medicine in another country, such as thosewho already took the local Physician Licensure Exam. Once pathway applications open (around late April this year), you can log on the Certification Pathways website using your ECFMG number. Pathway 1 would require access to your OET results, certificate of good standing (COGS) from the Professional Regulation Commission (PRC), and a payment of $900. To get a COGS, you have to set an appointment using the Licensure Examination and Registration Information System (LERIS). On the appointment day, be ready to showthem your valid PRC ID, pay ₱75, and ask them to email a copy to ECFMG. The other pathways, 2 through 6 are only for those who cannot apply for Pathway1. Pathway 2 is for those who do not have a license but passed a standardized clinical skills examination outside the United States. Unfortunately, as of writing none of these exams can be done in the Philippines. They are administered by medical councils in the UK, Australia, Canada, Ireland, New Zealand, Switzerland, Chile, and Malaysia, which will require you to fly to those countries. Pathways 3, 4, and 5 are only open for certain eligible medical schools, none of which are from the Philippines (as of writing). Although, in the upcoming years, Filipino IMGs might be eligible through Pathway 3 since the Philippine Accrediting Association of Schools, Colleges, and Universities (PAASCU)has applied for World Federation for Medical Education (WFME)
Programme Recognition. PAASCU is tentatively scheduled for an assessment visit this October 2021. Once PAASCU gains its recognition status, all Philippine medical schools accredited by it will be included in Pathway 3. Check out this map of countries served by agencies with recognition status.
Pathway 6 is the baby among them, introduced only this match season. Like before, it’s for those who do not fit into the first five pathways, or those who have failed the CS. This pathway will require you to take a Mini-Clinical Evaluation Exercise(Mini-CEX) which will assess your skills on medical interviewing, physical examination, professionalism and communication, and clinical reasoning and judgment. You will be evaluated by at least three acceptable physician evaluators in six acceptable clinical encounters. The criteria for being “acceptable” are enumerated on the ECFMG website. Not much has been elaborated on this pathway so far, so if you think this is going to be your path, be sure to keep yourself posted for when they announce further details.
Getting that certificate!
Once ECFMG receives your COGS (approximately after 1 business day) and OET scores (approximately after 3 business days), your application for Pathway 1 will be approved. This will be reflected on the Certification Pathways dashboard upon logging in. ECFMG conducts a final review of your applicant record usually taking up to two weeks. Once done, ECFMG will notify you that your standard ECFMG certificate will be delivered to your address in five days. Yay!
The process of getting certification from ECFMG has evolved so much since the pandemic started. This account of steps is updated as of writing, but may likewise get outdated as the world starts to open back up. Nonetheless, we hope this helps bring some semblance of order to help you plan for US residency.
Since the journey to US residency goes beyond ECFMG certification, make sure to check out part2 of this series.
Authors
Ray Ragasa, MD
Ray is a graduate of the University of the Philippines College of Medicine in Manila. He finished internal medicine residency at the Philippine General Hospital in 2019, and is applying into residency this 2022 match cycle. In his spare time he enjoys yoga, baking, and learning languages, most recently ASL.
Dizarelle Dela Cruz, Medical Student
Dizarelle is a medical student from Our Lady of Fatima University, Philippines. She is currently finishing her core rotations in Chicago and is hoping to apply in the next match cycle. When she’s not studying for her Steps, she enjoys reading, singing, dancing, and exploring the city.
Kevin Arendon, Medical Student
Kevin is a medical student of Our Lady of Fatima University in the city of Valenzuela of the Philippines. He is currently completing his core rotations in Chicago. Whenever he has time off, he is busy learning how to cook, singing, and riding bikes.