Caribbean Accreditation Authority for Education in Medicine and Other Health Professions

ECFMG Statement on USMLE® Policy Changes

The United States Medical Licensing Examination® (USMLE) program has announced three future changes to its examination program. One of these changes, a change in score reporting for Step 1 from a numeric score to a Pass/Fail designation, is designed to improve the transition of examinees from undergraduate medical education (UME) to graduate medical education (GME) programs (i.e., to residency programs). Two additional changes, a further limit on the number of times an examinee can take each Step or Step Component and the requirement that an examinee pass Step 1 before taking Step 2 Clinical Skills, will help to enhance exam security. Enhancing security is essential to maintaining the integrity of the examination, ensuring it remains an equitable assessment process for all examinees.

These changes are part of the USMLE program’s continuous process of improvement to ensure a high-quality assessment for all physicians who plan to train and practice in the United States. ECFMG is supportive of this process and of the thoughtful and inclusive approach employed by the USMLE program in arriving at these changes. ECFMG also supports the USMLE’s focus on the examinee experience and the goal of improving the transition from UME to GME—a transition that can present unique challenges for international medical graduates (IMGs) who seek to train in the United States.
ECFMG is a strong advocate for the role of IMGs in the U.S. health care system. IMGs comprise approximately 25% of the U.S. physician workforce and are vital to our ability to provide accessible, high-quality health care. Many IMGs who train in the United States stay to practice, frequently serving in primary-care specialties and in underserved areas. Others return home, where they benefit local communities by building physician capacity and providing care in much-needed specialties.
ECFMG is committed to the continued ability of IMGs to enter U.S. GME and offers programs that support IMGs along the continuum from international UME to U.S. GME and practice. ECFMG Certification is at the beginning of this pathway. The USMLE is an important component of ECFMG’s program of certification, the process by which IMGs demonstrate their readiness to engage in U.S. GME. An effective, high-quality assessment is essential for IMGs who wish to demonstrate their qualifications; compete for U.S. residency positions; and continue to contribute to the U.S. health care system through their talents, diversity, and international perspectives. 
For more information on the upcoming changes, please read the USMLE program’s announcement at As more information on these changes becomes available, please monitor the ECFMG website for details on how these changes will affect IMGs who pursue ECFMG Certification and U.S. GME.
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