of USMLE Step 1 and USMLE Step 2 Clinical Knowledge Meet the clinical and communication skills requirements (see section) Medical education credential requirements: A medical diploma of medical education taken at an institution registered in the World Directory of Medical Schools (WDOM). The official source to confirm that a medical school meets ECFMG’s requirements, is the World Directory at www.wdoms.org. Schools that meet the requirements will have an ECFMG note stating this in the schools’ World Directory listing. In comparison, regular graduates from medical schools in the United States need to complete USMLE Steps 1 and 2 as well, but can participate in the NRMP while still doing their final year of medical school before acquiring their medical diplomas. In effect, taking regular administrative delays into account, and with residency programs starting around July, there is a gap of at least half a year for IMGs between graduation from medical school and beginning of a residency program. Clinical and communication skills requirements The COVID-19 global pandemic has brought some changes to the ECFMG certification process. First as AAMC suspended temporarily and later eliminated the Step 2 CS examination, ECFMG moved to a pathways model for verification of clinical skills. IMGs who have already taken Step 2 CS may still use it to fulfill this requirement. All other IMGs will need: Assessment of communication skills, including English language proficiency through the Occupational English Test Medicine exam Meet the requirements for one of the pathways below: Certification expiration As of April 2021, ECFMG certifications obtained by fulfilling the clinical and communication skills requirements through a pathway will expire in 2022 if the applicant does not enter an ACGME-accredited training program in 2021 or 2022. If the applicant enters a training program they become permanent after one year of residency. Projects A pilot project was started in 2012 for an electronic verification system of medical credentials from international medical schools, with participation from approximately 20 international medical schools. After completion of this pilot project, ECFMG now allows all medical schools to register for free. Effective in 2024, the ECFMG will restrict eligibility to USMLE and employment as a doctor in the United States to graduates from medical schools accredited by an agency which is recognized by the World Federation for Medical Education or to an equivalent standard. The accrediting agencies that meet these requirements are: Communication International medical schools can send Medical Student