Pathway 6 for ECFMG Certification
In previous posts, we have explored the different pathways that international medical graduates can use to apply for certification with the Educational Commission for Foreign Medical Graduates, the ECFMG.
These pathways are application processes through which a foreign/international medical graduate can use to apply for residency positions in the United States.
If you are not eligible for Pathways 1 to 5, the last remaining option is Pathway 6.
Pathway 6
In Pathway 6, an applicant’s clinical skills are to be evaluated by licensed physicians.
The applicant will be evaluated through the ECFMG’s Mini-Clinical Evaluation Exercise, otherwise known as Mini-CEX.
Mini-CEX
The Mini-CEX is a series of 6 real, in-person clinical encounters.
The encounters must be real. No virtual encounters or telemedicine encounters are allowed. You cannot use standardized patients as used in an OSCE.
The exam has to be conducted in a formal, clinical setting: a hospital or clinic.
In other words, you will interview and examine patients, and as you do that, you will be evaluated by another physician.
The patient cases must be from general medical practice. This includes general internal medicine, family medicine, pediatrics, obstetrics and gynecology.
You are not allowed to have cases from your specialty or any specialty other than general medicine.
Criteria for Acceptable Clinical Encounters
There are 6 encounters you must take. Each encounter will be registered with the Electronic ECMFG Mini-CEX which will be accessed by the examining physicians.
You are evaluated in four (4) key areas.
- Medical Interviewing
- Physical Examination Skills
- Professionalism/Communication Skills
- Clinical Reasoning and Judgement
You will be scored on a scale of 1 to 9 for each encounter.
1 – 3 scores: Starting in medical school
4 – 6 scores: Graduated medical school
7 – 9 scores: Practicing medicine
The physician evaluating you will score you in the above areas. The final scores will be reviewed by the ECMFG and its team of physicians.
Criteria for Acceptable Physician Evaluators
One physician may evaluate one candidate on only 2 encounters.
As there are 6 encounters, you will need to have 3 physicians agree to evaluated you.
A physician who agrees to evaluate you can do so for only 10 candidates or less.
Candidates are required to get approval of the evaluator first, and the evaluator must provide his or her full name and email address.
The physician must be fully licensed, with no restrictions, to practice medicine in that jurisdiction. This means no supervision is required for the evaluator.
The physician must have a total of 5 years of experience of unrestricted medical practice.
The physician must not be a family member.
There must be no compensation for any member. You cannot pay the evaluator. You cannot pay the patient as well. The work must be done in the physician’s regular place of employment.
The candidate will need to attest – provide that the information is true and fact – that the evaluator meets the requirements for the position.
All General Requirements Apply
The same requirements for other pathway applicants for ECFMG certification apply for Pathway 6.
This includes:
Approved medical school (ECFMG and/or WFME)
United States Medical Licensing Exam (USMLE) Step 1 and
United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills
Occupational English Test (OET) Medicine
The pathway cost is $925 US.
Is Pathway 6 Good For You
If you do not meet the requirements for pathways 1 to 5, then pathway 6 is the only one left that available to you.
Pathway 6 allows you the chance to be observed performing medicine in a clinical situation. The encounter can be in your native language or the language of the patient; however, all documentation must be in English.
The drawback is that you will need 3 physicians that can work with you. They cannot be related to you in any way. One evaluating physician can work for only 10 applicants, this can pose a challenge to some medical school programs that are supporting their students with this pathway.
You are responsible for getting the physician examiner to agree to the test. The physician will need to access the portal with the email they provide, and download instructions.
Once you have submitted all physician information, you will have 15 days to complete the Mini-CEX. This means from the minute the physician agrees on the portal to perform the evaluations for you – the candidate – you both have 15 days to finish all 6 (or all 2 as it is one physician and 2 encounters only).
As this pertains to the next match (Match 2023), all Mini-CEX for the ECFMG must be completed by February 15, 2023.
If you really want to work in the United States, and options 1 to 5 do not match your situation, you can apply through Pathway 6.
Final Thoughts
Pathway 6 is the final option for international medical graduates to apply for residency certification for medicine in the US. The ECFMG has the right to change the pathway requirements.
