Choose the first Pathway whose eligibility rules apply to you. Pathway 1 covers qualifying unsupervised licensure; Pathway 2 covers a qualifying licensure OSCE; Pathways 3–5 depend on specific school or accreditation arrangements; Pathway 6 uses six qualifying Mini-CEX evaluations. A previous Step 2 CS failure directs applicants to Pathway 6 under current rules.
What to remember
- Pathways are eligibility categories
- Applicants cannot choose only by convenience
- All Pathway applicants need OET Medicine
- School and graduation rules matter
- Pathway 6 has six new clinical encounters
Pathway 1
This route is for applicants who currently hold or recently held a license or registration to practice medicine without supervision. Current rules define the eligible licensure period and require source verification.
Pathways 2–5
- Pathway 2: an acceptable medical school administers a qualifying OSCE required for licensure.
- Pathway 3: the school is accredited by an agency recognized by WFME and meets ECFMG criteria.
- Pathway 4: the school is accredited by an agency with an NCFMEA comparability determination and meets ECFMG criteria.
- Pathway 5: the school issues the degree jointly with an LCME-accredited U.S. medical school and meets current rules.
Pathway 6
Pathway 6 applies when the applicant is not eligible for Pathways 1–5. It uses six in-person Mini-CEX evaluations of acceptable clinical encounters by licensed physician evaluators who meet detailed criteria.
Encounters and evaluator acceptances must follow the current application sequence. Prior-season evaluations cannot automatically be reused.
How to choose safely
Read the general eligibility page, then every rule for the Pathway that appears to apply. If Pathway 1 applies, current ECFMG instructions generally require using it rather than selecting another route, subject to special rules such as previous Step 2 CS failure.
Questions students ask
Can I choose Pathway 6 even if I qualify for Pathway 1?
Current rules may require an applicant who meets Pathway 1 eligibility to use Pathway 1. Review the official hierarchy and any special rules for your history.
Can Pathway 6 encounters be virtual?
No. Current ECFMG guidance says telemedicine and virtual encounters are not accepted.
Primary references
Policy and format details were reviewed against these sources on August 8, 2026. Always verify a rule before making an application or scheduling decision.
2027 ECFMG PathwaysOfficial source ↗Pathway 1Official source ↗Pathway 6Official source ↗