01 Jun A guide for the Kenyan graduate considering US-based medical training: nuts and bolts of ECFMG certification, USMLE registration, and applying for US residency

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Before proceeding any further, the first question you are going to want to ask yourself is whether you are interested in pursuing post-graduate training. The next question to consider is whether you are considering pursuing this training in Kenya, or internationally. Kenyan trainees might have considered US-based post-graduate training for a myriad of reasons. If one can get into a US residency program, it is cheaper in the long run (as you do not pay fees and get a stipend), and may be more fulfilling for one’s long-term goals. Additionally, this training opens up a diversity of future opportunities, including options to practice in the US, Kenya, and possibly other countries.

Introduction: on getting into a residency

One of the most frequently asked questions on pursuing this option is how to get into residency. I advise people to think about the path to US residency as a “matatu” or a bus, and the wheels to that bus is Educational Commission for Foreign Medical Graduates (ECFMG) certification. Everything starts and ends with that, as long as you did not graduate from a US medical school (regardless of whether or not you are a US citizen). In this case, your administrative paperwork will go through ECFMG. ECFMG certification process starts with applying for ECFMG registration. You’ll need to dedicate a decent amount of time to familiarize yourself with the ECFMG website (https://www.ecfmg.org/). Alternatively, you can download the ECFMG booklet which provides an outline of the website’s content, and the overall process. I have always gone back to review this booklet to keep myself updated on the latest regarding ECFMG certification.

What is ECFMG?

This is a non-profit organization, which has been allowed by the US Department of State to support the Exchange Visitor Program for physicians. It also has a mandate from the Federation of State Medical boards to complete primary credential verification for International Medical Graduates (IMGs). As such, ECFMG handles everything from verification of medical credentials to visa sponsorship for IMGs. In essence, it ends up acting as your dean’s office for the purposes of residency or graduate medical education in the US. You can learn more about ECFMG’s programs from their website (https://www.ecfmg.org/). Fortunately, the website is user-friendly, and applicants should largely be able to follow the steps outlined on the website even without guidance.

Are you eligible for ECFMG certification i.e. does your medical school qualify for ECFMG certification?

For many years, there were only two universities in Kenya that ECFMG recognized for ECFMG certification; the University of Nairobi and Moi University. As new schools have been registered, this list has expanded. Prospective applicants for ECFMG certification must check to ensure that their university is eligible for ECFMG certification before proceeding with the application for certification. To do so, check the ECFMG website under “Requirements for Certification”, alternatively you can also check the World Directory of Medical Schools (WMS).
In order to confirm is your school and graduation year are eligible for ECFMG certification, search for your school on the WMS website (https://search.wdoms.org/), and then click on “Sponsor Notes” to get further details on your school’s eligibility for different international bodies including ECFMG. If your school is listed but your graduation year is not eligible or your school does not have a sponsor note from ECFMG, then you’ll need to work with ECFMG and your medical school to get your school eligible. I am not familiar with what this process entails but I suspect it is arduous and time-consuming. Bottom-line, you’ll need to contact ECFMG directly if you encounter issues on questions of eligibility.

Do you need to have graduated from medical school to begin the application process?

A common question is whether you need to have graduated from medical school to start the ECFMG registration process. The answer is no. As long as you are in an eligible medical school (including year of graduation), you can start the application process. However, to be ECFMG certified, you must have graduated from medical school and have provided ECFMG with a copy of your medical school diploma.

Outline for ECFMG certification, USMLE registration, and residency application

  1. You must register on the ECFMG website in order to be assigned an ECFMG/USMLE ID, which will be used throughout the process of your application and afterwards, as long as you remain under ECFMG sponsorship. To learn more about this process, click on the “New to Certification” link on the ECFMG website.
  2. Once you have familiarized yourself with the ECFMG requirements to apply, you will then access the Interactive Web Application (IWA) where you will start your registration process (https://secure2.ecfmg.org/emain.asp?app=iwa). For this step, you will need to fill out several forms. These requirements change often, so be sure to follow guidelines present at the time of your respective application. Go to the bottom and click on applying for a new account, which will walk you through the application process. Key tip: Remember that you’ll need to issue payments to both ECFMG and your school’s deans office. You will need a credit card to pay ECFMG, and either cash or a credit card to issue funds to your dean’s office (see below). They charge you a standard application fee. You will need to submit this fee as part of your application process. Thereafter, you will be able to access downloadable forms to confirm your identify and to start the process of primary source verification of your medical school credentials. The latter involves confidential communication between ECFMG and your medical school. Much of this process still occurs using hard-copy documentation, but ECFMG allows a few schools to use electronic submission. Expect the process to take time and plan to be proactive with the medical school folks. If you are no, it can take months or years to complete. Key tip: have someone that you know go to your medical school’s dean’s office to liaise on your behalf to follow-up on the process for you. Offer to pay for DHL or UPS express for mailing of the source documents. You may be charged a fee to process your documents by the dean’s office of your medical school. Key tip: have someone that you know go to your medical school’s dean’s office to liaise on your behalf to follow-up on the process for you.
  3. Once ECFMG has issued you an ECFMG/USMLE ID number, you should have access to the On-line Applicant Status and Information System (OASIS) within the ECFMG site (https://oasis2.ecfmg.org/). Through this portal, you will be able to monitor your medical school credentials verification process, pay for USMLE, receive notificatiosn from ECFMG e.t.c. Once ECFMG has verified and confirmed your identity, they will notify you if you can apply for USMLE exams in the OASIS application portal. Key tip: While applicants will need to pay for a USMLE exam when they complete the registration for the exam, there may be a lapse between when registration fees are paid and when you actually sit for the exam. I recommend that applicatns think about their individual timeline for sitting a USMLE exam and once committed to it, register in order to be able to find a convenient test centers. This applies to those who may be based in the US as well as those based internationally. For USMLE Step 2 CS, the timing is more crucial since this is only offered at a handful of centers across the US. Another tip is that if you think that you will be targeting programs that may sponsor for an H1b visa (immigrant work visa), you will be required to complete the above USMLEs plus Step 3. The H1b is a lottery visa and as immigration laws have gotten stricter,trainee programs slots supporting this visa have become rare. Please note that IMGs who are non-US citizens/green card holders can complete GME training under an exchange visa program sponsored. The ECFMG is the only organization that can sponsor an exchange physician visa (J1) for GME training once one has matched. Visas and immigration-related issues will be addressed through our webinar series. In the meantime, to read more about which visa might be right for you, please check out the AMA website, which discusses this topic further.
  4. All residency match placements will occur through a separate online portal called the Electronic Residency Application Service (ERAS) system. Applicants will need to apply through ECFMG to get their ERAS token, which is necessary to prepare and submit a residency application. Applicants should start preparing necessary materials as early as possible, and plan to upload materials to the system when the system opens in July. The residency applications are available to programs starting in September. Programs can then invite applicants for interviews after September. Typically, invitations to interview will continue through the entirety of application season which runs until late January, and even sometimes into early February. However, depending on your residency speciality, this may vary. At this stage, you will probably be working with your mentors to respond to individual needs and situations. Applicants should be available to travel even on short notice during that time as turnaround for invitations can be extremely short, even as short as a week to a couple of weeks and may not be available for rescheduling. Key tip: make you’re your application is ready and complete by the time programs can download applications (mid September). This will help increase the likelihood of obtaining interviews, as they fill up quickly. Match day is in March of that application cycle (or around one to two months after interviews have been completed), though there are a few exceptions to the rule for a couple of specialties.

How much does this process cost?

The total cost of this process includes administrative fees for ECFMG certification (which includes USMLE fees), residency application in ERAS, and Match registration. These may cost an estimated $3000 – 5000 depending on where the applicant ends up taking the tests and mailing fees. Additional costs include payment for test preparations materials or courses, travel for USMLE 2 CS (only offered in the US), travel for interviews (number will vary per person),and visa fees. While this may seem like an insurmountable amount, the necessary funds will be disbursed at various junctures in time spanning from a year to couple of years depending on the applicant’s timeline and progress, and will not occur as a lump sum payment. Additionally, one can anticipate paying this off with an average starting resident salary of $60,000 per year. All the same, it may be helpful for expectant trainees to have an overview of the anticipated costs and plan accordingly. Most of the administrative fees are non-refundable.

For additional resources on this topic, you can visit the following websites:

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