Requirements for ECFMG Certification for 2022 Match

ECFMG is no longer accepting new Pathways applications for applicants who wish to participate in the 2022 Match. If you submitted a Pathways application, you can continue to check its status using the on-line application. For information for 2023 Match participants, please monitor the ECFMG News page.

Information for Physician Evaluators for Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians

Overview

In response to the suspension and subsequent discontinuation of the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination^® (USMLE^®) by the USMLE program, ECFMG|FAIMER has offered Pathways to allow international medical graduates (IMGs) who have not passed Step 2 CS to meet the clinical and communication skills requirements for ECFMG Certification. ECFMG|FAIMER first offered the Pathways to IMGs participating in the 2021 Match and is continuing and expanding the Pathways for IMGs participating in the 2022 Match.

There are six Pathways through which applicants can apply to meet the clinical and communication skills requirements for ECFMG Certification. To meet the requirements for Pathway 6, the applicant’s clinical skills must be observed and evaluated by licensed physicians during six real, in-person clinical encounters using ECFMG’s Mini-Clinical Evaluation Exercise (Mini-CEX) for Pathway 6. The Mini-CEX is a well-studied workplace-based assessment tool used to evaluate an individual’s clinical skills in a variety of clinical settings.

The information provided on this web page is for physicians who have been asked to complete a Mini-CEX evaluation by an applicant, or applicants, to Pathway 6. Please read all the information on this page before completing the Mini-CEX and submitting your evaluation to ECFMG.

If you have any questions about this process or need assistance to complete a Mini-CEX for an applicant, please contact ECFMG at [email protected].

For general information on the Pathways, please see Requirements for ECFMG Certification for 2022 Match.

Steps for Completing the Mini-CEX for Pathway 6

Following are the steps required by both the physician evaluator and the applicant to complete the Mini-CEX for Pathway 6.

Step 1: Applicant confirms physician evaluator’s eligibility and obtains physician’s approval.

• The applicant must:
  • Confirm your eligibility to serve as an evaluator.
    • To be eligible, you must meet the Criteria for Acceptable Physician Evaluators outlined below.
  • Obtain your approval to:
    • Observe the applicant during a distinct, real, in-person clinical encounter.
    • Provide an evaluation of the applicant’s clinical skills as observed during the clinical encounter to ECFMG using the ECFMG Mini-CEX for Pathway 6.

Step 2: Applicant provides evaluator’s information to ECFMG.

• The applicant must:
  • Provide ECFMG with your name and e-mail address.
    • The name the applicant provides should be your full name as it appears on your license/registration to practice medicine.
    • Your e-mail address will be used to verify your access to ECFMG’s Clinical Skills Evaluation and Attestation Portal, which is where you will accept or reject the applicant’s request and, if accepted, complete the electronic Mini-CEX evaluation for the applicant. Please be sure to provide the applicant with the same e-mail address that you will use to access the portal.
  • Obtain your approval to provide this information to ECFMG.
  • Attest to a number of statements when providing your information to ECFMG, including statements indicating that you meet the Criteria for Acceptable Physician Evaluators.

Step 3: Evaluator receives an e-mail from ECFMG indicating that applicant has requested a Mini-CEX evaluation.

• Once the applicant has provided your name and e-mail address, ECFMG will send you an e-mail to:
  • Confirm that you have been asked to complete a Mini-CEX evaluation on behalf of the applicant.
  • Request that you log into ECFMG’s Clinical Skills Evaluation and Attestation Portal to complete your profile and accept or reject the applicant’s request.

Step 4: Evaluator logs in to ECFMG’s Clinical Skills Evaluation and Attestation Portal and completes portal profile.

• To log in to the portal, you will need to use the same e-mail address that you provided to the applicant and to which the e-mail from ECFMG was sent.
• The first time you log in to the portal, you will need to complete your profile, which includes:
  • Confirming your name as it appears on your license to practice medicine.
  • Providing the name(s) of the authority(ies) with which you are licensed.
  • Providing your medical license/registration number(s).
• Once you have completed your profile, you will be able to accept or reject requests from applicants and complete Mini-CEX evaluations.

Step 5: Evaluator accepts or rejects the applicant’s request for a Mini-CEX evaluation.

• If you agree to evaluate the applicant, you must accept the applicant’s request before observing the applicant during a clinical encounter (Step 7 below).
• You will have 15 days to accept the request after the applicant submits it. If you do not accept the applicant’s request within 15 days, the request will be automatically rejected. The applicant will be notified by e-mail that the request has been rejected and will be able either to submit information for a new evaluator or re-enter your information in order to send another request to you to complete the Mini-CEX.
• If the applicant has requested that you complete two Mini-CEX evaluations, each request must be accepted or rejected individually.
• If you reject the request, you will be asked to confirm that the encounter did not take place and provide a reason for rejecting the request. The applicant will be notified via e-mail that you have rejected the request and will be able to identify a new evaluator. The applicant will not be notified of the reason you provide for rejecting the request.
• The applicant may withdraw the request before you accept it. Once you accept a request, the applicant may no longer withdraw it, but you will still be able to reject it. If the applicant withdraws the request, you will be notified by e-mail and requested to contact ECFMG if the encounter has already taken place.
• The applicant is only able to identify one evaluator for each encounter; therefore, if you are unable to observe the encounter and submit the Mini-CEX evaluation, we kindly request that you reject the request as soon as possible to allow the applicant as much time as possible to identify another evaluator.

Step 6: Evaluator identifies an appropriate in-person clinical patient encounter in which to observe and evaluate the applicant’s clinical skills.

• The encounter must meet the Criteria for Acceptable Clinical Encounters below.

Step 7: Evaluator observes the applicant during the clinical encounter.

• The applicant must perform a medical interview and an appropriate physical examination of the patient.
• At the completion of the encounter, the applicant should summarize the patient’s clinical findings in a brief (less than five minutes) presentation that includes an appropriate differential diagnosis and a plan for the next steps for diagnosis and treatment.

Step 8: Evaluator logs into the Clinical Skills Evaluation and Attestation Portal to complete the Mini-CEX evaluation of the applicant’s clinical skills.

• See ECFMG Mini-CEX for Pathway 6 below for details on completing the Mini-CEX evaluation.
• Once you submit the Mini-CEX evaluation to ECFMG, the status of the applicant’s request will be marked as complete to the applicant in his/her on-line application; however, the applicant will not have access to the actual evaluation.
• Do not share your evaluation with the applicant.
• If you do not complete and submit the electronic Mini-CEX evaluation within 15 days of accepting the applicant’s request, the request will be automatically rejected. The applicant will be notified by e-mail that the request has been rejected and will be able to identify a new evaluator or re-enter your information if it is expected that you will complete the evaluation.

Important Notes:

All Mini-CEX encounters must be completed through the process outlined above, and all Mini-CEX evaluations must be completed through ECFMG’s Clinical Skills Evaluation and Attestation Portal. ECFMG will not accept Mini-CEX evaluations submitted outside of the Clinical Skills Evaluation and Attestation Portal in any way, including by e-mail.

It is the responsibility of applicants to ensure that their physician evaluators complete the Mini-CEX evaluations in support of their applications. An application cannot be approved until all completed Mini-CEX evaluations are received and accepted by ECFMG. All Mini-CEX evaluations must be received by ECFMG no later than December 31, 2021.

If an applicant does not meet ECFMG’s scoring requirements for the six Mini-CEX evaluations, all six Mini-CEX evaluations for that applicant will automatically be provided to the Pathway 6 Review Committee for review. The Pathway 6 Review Committee is comprised of physician reviewers from ECFMG|FAIMER and its Board of Trustees. The Committee will determine whether the applicant has met ECFMG’s clinical skills requirements for Pathway 6 based both on the scores and the reasons for the scores provided by the physician evaluators. The Committee may contact you for additional information about any Mini-CEX evaluation(s) you have submitted for an applicant whose evaluations are under review.

Criteria for Acceptable Physician Evaluators

To serve as a physician evaluator for an applicant, you must:

• Currently hold a full, unrestricted license to practice medicine without supervision.
• Have held a full, unrestricted license to practice medicine without supervision for a minimum of five years.
• Be authorized to perform the Mini-CEX activity in the jurisdiction where the encounter will take place.
• Directly observe and evaluate the applicant during an in-person clinical encounter and provide an accurate assessment of the applicant’s clinical skills to ECFMG using ECFMG’s Mini-CEX for Pathway 6.
• Give the applicant approval to share your name and e-mail address with ECFMG.
• Not be a relative of the applicant. For the purposes of this evaluation, “relative” is defined as a spouse, child, grandchild, parent, grandparent, sibling, uncle, aunt, nephew, niece, and/or cousin.
• Not be compensated by the applicant to perform the evaluation.
• Not be compensated by any third party to perform the evaluation other than what is provided as your salary or wage from the institution where you are employed and where the clinical encounter will take place.

The applicant will be required to attest that you meet these criteria at the time s/he submits your information to ECFMG. You will be required to attest that you meet these criteria when you complete the on-line Mini-CEX evaluation for the applicant.

In addition, please note that if you meet ECFMG’s criteria to serve as a physician evaluator, you may:

• Evaluate an individual applicant on up to two clinical encounters.
• Evaluate more than one applicant.

Criteria for Acceptable Clinical Encounters

Each clinical encounter in which the applicant is observed must:

• Be a real, in-person clinical encounter. Telemedicine and standardized patient encounters will not be accepted.
• Take place in a formal clinical setting such as an outpatient office, an urgent care clinic, an emergency room, or a hospital.
• Be primary care/general practice in nature and not subspecialized.
• Focus on the diagnosis and treatment of acute and/or chronic illnesses in a primary care setting (such as general internal medicine, family medicine, pediatrics, or obstetrics and gynecology) in which each of the four components of the Mini-CEX (Medical Interviewing Skills, Physical Examination Skills, Professionalism/Communication Skills, Clinical Reasoning & Judgment) can be assessed.
• Be one for which the patient has granted permission to be observed.
• Occur after you have accepted the applicant’s request to observe the encounter.

Additionally, both you and the applicant must take all steps necessary to ensure that the clinical encounter is conducted in compliance with all applicable licensure, regulatory, and/or legal requirements. The applicant will be required to attest to this at the time s/he submits your information to ECFMG. You will be required to attest to this at the time you complete the on-line Mini-CEX evaluation for the applicant.

ECFMG Mini-CEX for Pathway 6

To complete the Mini-CEX evaluation for the applicant through the Clinical Skills Evaluation and Attestation Portal, you will need to provide general information about the encounter, including the date on which the encounter took place, the health care facility/hospital at which the encounter took place, the setting of the encounter, the patient’s age, and the patient’s gender.

You will then score applicant’s performance during the clinical encounter on each of four clinical skills components:

• Medical Interviewing Skills
• Physical Examination Skills
• Professionalism/Communication Skills
• Clinical Reasoning & Judgment

For each component, you will score the applicant’s performance on a scale of 1 to 9, with 1 being the lowest score and 9 being the highest score, based on the following anchors:

• a medical school student beginning clinical training (1, 2, 3)
• a medical school graduate (4, 5, 6)
• an experienced doctor or practicing physician (7, 8, 9)

The Mini-CEX for Pathway 6 also includes descriptions of the skills expected at the level of an applicant who is a medical school graduate ready to enter postgraduate training/graduate medical education (GME). If you score the applicant below this level, you will be required to provide additional information about what you observed during the encounter that led to the score.

For a sample Mini-CEX form, which includes a scoring rubric, see the PDF version of the ECFMG Mini-CEX for Pathway 6. Please note that this sample version is for your reference only; it should not be used to complete the evaluation or be submitted to ECFMG. All Mini-CEX responses must be collected and scored electronically through ECFMG’s Clinical Skills Evaluation and Attestation Portal. Paper evaluations and evaluations sent via e-mail will not be accepted.

The preceding information is current as of January 13, 2022 and is subject to change. Please visit the ECFMG website frequently for updates regarding these requirements.