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Through its program of certification, the Educational Commission for Foreign Medical Graduates (ECFMG) assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).

ECFMG acts as the registration and score-reporting agency for the USMLE for foreign medical students/ graduates, or in short, it acts as the designated Dean’s office for International Medical Graduates (IMGs) in contrast to the American Medical Graduates (AMGs).

It conducts three examinations: Step 1, Step 2CK, Step 2CS. The ECFMG certificate is issued to a physician if he or she passes the three exams within a time period of seven years.

Medical schools in Canada that award the M.D. are not assessed by ECFMG because the Liaison Committee on Medical Education historically accredited M.D.-granting institutions in both the U.S. and Canada (today, Canada has its own accrediting body that generally follows U.S. standards). M.D. graduates of American and Canadian institutions are not considered IMGs in either country.