IMG · USMLE Service Transition
The ECFMG to FSMB USMLE Transition — What IMGs Need to Know
On January 12, 2026, all USMLE Step examination services for international medical graduates transitioned from ECFMG (MyIntealth) to the Federation of State Medical Boards (usmle.fsmb.org). This page is the complete guide: what changed, what stayed the same, the registration walkthrough, the seven-year rule, Pathways deadlines, and what the transition means for the 2027 Match cycle.
Updated 12 May 2026 · For IMG candidates in the 2026 and 2027 ERAS cycles
The headline. USMLE Step exam registration, scheduling, and score reporting for IMGs now run through FSMB at usmle.fsmb.org. ECFMG Certification and the Pathways for clinical and communication skills verification still run through ECFMG. Your USMLE Identifier and previous Step scores follow you across the transition. The seven-year rule and Step 2 CK passing score (218, raised from 214 in July 2025) are unchanged by the transition.
Before vs after the transition
| Service | Before 12 Jan 2026 | After 12 Jan 2026 |
|---|---|---|
| USMLE Step registration (IMGs) | ECFMG via MyIntealth | FSMB via usmle.fsmb.org |
| USMLE Step scheduling | ECFMG / Prometric | FSMB / Prometric |
| Step score reporting | ECFMG to ECFMG Cert | FSMB to ECFMG for Cert process |
| ECFMG Certification | ECFMG | ECFMG (unchanged) |
| Pathways for clinical/communication skills | ECFMG | ECFMG (unchanged) |
| Credential verification (EICS) | ECFMG | ECFMG (unchanged) |
| USMLE Identifier | Same number | Same number — follows the applicant |
What the transition does NOT change
- Step 1 is still pass/fail (since January 2022). The transition does not affect Step 1 scoring format.
- Step 2 CK is the primary numeric input to residency applications. Mean across all applicants ~248-250; matched US IMGs mean 235.6; matched non-US IMGs mean 244.8 (2024 data). Pass mark raised to 218 in July 2025.
- ECFMG Certification requirements are unchanged: World Directory-listed medical school, Step 1 + Step 2 CK pass, Pathway acceptance.
- The seven-year rule still applies: all USMLE exams passed and Pathway accepted within seven years of passing your first USMLE exam.
- Pathways deadlines follow the same structure each year: typically the Pathways application deadline is January 31 of the Match year, with new applications no longer accepted after late April.
- NRMP Match registration is unaffected — Match registration is through NRMP directly, not ECFMG or FSMB.
Practical implications for the 2027 Match
If you are an IMG planning to apply in the 2027 Match cycle (applications open June 2026):
- Register for USMLE Steps through FSMB at usmle.fsmb.org. If you have a previous MyIntealth account, follow FSMB's account migration guidance — your USMLE Identifier carries forward.
- Plan your Pathway timing. The Pathways application deadline for the 2027 Match cycle is January 31, 2027 at 5pm ET. After April 20, 2027, ECFMG no longer accepts new applications for the 2027 Pathways year. If you do not have your Pathway accepted by these dates, you will not meet ECFMG Certification eligibility for the 2027 Match.
- Check the seven-year rule against your first USMLE date. If you passed Step 1 in 2020, your deadline to complete Step 2 CK and have your Pathway accepted is 2027. If you passed Step 1 earlier, build a calendar that completes the certification within seven years of that date.
- Plan Step 2 CK with the 218 pass mark and the matched-applicant mean in mind. Matched non-US IMGs averaged 244.8 in 2024; matched US IMGs averaged 235.6. Aiming for or above your applicant-type mean is the strategic target — not just passing.
- Build US clinical experience for the 2027 application. Observerships, externships, and clinical-experience programmes are the highest-leverage thing an IMG can do during a gap year — and US-based LoRs from US programmes are uniquely valuable for the residency application.
Frequently asked
What exactly transitioned on January 12, 2026?
All USMLE Step examination services for international medical graduates moved from ECFMG (via the MyIntealth portal) to the Federation of State Medical Boards (FSMB, via usmle.fsmb.org). This includes registration, scheduling, score reporting, and re-registration for retakes. ECFMG itself continues to handle ECFMG Certification, Pathways for clinical and communication skills verification, and verification of medical credentials — those are not part of the transition.
Why did the transition happen?
The USMLE programme is jointly sponsored by FSMB and the National Board of Medical Examiners (NBME). Historically, ECFMG administered USMLE for IMGs on behalf of the sponsors. Phase One of a multi-year service transition consolidated USMLE-related services for IMGs under FSMB directly — bringing IMG and US/Canadian-graduate USMLE services onto a single regulatory pathway under FSMB. Phase One was announced complete on January 12, 2026.
Where do I register for USMLE now if I am an IMG?
At usmle.fsmb.org. This is the new IMG registration portal. The previous MyIntealth portal (intealth.org) is no longer the route for USMLE Step registration. ECFMG continues to operate its other services (Certification, Pathways, credential verification) at its existing infrastructure.
Does this affect ECFMG Certification?
Indirectly. ECFMG Certification requirements are unchanged: you must graduate from a medical school listed in the World Directory of Medical Schools, pass USMLE Step 1 and Step 2 CK, and complete one of ECFMG's certification Pathways verifying clinical and communication skills. What changed is where you register and take the Step exams — that is now FSMB, not ECFMG. Your USMLE scores will continue to be reported to ECFMG for the Certification process.
What are the Pathways and when is the deadline?
The Pathways for ECFMG Certification verify your clinical and communication skills, which is one of the ECFMG Certification requirements. There are multiple Pathways depending on your circumstances (e.g. Pathway 1 for graduates with national licence in their home country, other Pathways for other situations). The Pathways application deadline for the 2027 Match cycle is January 31, 2027 by 5pm ET. After April 20, 2027 ECFMG no longer accepts new applications for the 2027 Pathways year. The same deadlines apply structure-wise each year; check ECFMG's current cycle documentation for the exact 2028 dates.
What is the seven-year rule?
Applicants must pass all required USMLE exams and have their Pathway accepted within seven years of passing their first USMLE exam. This is a long-standing ECFMG Certification rule and is unchanged by the FSMB transition. If you passed Step 1 in 2020, your deadline to complete Step 2 CK and have your Pathway accepted is 2027.
Has the Step 2 CK passing score changed?
Yes — separate from the ECFMG/FSMB transition. The Step 2 CK passing score was raised from 214 to 218 in July 2025. This is a USMLE-programme change (jointly approved by FSMB and NBME) and applies to all examinees from July 2025 forward. The mean Step 2 CK score across all applicants is approximately 248-250; the median is around 245. Matched US IMGs had a mean Step 2 CK of 235.6 in the 2024 data, and matched non-US IMGs had a mean of 244.8.
Does the transition affect Step 1 pass-fail status?
No. Step 1 has been pass/fail since January 2022, and that is unchanged by the FSMB transition. The practical consequence is that Step 2 CK has become the primary numeric input to residency applications across all applicant cohorts including IMGs.
What about USMLE scheduling — has that changed?
Scheduling is now handled through the FSMB portal at usmle.fsmb.org. The Prometric testing-centre network continues to be the delivery infrastructure (no change there). IMG candidates schedule their Step exams through FSMB's scheduling system; US/Canadian graduates also schedule through FSMB. The unified scheduling is part of the consolidation.
Do I need to create a new FSMB account if I had a MyIntealth account?
Most IMG candidates will need to register or migrate to the FSMB portal at usmle.fsmb.org. FSMB published transition guidance for IMG candidates in late 2025 and early 2026; consult the FSMB transition pages and the ECFMG news announcements for the specific account-migration steps applicable to your situation. Your USMLE Identifier follows you across the transition; your previous Step scores are not lost.
Does this affect IMG match rates?
Not directly. The transition is a registration and service-layer change, not a substantive change to USMLE content, scoring, or eligibility. IMG match rates in the 2025 cycle were 67.8% for US IMGs (3,108 of 4,587) and 58.0% for non-US IMGs (6,653 of 11,465), per NRMP's 2025 Main Residency Match Results published in May 2025. Those rates reflect 2025 cycle outcomes and are the most recent published data.
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