A Canadian who graduates from an Irish medical school and wants to train in the United States is, in American terms, an international medical graduate. That label comes with a gatekeeper: ECFMG, the Educational Commission for Foreign Medical Graduates, now operating under the name Intealth.
ECFMG certification is what lets an IMG enter US residency training. It is also the item on this list with the most moving parts and the most ways to lose time. We are not advisors, and the rules are long. We read the ECFMG pages directly, last checked 14 October 2026, and we send you back to them for anything you will rely on.
What It Is
ECFMG certification means you have satisfied three types of requirement: medical science, clinical skills and communication skills. ECFMG’s exam requirements page says applicants must satisfy all three. [1]
The medical science requirement is met by passing USMLE Step 1 and Step 2 Clinical Knowledge. [1] The clinical skills and communication skills requirements are met through an accepted ECFMG pathway. [2] Your medical education credentials also have to be verified.
What Changed Recently
Starting with the January 2026 USMLE service transition, the Federation of State Medical Boards provides all USMLE Step exam services for IMGs. [1] If you are reading older guides that tell you to register for Step exams through ECFMG, check the current USMLE bulletin first.
Credentials
ECFMG verifies your final medical diploma and your final medical school transcript. It lists the cost at $110 for each, $220 in total, and says credentials must be uploaded through MyIntealth. Copies sent by mail, courier or email are not accepted. [3][4] If a transcript needs translating, the fee is $52 per page. [3]
Because verification involves your school, it can take time. If your school is slow to respond, that can shape your timeline.
The Fees
All figures are US dollars from the ECFMG fee page, last updated 1 June 2026, and the page says fees are subject to change without notice. [3]
The ECFMG certification application is $580. Applying to a pathway for ECFMG certification is $945. The ERAS token is $185. The USMLE exam application fees are not listed on that page, which sends you to the USMLE website. [3]
Added together, the fees we can confirm come to $580 plus $945 plus $220 plus $185, which is $1,930 before exam fees, ERAS program fees, NRMP fees, travel or a visa. That is a floor, not a budget.
The Seven-Year Clock
This is the rule that most surprises people. ECFMG says IMGs must meet the examination requirements within seven years, counted from the date of the first exam passed and ending exactly seven years later. If you miss it, your earliest passing performance is no longer valid. [5]
ECFMG does not send reminders or notices when a passing performance becomes invalid, so you track it yourself, including on the ECFMG Certificate tab in MyIntealth. [5] There is a route to ask for an exception to retake a step whose pass is no longer valid, described in the USMLE Bulletin. [5]
For a student taking Step 1 during medical school and then pausing for clinical years, this deserves a calendar entry on the day you pass.
How It Connects to the Match
ECFMG certification is not required before you apply, but meeting the exam requirements is required to take part in the match. ECFMG says IMGs must have passing results or satisfactory completion of the certification exam requirements by the NRMP rank order list certification deadline. [6]
It also says that finishing exams in time is solely the applicant’s responsibility and that ECFMG does not guarantee exam space or assume liability if deadlines are missed. [1] We would take that sentence seriously when planning around test centre availability.
Do Canadians Get Any Shortcut?
We did not find one on the pages we read. The ECFMG pages we fetched do not mention Canada. The practical consequence is that a Canadian who studied abroad follows the same process as any other IMG, and that doing the Canadian MCC exams does not substitute for the American ones. We cover the comparison in our USMLE article.
Planning It With Everything Else
If you are applying to both countries, ECFMG sits alongside the MCCQE and NAC. The costs add up, and so do the deadlines. We put the numbers side by side in our residency application cost article, and we explain how the two matches interact in the dual application article.
The Bottom Line
ECFMG certification requires passing USMLE Step 1 and Step 2 CK, meeting the clinical and communication skills requirements through a pathway, and having your credentials verified. The confirmed ECFMG-side fees come to $1,930 before exams, and all exam requirements must be met within seven years of your first passing result.
Start with the ECFMG Information Booklet, then the USMLE bulletin, and keep a record of the date you pass your first step. Our Resources page lists the sources we trust.
References
- Intealth ECFMG. (2026). Medical science examination requirement. https://www.ecfmg.org/2026ib/exam-requirements.html
- Intealth ECFMG. (2026). Time limit for completing examination requirements. https://ecfmg.org/2026ib/time-limit-complete-exams.html
- Intealth ECFMG. (2026). Fees. https://ecfmg.org/fees/index.html
- Intealth ECFMG. (2026). 2026 Information Booklet: introduction. https://www.ecfmg.org/2026ib/index.html
- Intealth ECFMG. (2026). Time limit for completing examination requirements. https://ecfmg.org/2026ib/time-limit-complete-exams.html
- ECFMG. (2026, June 24). ERAS 2027 residency tokens now available. https://www.ecfmg.org/news/2026/06/24/eras-2027-residency-tokens-now-available/