ECFMG was founded in 1956, in response to the increase need for the evaluation of the readiness of international medical graduates entering the physician workforce during the 1950 expansion of US healthcare system.

In conjunction with NBME, it created what became known as the ECFMG certification which included examinations and assessments of English language proficiency.

[3] The main pathway for international medical graduates who wish to be licensed as a physician in the United States is to complete a U.S. residency hospital program.

First as AAMC suspended temporarily and later eliminated the Step 2 CS examination,[9] ECFMG moved to a pathways model for verification of clinical skills.

All other IMGs will need: As of April 2021, ECFMG certifications obtained by fulfilling the clinical and communication skills requirements through a pathway will expire in 2022 if the applicant does not enter an ACGME-accredited training program in 2021 or 2022.

[12] Expected to be implemented in late 2024, a notable development is anticipated in medical education application procedures.