When unrest broke out in the state and Church, the Synod chose Jefrem to succeed as patriarch on 3 October 3, 1375.

To protect the Church from interference from feudal lords, he renounced his throne and turned it over to Spiridon,[clarification needed] becoming an ascetic.

He died in the evening of 14 June 1400, and was buried the next day at the Patriarchal Monastery of Peć.

[4] Jefrem left a large original poetry work, preserved in a 14th-century manuscript from Hilandar.

[5] In 1406 or 1407 ("seven summers after ascendance") he was proclaimed a saint by Sava V after showing signs of sainthood.