To the Educational Commission for Foreign Medical Graduates (ECFMG/Intealth):

We, the undersigned international medical graduates (IMGs), respectfully request that ECFMG review its current policies regarding the Occupational English Test (OET) Medicine as a requirement for ECFMG Certification through the Pathways.

We fully recognize and support the importance of demonstrating adequate English-language and clinical communication skills before entering graduate medical education in the United States. Effective communication is fundamental to patient safety and high-quality medical care.

However, we believe that several aspects of the current OET requirement create unnecessary financial, logistical, and professional burdens for qualified international physicians without clearly improving the assessment of their communication abilities.

1. Allow Candidates to Retake Individual OET Subtests

Under the current ECFMG policy, applicants must obtain satisfactory scores in Listening, Reading, Writing, and Speaking during a single OET Medicine test administration.

If a candidate meets or exceeds the required score in three subtests but falls below the required score in only one, the candidate is required to repeat all four components.

We respectfully request that ECFMG allow candidates to retain passing scores and retake only the subtest or subtests in which the required score was not achieved.

A physician who has already demonstrated sufficient proficiency in Listening, Reading, and Speaking should not be required to prove those same competencies again solely because of an insufficient score in Writing, for example.

Permitting individual-subtest retakes would preserve the integrity of the English-language requirement while substantially reducing unnecessary costs, scheduling difficulties, travel, preparation time, and stress for applicants.

2. Increase Transparency in the Assessment of Writing and Speaking

Unlike objective examination components, Writing and Speaking involve evaluator judgment.

Candidates frequently receive only a numerical score without sufficiently detailed feedback explaining which specific aspects of their performance resulted in the score assigned.

For a high-stakes examination that may determine whether a physician can proceed with ECFMG Certification and participate in the U.S. residency application process, greater transparency is warranted.

We request:

• More detailed candidate feedback for Writing and Speaking;

• Clearer explanations of how assessment criteria are applied;

• Greater transparency regarding examiner standardization and quality-control procedures;

• Meaningful information about the basis for a score following a formal re-mark request.

3. Establish a More Transparent and Independent Review Process

Candidates should have access to a meaningful appeal or review mechanism when they believe a subjective component may have been assessed inconsistently.

We ask ECFMG to evaluate whether the current OET review and re-mark procedures provide sufficient safeguards for an examination that ECFMG requires for certification.

Where feasible, disputed subjective assessments should be reviewed independently by an examiner who did not participate in the original assessment.

4. Review the Financial Burden Created by Mandatory Full-Test Retakes

International medical graduates already incur substantial expenses associated with USMLE examinations, ECFMG Certification, credential verification, residency applications, travel, observerships, and other requirements necessary to pursue graduate medical education in the United States.

Requiring candidates to purchase and repeat four OET subtests when only one competency remains below the required threshold imposes an additional financial burden that may disproportionately affect applicants with limited financial resources.

The purpose of the examination should be to establish competency—not to repeatedly test competencies that have already been demonstrated.

5. Provide Greater ECFMG Oversight of a Mandatory Third-Party Examination

Because satisfactory OET Medicine performance is required by ECFMG for applicants pursuing the Pathways, OET is not merely an optional language examination for these physicians.

Its results can directly affect an IMG’s ability to obtain ECFMG Certification and participate in the residency process.

We therefore respectfully ask ECFMG to provide greater transparency regarding:

• How ECFMG evaluates the reliability and validity of OET Medicine;

• How ECFMG monitors scoring consistency;

• How candidate complaints and concerns regarding OET are reviewed;

• What safeguards exist to ensure that the examination remains fair, accessible, and appropriate for its high-stakes role in ECFMG Certification.

Our Request

We respectfully ask ECFMG/Intealth to consider the following reforms:

1. Permit candidates to retain passing OET subtest scores and retake only unsuccessful subtests.

2. Increase transparency and detailed feedback for Writing and Speaking assessments.

3. Strengthen independent review and appeal procedures for subjective components.

4. Review the financial impact of mandatory full-test retakes on international medical graduates.

5. Provide greater transparency regarding ECFMG oversight of OET Medicine as a mandatory certification requirement.

6. Engage directly with IMG applicants regarding possible reforms to the current communication-skills assessment process.

We are not requesting the elimination of English-language competency standards.

We are asking for a system that measures those competencies in a manner that is fair, transparent, evidence-based, financially reasonable, and appropriate for a high-stakes requirement affecting thousands of international physicians seeking to enter the U.S. health care system.

We respectfully request that ECFMG review these concerns and provide a formal response regarding whether these reforms can be considered for future Pathways cycles.

International Medical Graduates and ECFMG Applicants