TOEFL/OET for USMLE? ECFMG OET Medicine Scores 2027
OET for USMLE Quick Summary
You do not need TOEFL, IELTS or OET to sit the USMLE Steps. To become ECFMG certified, every IMG applying through the ECFMG Pathways must pass OET Medicine: at least 350 in Listening, Reading and Speaking and 300 in Writing, in a single sitting. For the 2027 Pathways, the test must be taken on or after January 1, 2025.
Is TOEFL or OET required for the USMLE?
Neither is needed to register for Step 1 or Step 2 CK of the United States Medical Licensing Examination (USMLE). The English requirement comes from ECFMG Certification, which international medical graduates (IMGs) need to enter an accredited US residency program and to take Step 3. ECFMG assesses English through the Occupational English Test (OET) Medicine only. TOEFL and IELTS are not accepted for ECFMG Certification.
Why ECFMG requires OET Medicine
Until January 2021, IMGs showed their clinical and communication skills through USMLE Step 2 Clinical Skills (CS). After Step 2 CS was discontinued, ECFMG introduced the Pathways for ECFMG Certification, and passing OET Medicine is part of every Pathway. OET Medicine is a healthcare English test: its tasks are based on real clinical situations such as consultations, referral letters and patient handovers.
OET Medicine scores required by ECFMG
How to complete the OET requirement
- Create your MyIntealth account with ECFMG and note your MyIntealth ID.
- Book OET Medicine at a test venue and enter your MyIntealth ID when booking, so your results go to ECFMG automatically.
- Sit the test early enough to retake it if needed. For the 2027 Match, ECFMG advises sitting it on or before the last test date in December 2026.
- Apply for the 2027 Pathways by January 31, 2027, and make sure your OET scores reach ECFMG by the same date.
- Pass Step 1 and Step 2 CK so that all exam requirements are met by the NRMP rank order list deadline of March 3, 2027.
See our USMLE timeline for how OET fits around your Steps, and our guide to USMLE exam fees for ECFMG costs.
Frequently asked questions
> Is TOEFL required for the USMLE?
No. TOEFL is not required for the USMLE and is not accepted for ECFMG Certification. ECFMG uses OET Medicine as its English language assessment.
> Do I need OET before taking USMLE Step 1 or Step 2 CK?
No. OET Medicine is required for ECFMG Certification, not for registering for Step 1 or Step 2 CK. You can take it before or after your Steps, as long as you meet the Pathways deadlines.
> What OET score does ECFMG require?
At least 350 in Listening, Reading and Speaking, and at least 300 in Writing, all in one test administration.
> Is OET required even if I studied medicine in English?
Yes. ECFMG requires OET Medicine from all Pathways applicants regardless of native language, language of instruction at medical school, or citizenship, with no exceptions.
> Can I take OET at home for ECFMG?
Only if there is no physical OET test venue in your country. Otherwise you must take the paper-based or computer-based test at a venue.
Not sure where OET fits in your plan? Contact us, or read when you can sit each USMLE Step.
Preparing for Step 1 or Step 2 CK?
Join our live online USMLE course, taught in small groups by experienced medical teachers.
Explore the USMLE Course