Clinical Skills Assessment

    The Clinical Skills Assessment (CSA) provides a means of comparing the clinical skills of International Medical graduates with the skills expected of US medical graduates. The exam allows ECFMG to give greater assurance to program directors that ECFMG-certified residents and fellows will be able to successfully carry out the doctor/patient relationship that they will encounter in graduate medical education.

    Eligibility Criteria -Passing USMLE Step 1 and the English Language Proficiency Test.

    The Clinical Skills Assessment is a full day of testing that evaluates your ability to gather and interpret clinical patient data, perform physical examinations and communicate effectively in the English language.  CSA includes test cases in the following disciplines:


Disciplines tested on step 3


Internal Medicine




Obstetrics and Gynecology

    The entire examination takes approximately 8 hours.  It consists of eleven stations; ten of the eleven stations are scored.  The examinee is not aware of which station is not being scored and the result is being used by ECFMG for research purpose.  In each station the examinee encounters a Standardized Patient (SP) i.e. a layperson (usually an actor) trained to realistically and consistently portray a patient with a particular problem.  The examinee is expected to proceed through each encounter with an SP as he/she would with a real patient. The SP is trained to document an examinee's history-taking, physical exam, and communication skills using checklists.  Examinees have to perform a focused history and physical examination on each standardized patient in 15 minutes.  There will be a warning bell at 10 minutes.  After each case, examinees will have 10 minutes to write a patient note.

    The following skills are assessed in the examination by the standardized patient: data collection i.e. history and physical assessment skills, spoken English, and interpersonal skills.  The patient notes written by the examinee are evaluated by a health care professional.

    The results of CSA are declared 4 6 weeks after the date of the exam.  CSA is valid for three years from the date passed for the purpose of entering a program of graduate medical education in the United States.

    The Clinical Skills Assessment fee is $1,200 (U.S. dollars) and is subject to change.  The exam is currently administered only in Philadelphia, Pennsylvania, USA. CSA is offered year-round.  If you meet the eligibility requirements, you may apply for CSA at any time, as there is no application deadline.  The dates of the exam can be scheduled by phone (215) 790-1982 or through the internet at ECFMG.  The test should be scheduled within four months and take the CSA within a year of the registration date.


  Contact Information                 Location of the Examination Center


PO Box 820992
Philadelphia, PA 19182-0992      




3624, Market Street

CSA Center, 3rd Floor

Philadelphia, PA 19104 - 2685