Test Of English as Foreign Language 


    All IMGs must take an English test (TOEFL), irrespective of their citizenship (including US-born US citizens) and native language.  English test scores are valid for only two years. You must keep these scores current, or the ECFMG certificate will become invalid. Previously ECFMG conducted the English test on second day of step II examination that has been discontinued and presently all IMG have to take TOEFL.

    Education Commission for Foreign Medical Graduates (ECFMG) requires TOEFL scores of 213 on computer based tests and 550 on paper and pencil tests.

    TOEFL test can be taken at any time of the year however we recommend candidates to take the exam immediately after Step 1 in order to be eligible for taking Clinical Skill Assessment (the basic eligibility criteria for CSA - passing Step 1 and TOEFL).

    Registration can be made online at or by calling 1-800-GO-TOEFL.


Test of Spoken English (TSE)


    Developed by TSE for nonnative speakers of English to test communication skills.

    The test lasts for 30 minutes. Scores consists of single score of communicative language ability on a scale of 20-60. A score of 35 or above suggests effective communication necessary to pass CSA.

    TSE is not a prerequisite for CSA but a screening tool. Good scores do not imply passing CSA.

    For more information, visit