Occupational English Test

In order to preserve the health of both examiners and examinees, the USMLE Step 2 CS exam was suspended until at least June 2021.1 What has taken its place for international medical students is the option to fulfill the ECFMG accreditation with one of five pathways, as well as an English-proficiency test.2 The Occupational English Test (OET) is the officially-accepted English proficiency test now required of IMG’s in order to enter The Match. However, the OET requirement is an unfair and unsafe, for-profit exam taking advantage of an already vulnerable portion of medical school applicants.

One of the biggest issues with the OET is that medical students are now being forced to travel (at times) far distances to major hub cities such as Boston, Portland, or San Diego during a pandemic. Additionally, part of the examination also includes a 20 minute face-to-face speaking portion. An online test version was originally offered, but it is not expected to be delivered until September according to OET. Additionally, OET has not confirmed that students would be able to switch from a scheduled in-person test to an at-home test.3 This uncertainty around exact online test availability is likely to lead many students to opt to take an in-person test instead – putting themselves, the examiners, and the population of the city they are returning to after the test at an unnecessary and significant risk.

Along with the prior-mentioned issues, the test also comes at a significant monetary cost to IMG students. Not only does the test cost in excess of $400, but those students who have to travel to a testing site are likely going to be spending hundreds of dollars more for airline travel, accommodation, and other travel expenses.

While the confirmation of an applicant’s English-proficiency is a vital component of the selection process, it is simply unnecessary for many IMG applicants. There are a large number of IMG applicants that come from schools such as American University of the Caribbean School of Medicine, Sackler School of Medicine, The University of Queensland – Ochsner Clinical School, and others who are doing their two years of clinical education in US hospitals already. Additionally, these schools teach their curriculum in English, making another English-proficiency test superfluous.4,5,6

Taking these facts into account, AAEM/RSA does not support the mistreatment of IMG candidates who have already proved their English-proficiency through a US undergraduate degree, a medical school curriculum taught in English, or through their performance of two years of clinical rotations in US hospitals. While we are aware that the current state of affairs may prevent any significant changes to this portion of the ECFMG accreditation process for the current application cycle, we believe that changes to the OET requirement should be addressed for the following Match if the Step 2CS exam continues to be suspended.


  1. United States Medical Licensing Examination | Step 2 CS (Clinical Skills). Usmle.org. https://usmle.org/step-2-cs/. Published 2020. Accessed July 29, 2020.
  2. Requirements for ECFMG Certification for 2021 Match. ECFMG. https://www.ecfmg.org/certification-requirements-2021-match/. Published 2020. Accessed July 29, 2020.
  3. OET – The English Language Test for Healthcare Professionals. OET – Occupational English Test. https://www.occupationalenglishtest.org/. Published 2020. Accessed July 29, 2020.
  4. AUC Medical School – Discover AUC’s Caribbean Med School. AUC School of Medicine. https://www.aucmed.edu/. Published 2020. Accessed July 29, 2020.
  5. Sacklerschool.org. https://www.sacklerschool.org/. Published 2020. Accessed July 29, 2020.
  6. Ochsner MD Program. Ochsner.uq.edu.au. https://ochsner.uq.edu.au/. Published 2020. Accessed July 29, 2020.

Approved: 8/6/2020