English Test Requirements for US Medical, Nursing, and Health Science Programs
By Muntasir Minhaz • Published Aug 19, 2026
Medical, nursing, and other health-science programs often set the highest English score bar on campus because clinical communication affects patient safety. Doctors need ECFMG's OET Medicine test, and internationally educated nurses need TruMerit VisaScreen certification with an approved English test.
🎓 ECFMG requires OET Medicine scores of 350 on Listening, Reading, and Speaking, and 300 on Writing, all in one sitting.
🛂 Nurses need a TruMerit VisaScreen certificate that includes an approved English test before their visa case moves forward.
⏱️ Miss one OET Medicine subtest minimum and you retake all four subtests together, not the one you failed alone.
📩 TruMerit does not accept at-home or online-proctored English tests for VisaScreen.
Your degree program sets its own separate English score minimum at admission, on top of any later licensing requirement.
Why health-science programs set the highest bar
Medical, nursing, physician assistant, pharmacy, and other clinical programs put you in front of patients early. A misheard instruction or an unclear chart note carries real risk, so these programs and the licensing bodies behind them test English more strictly than a typical undergraduate admissions office does.
Two separate systems apply on top of your degree program's own admissions requirement: ECFMG certification for doctors who want a US residency, and TruMerit VisaScreen certification for internationally educated nurses. Both sit alongside, not instead of, whatever English score your specific program asks for when you apply.
Doctors: the ECFMG English requirement
If you are an international medical graduate applying for a US residency through the Match, ECFMG certification requires proof of your English and clinical communication skills. As of August 2026, ECFMG accepts the Occupational English Test (OET) Medicine for this requirement, or a still-valid pass on the former USMLE Step 2 Clinical Skills exam for graduates who sat it before the USMLE program (NBME/FSMB) permanently discontinued it in January 2021.
OET Medicine sets a minimum of 350 on the Listening, Reading, and Speaking subtests, and 300 on Writing, achieved in a single sitting. Miss the minimum on any one subtest and ECFMG requires you to retake and pass all four subtests together in a new sitting rather than the single subtest you failed. Scores need a test date on or after January 1, 2025 to count toward the 2027 certification pathway, and ECFMG recommends testing no later than the last scheduled OET date in December 2026 so results arrive in time for Match participation.
Nurses: VisaScreen and the English test list
Internationally educated nurses moving to the US on an employment-based visa need a VisaScreen certificate from TruMerit (formerly CGFNS International). Part of that certificate confirms English proficiency through an approved exam.
TruMerit's current test and score table, updated May 2026, accepts TOEFL iBT, Academic IELTS, PTE Academic, the Michigan English Test (MET), OET, and Cambridge English (B2 First, C1 Advanced, or C2 Proficiency). Minimum scores differ by exam and by profession, so read the current table before you register for any of them. One rule holds across every exam on the list: TruMerit does not accept at-home or online-proctored versions, so plan to sit an in-person test at a physical center.
For PTE Academic specifically, TruMerit has required a Speaking score of 63 since December 1, 2024, alongside an overall score of 55 and a minimum of 50 on every other section.
How the pieces fit together
| Path | Certifying body | English test route | Score detail |
|---|---|---|---|
| Doctors entering residency | ECFMG | OET Medicine | 350 on Listening, Reading, and Speaking, 300 on Writing |
| Internationally educated nurses | TruMerit VisaScreen | TOEFL iBT, IELTS Academic, PTE Academic, MET, OET, or Cambridge English | Varies by exam and profession, no at-home test versions accepted |
| Any health-science degree admission | Your university program | Set independently by the program | Check the program's international admissions page |
Other health-science programs set their own rules
Nursing, physician assistant, physical and occupational therapy, pharmacy, and public health programs run their own admissions offices and set their own TOEFL, IELTS, or Duolingo English Test minimums, separate from ECFMG or VisaScreen. Many add a required minimum on each individual section rather than judging your overall score alone, because clinical instructors need every student to follow spoken instruction and write a clear patient note from the first semester of clinical work.
Treat ECFMG and VisaScreen as licensing-stage requirements. They come later than admission, and they do not replace whatever English score your program's application asks for today.
Two different timelines to plan around
Your program's own TOEFL, IELTS, or Duolingo requirement applies when you apply to the degree program itself, often years before you need ECFMG or VisaScreen certification. OET Medicine and VisaScreen apply later, closer to when you enter residency or accept a nursing job offer. Treat these as two separate checkpoints on your timeline rather than one combined test to prepare for at the same time.
Budget separate preparation time for each. A strong TOEFL or IELTS score at admission does not guarantee you clear OET Medicine or VisaScreen later, since these later tests focus on clinical communication rather than general academic English.
How to check your exact requirement
Confirm which path applies to you: ECFMG for doctors, TruMerit VisaScreen for nurses, or neither for most other health-science degrees.
Read your specific program's international admissions page for its own TOEFL, IELTS, or Duolingo minimum and any per-section rule.
If you plan to work clinically in the US after graduation, check the licensing body for your profession on top of your admissions requirement, since the two are separate tests with separate deadlines.