Two points matter for candidates across 2024–2026: ECFMG requires its OET minimums in one test administration (this is not new), and some regulator requirements have moved. OET has announced no change to how Writing is marked. Here is what each change means, what has not changed in marking, and what we see costing marks in the letters we correct.
Quick answer
Two points matter for OET candidates across 2024–2026: (1) ECFMG requires international medical graduates to reach 350 in Listening, Reading and Speaking and 300 in Writing in one test administration (not a new rule); (2) some regulator requirements have moved, including AHPRA's for tests taken from 23 April 2026. The six Writing criteria and the Grade B (350) pass threshold have not changed. The OET is owned by Cambridge Boxhill Language Assessment Trust (CBLA).
International medical graduates targeting US residency need 350 in Listening, Reading and Speaking and 300 in Writing within a single OET test administration. ECFMG does not combine results from separate sittings; missing any minimum means retaking all four sub-tests.
Full ECFMG guideFor tests taken from 23 April 2026, AHPRA requires 350 in Listening and Writing and 360 in Reading and Speaking. Check your regulator's current requirements before you book.
The six criteria and their descriptors are unchanged since August 2018. In the letters we correct, marks are most often lost by including everything in the case notes or omitting clinically critical details, which the Content criterion has always covered.
In our experience Writing is the sub-test candidates most often need to retake. If you have limited preparation time, prioritise Writing — Listening and Reading practice compounds faster on its own.
Most candidates can write a 250-word letter. Fewer can choose which 250 words to include. Mark the clinically significant items first; structure your letter around those.
Generic correction can catch grammar. Profession-aware correction also catches the clinical-relevance judgement calls on case-note selection.
For doctors targeting US residency: prepare all four sub-tests in parallel from day one. Do not assume you can retake Writing alone later; ECFMG does not combine sittings.
AI is useful for daily practice between corrections — flagging common errors, reinforcing structure. It does not replace expert educator correction.
Two points matter for candidates across 2024–2026. First, ECFMG (USA) requires 350 in Listening, Reading and Speaking and 300 in Writing in one test administration; this is not a new rule, but it catches many international medical graduates out. Second, some regulator requirements have moved, including AHPRA's for tests taken from 23 April 2026. OET has announced no change to how Writing is marked: the six criteria and their descriptors are unchanged since August 2018.
The OET is owned by Cambridge Boxhill Language Assessment Trust (CBLA), a joint venture between Cambridge University Press & Assessment and Box Hill Institute. CBLA is the authoritative source for changes, scoring criteria, and regulator-acceptance notices.
No. Grade B (a score of 350) remains the standard benchmark, and Grade B in all four sub-tests is accepted by regulators such as the GMC and GPhC. The NMC accepts Grade C+ (300) in Writing with Grade B in Listening, Reading and Speaking. In Australia, for tests taken from 23 April 2026, AHPRA requires 350 in Listening and Writing and 360 in Reading and Speaking.
Three adjustments. One: invest in Writing-specific practice — in our experience Writing is the sub-test candidates most often need to retake. Two: ECFMG-bound doctors must prepare all four sub-tests in parallel for a single test administration, not sequentially. Three: practise profession-aware case-note selection, because generic 'include everything' letters lose marks on Content.
AI tools are useful for daily practice — flagging common errors and reinforcing the six criteria. They do not replace expert educator correction. Case-note selection and addressee register involve judgement calls that generic AI cannot reliably reproduce. Use AI tools between expert educator corrections, not instead of them.
Full guide for IMG doctors targeting US residency.
What examiners look for, criterion by criterion.
Profession-specific guidance for every OET profession.
Nursing-specific 2026 guidance.
Result timelines and how to read your statement of results.
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