The ECN is only for France. Actually the process is a bit complicated for France (unless you have an EU medical degree.) You would have to apply to med school and after the 1st year take the Concours exam. Upon successful completion of this exam, you can then get exemption for 2nd, 3rd, 4th, and 5th year courses. You then enter the 6th year and take the final exam (the ECN) and depending on the score you get, you will be ranked accordingly. Your rank ultimately determines your specialty. There are 7,500 spots every year, so everyone will match. Getting into the tougher specialties means getting a higher rank.