How to Apply
for Residency Training: A General Guide for Foreign Medical Graduates
In the united States, all physicians are required to
complete a post-graduate medical program, usually called
residency, in one of the recognized medical specialties before they can
practice medicine. The training
program has to be accredited by the Accreditation Council for Graduate Medical
Education (ACGME). It usually
includes three to seven years’ formal training (residency training) and the
passing of a comprehensive examination (the Boards examination).
Each year, there are about 6000 foreign medical graduates
entering the residency programs. Graduates
of foreign medical schools, regardless their experiences in their native
country, are also required to complete the same graduate medical program before
they can practice medicine in USA..
Applying for residency training is a very complex process
even to American medical graduates. In the rest of this treatise, I will outline
the general procedures of residency program application for foreign medical
graduates.
Your visa and your school
Visa status: If you are in the United States and are a
resident alien (i.e., you have a green card) you generally do not have any
limitation for your residency application.
If you are outside of USA or you are in USA but are not a Resident Alien
, you must possess a visa (e.g., J-1) that permits direct patient care. The
appropriate visa application should be submitted well in advance of the
anticipated date of enrollment. You
should contact your lawyer, American embassies, consulates, or U.S. district
offices of the Immigration and Naturalization
Service to obtain further information.
Medical School: Not all foreign medical schools are created
equal. To qualify for American residency training, your medical school must be
listed at the time of graduation in the World Directory of Medical Schools
published by the World Health Organization.
You can go to public libraries to find out if your school is listed or
not. If your school is not listed,
you can contact the Educational Commission for Foreign Medical Graduates
(ECFMG). They will review
each school on individual basis.
Academic requirement
It is very simple: you need to obtain a ECFMG certificate.
Educational Commission for Foreign Medical Graduates (ECFMG)
is an independent organization set to
assess the readiness of graduates of foreign medical schools to enter residency
or fellowship. A certificate from ECFMG provides assurance to directors of
residency and fellowship programs, and to the people of the United States, that
graduates of foreign medical schools have met minimum standards of eligibility
required to enter such programs. However, this certification does not guarantee
that such graduates will be accepted into these programs in the United States
since the number of applicants frequently exceeds the number of positions
available.
The requirement for an ECFMG certificate includes the
following:
A.
English proficiency test: Beginning on March 3, 1999, ECFMG
requires applicants to take the Test of English as a Foreign Language (TOEFL)
to meet the English language proficiency requirement for ECFMG certification.
Passing performance on the English test is valid for two years from the date
passed for the purpose of entry into graduate medical education.
B.
Medical Science Examination: Currently,
Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE) are
the only medical science
examinations administered to assess
knowledge in the basic medical and clinical sciences.
These are the same test given to American medical graduates. ECFMG also
accepts a “pass” grade on any of the following formerly administered
examinations for ECFMG certification; the ECFMG Examination, the Visa Qualifying
Examination (VQE), Part I and Part II Examinations of the National Board of
Medical Examiners (NBME), of the Foreign Medical Graduate Examination in the
Medical Sciences (FMGEMS).
C. Clinical Skills Assessment (CSA). This test only applies for foreign medical graduates. CSA is administered throughout the year at the ECFMG Clinical Skills Assessment Center in Philadelphia, Pennsylvania, USA. The test uses “standard " patients to assess candidate’s clinical proficiency and spoken English language proficiency. Applicants must pass the medical science examination in the basic medical and clinical sciences and the English language proficiency test as prerequisites to taking CSA. There is no limit on the amount of time which may elapse between these prerequisite examinations and CSA. Passing performance on CSA is valid for three years from the date passed.
D.
Documentation: Applicants for ECFMG certification must document the
completion of all requirements for, and receipt of, the final medical diploma. A
graduate of a foreign medical school must have had at least four years
in attendance at a medical school. Medical school diplomas received by
ECFMG are sent to the foreign medical schools for verification by the
appropriate officials. Documents
required for verification process include A) Two photocopies of original
diploma, B). An original English translation of the diploma if not
originally in English (A photocopy from a photocopy is not acceptable), and C)
Two current, full-face photographs of the applicant. English translation must be
prepared by and certified to be correct by a government official, medical school
official or recognized translation service. The translation must appear on
official stationery, must identify the translator, and must bear the signature
of the official or representative of the translation service. These materials
should be submitted with the
initial application for examination. Submitting the medical diploma with the
initial application for examination
greatly facilitates processing. If the medical diploma has not yet been issued,
the graduate must submit with the application form a certificate signed by the
Medical School Dean, Vice Dean or Registrar that confirms that the applicant
graduated from medical school. Photocopies of the medical diploma and the
photographs must then be submitted to ECFMG as soon as the diploma is issued.
Students should submit two photocopies of their diploma and their
photographs to ECFMG as soon as they graduate and receive the diploma. If
credentials are complete, applicants are generally not required to resubmit
these documents when they apply for subsequent examinations.
After you have fulfilled all the requirements, the ECFMG
will issue you a certificate.
Application of residency training
First you need to Obtain information about programs.
The American Medical association (AMA) 's Graduate Medical Education
Directory (the Green Book) is the ultimate source.
This directory describes the
ACGME accreditation process,
institutional and program requirements for graduate medical
education, and
provides information about the entry of foreign-born medical graduates to
the United States. The AMA also has an interactive on-line program called
Fellowship and Residency Electronic Interactive Database Access (FREIDA) which
is available for purchase by calling 1-800-AMA-3211.
Most hospitals, and many programs also provide descriptive brochures,
available by writing to the address listed in either the Graduate Medical
Education Directory or the NRMP Directory.
The next step is to contact the programs after deciding
which specialty/specialties you want to be trained and which programs you like.
You should contact them at their earliest opportunity to determine eligibility
requirements, institutional employment policies, and to request application
materials. Programs may provide individual applications, participate in the
Electronic Residency Application Service (ERAS), or instruct candidates to use
the Universal Application for Residency. The Universal Application form is
designed by the Association of American Medical Colleges. It collects
information generally required for consideration by program directors.
More and more programs are using this form for application.
Materials required for application usually include a
Dean’s letter from your medical school, two to three letters of
recommendation, transcripts, a copy
of ECFMG certificate, and two recent photos.
The Dean’s letter is usually optional for foreign medical graduates.
You should forward the materials
directly to each program by the deadline established by each program using
either the Universal Application for Residency
or specific application forms from each program. You can also use the
Electronic Residency Application Service (ERAS) to apply. ERAS is developed by
the AAMC to transmit via the Internet residency applications, personal
statements, recommendation letters, Deans' Letters, transcripts and other
supporting credentials from medical schools to residency Program Directors. It
is used by most U.S. medical graduates. The
Educational Commission for Foreign Medical Graduates (ECFMG) serves as the ERAS
coordinator for foreign medical graduates. You can obtain more information on
ERAS in ERAS website.
Applications should be
submitted to programs as soon as possible in order to accommodate
deadlines for supporting documents and interview schedules. Late applications
may not be considered. Candidates should allow additional time for overseas mail
services when attempting to meet program deadlines.
If you are of the many lucky ones, you will receive letters
or phone calls from program directors to invite you for interviews.
This process usually takes one full day and you will be interviewed by
3-7 faculties/physicians. This is the best chance for you to know the program and for
the program to know you.
Although some programs may offer positions to foreign
medical graduates outside match, Most programs require applicants to enroll in
the National Resident Matching Program (NRMP) to obtain residency positions.
The National Resident Matching Program (NRMP) is a private,
not-for-profit corporation to
provide a uniform date of appointment to positions
in graduate medical education (GME). Each year, the NRMP conducts a match that is designed to
optimize the rank ordered choices of students and program directors. In the
third week of March, the results of the Match are announced. The NRMP provides an impartial venue for matching applicants'
and programs' preferences for each other consistently. This algorithm assumes that the offers made to applicants for
training at the various programs are determined by the applicants' preferred
order lists (Rank Order Lists). Applicants match into the program listed highest
on their list that had also ranked the applicant, and that had not filled all of
its available positions with applicants the program preferred as determined by
the program's Rank Order List. For more information about the match, visit NRMP
homepage at www.nrmp.org.
You should register at NRMP at the beginning of
application. After finishing all interviews, you are to fill the Ranking order
List from NRMP based on your preference of each program.
Likewise, the program will fill the ranking order list based on the
strength of candidates. You should
only list the programs you have been interviewed.
The match results are usually I result published on USA
Today at the third Wednesday of the March.
If you are matched to a program, congratulations; you will find out your
NRMP number in the newspaper. You
will also receive a letter in a couple of days later to inform the detailed
results.
If you are not matched, you will receive the NRMP Program Results/Listing of Filled and Unfilled Programs. This document shows the number of applicants sought and the number matched for each residency program participating in the NRMP, a section of unfilled programs by specialty. It is time for your last endeavour to obtain a residency position: contact the unfilled programs of your interest and fax them your application. Good luck.