Michael Ott MD, M.Sc.

Schulich School of Medicine

University of Western Ontario

London Health Sciences Centre

Goals To give a brief overview of the process Give you a start on how to collect information

Disclaimer: Primarily based on my own experience in the

Colorectal Surgery Match

The process can be confusing Best advice I can give is to start early

FellowshipInterest

ECFMG

DetermineEligibility

ERAS

ACGME

FRIEDA

US Customs and

Immigration

Immigration Visa

Social Security Number

EFDO

NRMP

FSMB

State Medical Board

Educational or

permanent License

USMLE

Eligibility Need to determine fellowship of interest and

determine eligibility Need to complete applications as soon as

deadline as some programs will stop accepting applications

Majority of programs will have a co-coordinator / secretary whom can be contacted for details

Some fellowships begin matching in R4 year

FellowshipInterest

DetermineEligibility

ERAS

EFDO

NRMP

EFDOERAS Fellowships Document Office

Fellowship applicants contact the EFDO to get an electronic token to access the ERAS system

Easy application process need just a SSN or SIN to apply

EFDO token just allows you access to the ERAS site

It is the first step in the electronic application process

ERASElectronic Residency Application Service

A service that transmits

○ Fellowship applications○ Letters of recommendation○ Performance evaluations○ Medical school transcripts○ USMLE/COMLEX transcripts

Essentially a electronic document warehouse

ERASElectronic Residency Application Service

All application information is done through ERAS electronically

Applications are transmitted to program directors via ERAS

Need EDFO (ERAS Fellowships document office) token to apply to ERAS

EDFO Token application July 1 usually

Function of ERAS and EFDO

ERAS Deadlines Example for 2008 cycle

June 2007 EDFO tokens generated July 1 2007 ERAS opens for application

production and supporting documents

July 15 2007 Open to programs to transmit documents

http://www.aamc.org/students/eras/start.htm

FellowshipInterest

ECFMG

DetermineEligibility

ERAS

ACGME

FRIEDA

EFDO

NRMP

ACGME The Accreditation Council for Graduate Medical Education

ACGME is responsible for the Accreditation of post-MD medical training programs within the United States

Accreditation is accomplished through a peer review process and is based upon established standards and guidelines

Allows you to ensure that the program applied to is accredited

Used to track duties hours and log cases Need to apply so that your institution that you

have trained in is accredited Canadian schools are accredited

FRIEDAFellowship and Residency Electronic International Data Base

FREIDA lists information for all the graduate medical education programs accredited in the U.S.

Program data are collected by the AMA and the Association of American Medical Colleges

FREIDA displays aggregate training program statistics for each specialty and subspecialty

Information on recent graduates of training programs is also available on FREIDA

Data about the programs and applicants from past years Need to apply to FRIEDA so you can be recognized for

the NRMP

http://www.ama-assn.org/ama/pub/category/2997.html

ECFMGThe Educational Commission for Foreign Medical Graduates

Program of certification for international medical graduates ECFMG issues the Standard ECFMG Certificate to applicants

who meet all of the examination and medical education credential requirements

○ Students completing their medical education in schools outside the United States and Canada are considered international medical graduates

○ Non-U.S. citizens who have graduated from medical schools in the U.S. and Canada are not considered international medical graduates

Canadian Graduates can obtain ECFMG # without USMLE exams

ECFMGThe Educational Commission for Foreign Medical Graduates

Applicants for ECFMG Certification must satisfy both the medical science examination and clinical skills requirements

Applicants must pass Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE)

Canadian graduates can obtain ECFMG # without USMLE exams but require:

○ Medical degree○ Transcripts○ Letter from dean of medical school○ MCCQE exams

http://www.ecfmg.org/

NRMPNational Residency Matching Program

Use a system similar to CaRMS for matching Not All fellowships are through the NRMP so check

early Specialty matches occur throughout the year all have

different dates Each requires its own registration process with the

NRMP NRMP allows ranking of programs and a matching

algorithm similar to CaRMS www.nrmp.org

Application to NRMP Applicants interested in fellowships apply to the

NRMP in order to be involved in the ranking and matching process

Registration requires:○ USMLE ID #, ECFMG #○ Enrolment in ERAS

Electronic Residency Application Service○ ACGME accreditation

Accreditation Center for Graduate Medical education○ FRIEDA enrollment

Fellowship and Residency Electronic International Data Base

FellowshipInterest

ECFMG

DetermineEligibility

ERAS

ACGME

FRIEDA

US Customs and

Immigration

Immigration Visa

Social Security Number

EFDO

NRMP

Immigration Visa ECFMG is authorized by the U.S. Department of State to

sponsor foreign national physicians as J-1 Exchange Visitors J-1 is for resident alien in programs of graduate medical

education and training The duration of stay for a J-1 Exchange Visitor physician is

limited to the time to complete the advanced medical education program

J1 visa is the easiest to obtain Need to apply through U.S. Citizenship and immigration

services

www.uscis.gov

Qualifying for J1 Visa At a minimum, applicants must:

○ Register with SEVIS (Student and Exchange Visitor Information System)

○ Have passed USMLE Step 1 and Step 2 or an acceptable combination thereof ( Canadian Graduates exempt )

○ Standard ECFMG Certificate ○ Contract or an official letter of offer for a position in a program○ Provide a statement of need from the Ministry of Health of the country

of most recent legal permanent residence

Federal and Provincial letters required

- Statement must provide written assurance that- The country needs specialists in the area in which the Exchange Visitor

will receive training- Confirm the physician’s commitment to return to that country upon

completion of training in the United States

SEVISStudent and Exchange Visitor Information System

SEVIS is an Internet-based system that provides tracking and monitoring of nonimmigrant students (F and M visa) and exchange visitors (J visa), and their dependents (F-2, M-2, and J-2)

SEVIS application is done through the Department of Homeland Security

Must Pay SEVIS fee to have valid visa

Other Non-Immigrant Visa J1 – Exchange visitor F1 – Academic student

○ (need enrollment in University) H1b – Temporary specialty worker

FellowshipInterest

ECFMG

DetermineEligibility

ERAS

ACGME

FRIEDA

US Customs and

Immigration

Immigration Visa

Social Security Number

EFDO

NRMP

FSMB

State Medical Board

Educational or

permanent License

USMLE

USMLEUnited States Medical Licensing Exam

Each medical licensing authority sets its own rules and regulations

The USMLE provides them with a common evaluation system for applicants for initial medical licensure

3 Steps required Not essential in all States Needed to obtain medical license in majority of

US states

USMLEUnited States Medical Licensing Exam

Can obtain a educational license in most states for the purpose of fellowship training

Can not moon light with an educational license

Need to ensure that programs do not base your salary on shadow billing or assist billing

Most ACGME programs have a straight salary

USMLEUnited States Medical Licensing Exam

Several States require USMLE 1 and 2 for licensure:California ColoradoDelaware IdahoIndiana LouisianaMaine MassachusettsMississippi MontanaNew Hampshire OklahomaPennsylvania South DakotaTennessee

Federation of State Medical Boards publishes all the requirements for license

http://www.fsmb.org/

Costs EDFO token application charge $ 75 ERAS (up to 10 programs) $ 60 USMLE transcript fees $ 50 COMPLEX fee $ 50 International medical Graduates fee $ 75 NRMP $ 40 ECFMG sponsorship of J1 Visa $ 200 SEVIS fee $ 100 J1 Visa application Fee $ 100 USMLE 1,2,3 $ 1715

Total $ 2465