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Getting a U.S. Fellowship: Requirements for Foreign Medical Graduates

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Once you’ve decided to do a fellowship, the next question becomes where to do it. Fortunately, there are many wonderful learning opportunities and teaching hospitals in the United States — so many, in fact, that the United States has become a destination point for many international ophthalmologists looking to expand their knowledge base.

If you live outside the United States and would like to pursue a fellowship in America, requirements include:

  • Meeting the education and training prerequisites
  • Securing the necessary visa
  • Obtaining the ECFMG certification
  • Ensuring that you meet state licensing requirements

First, according to, U.S. students are required to complete the following education:

  • 16 years of undergraduate schooling (eight years grade school, four years high school, four years college);
  • Medical school;
  • Internship (also known as post-graduate year 1 or PGY-1);
  • After internship, you can obtain a license to practice; and
  • Specialty training (residency) for three to four years.

Once these levels of education and training (or their equivalent) have been met, you can register for a fellowship (though many students apply for fellowship during their residencies).

Visa Requirements
According to, because fellows often provide direct patient care, “any non-U.S. citizen wishing to participate in a U.S. graduate medical education program must possess a visa that permits direct patient care.” The necessary visa is either a J-1 visa or a H1 B visa, depending on the policy of the desired institution.

The appropriate visa application should be submitted well in advance of the anticipated date of enrollment. For more information about how to secure the needed visa, contact your local American embassy, consulate or U.S. district offices of the Immigration and Naturalization Service.

ECFMG Certification
You will also need to be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). In 2000, the ECFMG established the International Credentials Services (EICS) to help international medical students secure the records and credentials needed to apply for licensure in foreign countries. EICS can help you obtain “primary source verification of medical school diplomas, medical school transcripts, certificates of postgraduate training and certificates of medical registration.”

In order to secure ECFMG certification, international medical graduates need to meet several requirements, which include passing a medical science examination. Currently, Step 1, Step 2 Clinical Knowledge and Step 2 Clinical Skills of the United States Medical Licensing Examination® are the exams used to meet this requirement. You must pass both steps within seven years in order to be ECFMG certified.

More information about taking Step 1 and Step 2 for ECFMG certification can be found in the ECFMG Information Booklet, which ECFMG calls “the definitive source of information” on the exams. Applying for the exam is a two-step process:

  1. Create an account with ECFMG.
  2. Visit ECFMG’s Interactive Web Application to register.

All fellows who plan to treat patients during their fellowship must also secure a medical license from the state in which they will be training. Because medical licenses are issued on a state-by-state basis, licensure requirements often vary. For general information, contact the Federation of State Medical Boards of the U.S., Inc. (The International Fellowship in Ophthalmic Pathology may be an exception in some cases.)

Individual Requirements
Depending on the program that interests you, a U.S. fellowship may also involve additional requirements.

Sample Program Requirements

  1. Verbal fluency in the English language is mandatory. Interpreters are not a substitute for fluency in English. Written proof of verbal fluency in English is required.*
  2. Written evidence of financial support is required.**
  3. J-1 visa holders and their dependents are required to have medical insurance. The department of ophthalmology may be able to assist you in purchasing this insurance through the University of Utah’s benefits program. This issue will be dealt with on a case-by-case basis.
  4. If an applicant is accepted into this program but has not previously met with or been interviewed by an ophthalmology faculty member, this individual will be in a one-month probationary period to determine suitability and functional capability in the ophthalmology environment.

The following is required:

  1. Identify the ophthalmology subspecialty you wish to rotate.
  2. Provide the dates you wish to rotate.
  3. A letter from you identifying your goals (what you want to accomplish while at the University of Utah), expectations and suggested course of study.
  4. A current curriculum vitae with publications.
  5. Copies of academic degrees translated in English.
  6. Three letters of support from professors/physicians you have worked with and who know you well.

* Proof of fluency in English. Some samples of proof could be:

  1. A letter from an ophthalmology faculty member in the United States who has personal knowledge of you and your level of English.
  2. English test scores such as the TOEFL or the Michigan Test.
  3. A letter from an English teacher who has personal knowledge of your fluency in English.

** Verification of your financial support:

  1. Agency Support - A letter from the agency that will be financing you stating the amount of their support in U.S. dollars and the period of time of support.
  2. Part Agency-Part Self Support - A letter from the agency that will be financing you stating the amount of their support in U.S. dollars and the period of time of support AND a bank statement verifying the amount of money available.
  3. Self Support - A bank statement verifying the amount of money available.

Source: Program Web site for the John A. Moran Eye Center at the University of Utah School of Medicine.

There are several universal requirements to pursue a fellowship in the United States. Further, as the University of Utah example shows, each program has its own specific requirements. Once you have narrowed down your preferences, you will need to contact that program or visit its Web site to determine any additional requirements. You will then be prepared to be a jet-setting fellow in the United States.

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About the author: Kimberly Day is a freelance health writer and medical editor and a frequent contributor to YO Info. She is the co-author of Hormone Revolution and ghost writer of Eat Papayas Naked.