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

Fellowship Interest ECFMG Determine Eligibility 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

Fellowship Interest Determine Eligibility ERAS EFDO NRMP

EFDO ERAS 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

ERAS Electronic 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

ERAS Electronic 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 2007EDFO tokens generated  July ERAS opens for application production and supporting documents  July Open to programs to transmit documents 

Fellowship Interest ECFMG Determine Eligibility 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 StatesAccreditation  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

FRIEDA Fellowship 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 

ECFMG The 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

ECFMG The 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 

NRMP National 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 

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

Fellowship Interest ECFMG Determine Eligibility 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 

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

SEVIS Student 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

Fellowship Interest ECFMG Determine Eligibility ERAS ACGME FRIEDA US Customs and Immigration Immigration Visa Social Security Number EFDO NRMP FSMB State Medical Board Educational or permanent License USMLE

USMLE United 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

USMLE United 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

USMLE United States Medical Licensing Exam  Several States require USMLE 1 and 2 for licensure: CaliforniaColorado DelawareIdaho IndianaLouisiana MaineMassachusetts MississippiMontana New HampshireOklahoma PennsylvaniaSouth Dakota Tennessee  Federation of State Medical Boards publishes all the requirements for license 

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