APPNA YPC Obversvership Program
The APPNA YPC Observership program aims to acculturate international medical graduates to American medical practices and help prepare them for residency. Programs will typically last from two to four weeks per rotation or specialty. These are not for-profit and all APPNA physicians volunteer their time and efforts. All clinical activities as an observer should be performed under the supervision of an attending. Learning objectives include:

• Monitor how a physician interacts with patients, noting how to take a history, perform an examination and diagnosis, recommend a treatment, code, write prescriptions and enter information on the patient’s chart, etc.
• Study professional communication and interaction between the physician and all members of the health care delivery team and hospital administration
• Understand and use American colloquialisms (slang, euphemisms, medical jargon, etc.)
• Observe the delivery of health care in a private practice, hospital or clinical setting
• Gain exposure to electronic medical records, and learn how to access and enter data

The following two forms are to volunteer as a preceptor and apply for an observership. This is a wonderful opportunity both preceptors and graduates to prepare for residency or any choices that involve the American healthcare system.

• YPC Physician Preceptor Application Form
  Click here to access the form for submission
• Observer Application Form
  Click here to access the form for submission

Requirements:
– Medical school degree/diploma
– ECFMG certificate if certified
– Passport and Visa copy
– One LOR
– A non-refundable fee of $100 will be charged after confirmation of placement
– Requests from applicants who are in the US, or have a valid visa to enter the US, will be considered.  ECFMG certification is preferred (not required).
– No letters for visa interviews will be provided.

Visa application /interview tips.
– Apply for visa interview appointment as soon as You have been issued DS2019 and SEVIS ID.

• each dependent will be issued a separate DS2019 and SEVIS ID
• Each dependent will need separate DS160 application and fee.
• Ask for group interview if you have dependents .
• Duration for stay can be any where from 3-7 years depending on your residency speciality and fellowship plans.
• J-1 visa will be valid only for a year but you can stay without getting visa stamped on passport for longer time.
• You will be given new DS2019 every year and allowed to work even if your J-1 visa is expired on passport .
• If you travel outside USA and visa is still valid , you can return to USA without getting visa Re stamped on passport.
• If you travel outside USA and visa is expired you will need to have visa Re stamped on passport and will need to go through new DS160 , fee and visa interview. There is possibility of visa going in administrative processing even if you have been in USA and working as resident . It is highly recommended to travel outside USA while your visa is valid or only if you HAVE to go for something very important.
• H-1 B is usually valid for 3 years and can be extended for another 3 years.

Emergency/expedited visa interview appointments :
– If you don’t get appointment date in May or early June , get whatever appointment is available. Then use the system and ask for expedited/ emergency visa interview appointment date. You may ask for group interview if you have dependents.

Interview :

• For interview , dress professionally and be on time.
• Take your dependents with you for interview even if they are not traveling with you in June.
• Answer all questions honestly and to the best of your knowledge . If you are not sure about any question ask politely,the person on window , “can you repeat the question please “ . And if you don’t know the answer for sure , tell the person I don’t know . Don’t just guess.
• Take all supporting documents with you including Ds2019, contract letter, letter from program to the consulate , previous/ expired passports if you have traveled to USA in the past. Take bank statements to provide proof that your previous visit to USA was financed by yourself or a family member. If you opened up an account in USA , take copy of last statement and if you received any funds in USA from family and or friends , take proof and have details of the person who gave you the money including relationship, name , and address of the person. You want to make sure that the visa section officer is satisfied you did not work and got paid in USA on visit visa.
• Write down the dates and duration of your previous trips to the US with addresses where you stayed /did observer-ship/ rotations in the USA.
• Be confident and respectful to the staff and look into the eyes when talking to them.
• Technically, it is not recommended to do an observership on a B-1/B-2 visa. If you have done , be truthful and tell the officer. Make sure to tell “It was voluntary, unpaid and without direct patient contact. If you did clinical rotation as a student, nothing to worry about if you had direct patient contact as it is allowed for students.
• It is possible that your visa may undergo an administrative process and the paper officer will handover to you may say “refused” .
• Don’t worry it is a routine screening and will get done in 1-2 weeks in most of the cases. Let APPNA know about it and we will try our best to get it expedited.
• The officer might ask you to provide an answer to a few written questions like your previous addresses, details of previous trips out of Pakistan, details of your family, details of your social media accounts, copies of phone records, etc. Don’t rush and don’t panic. Discuss and formulate a complete and accurate response.

Social media accounts :
Please review your social media accounts and remove any objectionable pictures, like
Photos with firearms etc. Also, delete any hateful posts or anti-USA posts.

FAQ on Fellowships for accredited and non-accredited fellowships in the US for International Medical Graduates (IMG) without completing an ACGME approved residency program

This document was created due to the need highlighted by multiple trainees on the APPNA YPC Facebook forum. This document serves as a “guide” and will be updated occasionally.

Direct fellowship is a pathway for a very small group of exceptionally qualified applicants. APPNA YPC recommends IMGs to seek residency through conventional pathways.

1-What are the pre-requisites for applying?

A Review Committee may grant the following exception to the fellowship eligibility requirements: An ACGME-accredited fellowship program may accept an exceptionally qualified applicant, who does not satisfy the standard eligibility requirements

An exceptionally qualified applicant has

1) completed a non-ACGME accredited residency program in the core specialty, and (2) demonstrated clinical excellence, in comparison to peers, throughout training. Additional evidence of exceptional qualifications is required, which may include one of the following:

(a) participation in additional clinical or research training in the specialty or sub-specialty.

(b) demonstrated scholarship in the specialty or sub-specialty.

(c) demonstrated leadership during or after residency training.

(d) completion of an ACGME-International-accredited residency program.

• USMLE Step1 and 2, Valid and current ECFMG certificate in addition to other requirements unless applicant is a medical graduate of Canada/Puerto Rico
• In Canada the only mandatory requirements are clinical experience in home country and passing of TOEFL or IELTS. In USA mandatory requirements are clinical experience in home country and passing of USMLE steps 1-3.
• For General Surgery programs require 5 years General Surgery training including boards in the country of training

2-Which specialties offer fellowships for IMGs who have not completed an ACGME accredited Residency Program?

• Allergy and Immunology* Yes
• Anesthesiology Subspecialties Yes
• Dermatology Subspecialties Yes
• Diagnostic Radiology Subspecialties Yes
• Emergency Medicine Subspecialties Yes
• Family Medicine Subspecialties Yes
• Internal Medicine Subspecialties Yes
• Medical Genetics and Genomics Subspecialties No
• Neurological Surgery Subspecialties No
• Neurology Subspecialties No
• Nuclear Medicine* Yes
• Obstetrics and Gynecology Subspecialties No
• Ophthalmology Subspecialties Yes
• Orthopedic Surgery Subspecialties Yes
• Otolaryngology Subspecialties No
• Pathology Subspecialties Yes
• Pediatrics Subspecialties Yes P
• Physical Medicine and Rehabilitation Subspecialties No
• Plastic Surgery Subspecialties No
• Preventive Medicine Subspecialties Yes
• Psychiatry Subspecialties No
• Radiation Oncology Subspecialties No
• Surgery Subspecialties No
• Thoracic Surgery Subspecialties No
• Urology Subspecialties No

http://www.acgme.org/portals/0/pdfs/eligibility-exception-decisions-byspecialty.pdf

* The Review Committee does allow the exception to the eligibility requirements for residency programs that require completion of a prerequisite residency program prior to admission.

3-How to search for these fellowships ?

• The American Academy for Orthopedic Surgery has a fellowship listing: https://www.aaos.org/quality/career-center/postgraduate-orthopaedic-fellowships/
• The various subspecialty organizations have websites with listings for their certain specialties. For instance, the Orthopedic Trauma Association has a listing:  https://ota.org/education/fellowship
• The Arthroscopy Association of North America has a listing for Sports Fellowships
• https://www.aana.org/aanaimis/Members/Fellowships_Research/Fellowship_Directory/Members/Fellowships-Research/Fellowship-Directory.aspx?
• American medical Association web site
• For the length of the educational program for a particular subspecialty, refer to the current subspecialty-specific Program Requirements, which can be found on the Program Requirements, FAQs, and Applications page of the specialty’s section on the ACGME website.
• For example, this link takes you to the Program Requirements and FAQs and Applications page for Orthopedic Surgery, from which you can access the Program Requirements for all subspecialties of orthopedic surgery: https://www.acgme.org/Specialties/Program-Requirements-and-FAQs-andApplications/pfcatid/14/Orthopaedic%20Surgery

4-Are there any advantages to doing a fellowship in the U.S. and Canada without completing an ACGME accredited residency?

• Gaining expertise
• Possibility of Job in the US if eligible for medical license
• completing a US fellowship can count towards training requirements to for a medical license in certain states in the United States, if that is a goal.

5-Are high USMLE Scores a requirement?

• Successful completion USMLE is required for applications.
• Competitive fellowships will likely prefer candidates with higher scores. However, there are other considerations including research, letters of recommendation, and activities during residency.
• Interviews play a significant role

6-Can you practice in the US and Canada after 1 year of fellowship training?

• Ability to practice in the is dependent on eligibility for State Medical License.
• Most State Medical Boards require a minimum of two years of training in the US to be eligible for a license.
• check the State license requirements for eligibility to work in the US after one year.

7-How can applicants find programs that are willing to accept IMGs without US or Canadian residency training?

• Individual programs indicate whether they accept applicants without residency training.
• Refer to individual program webpages for more information regarding this.

8-Is it only applicable for fellowships that go unmatched or can candidates apply during the match cycle?

Candidates can apply during the usual match cycle

9-Which states allow candidates to practice after fellowship without a US residency? Are these jobs eligible for a Conrad 30 waiver or O1 visa sponsorship?

• Any state can allow a surgeon to practice as long as he/she has the license to practice medicine.
• It would also depend on the hospital if it would allow credentialing of a physician without ACGME accredited residency training.
• One has to have ACGME accredited fellowship experience of at least 2 years to qualify for a medical license in most states.
• If someone does a non- accredited fellowship, one may not get a license. In that case, you can’t practice in United States.

10-Is candidate eligible for board certification after completion of fellowship?

Orthopedics ( ABOS) and Radiology programs allow a person to sit for boards exam after practicing in an academic setting for 5 years.  In Orthopedics, it’s called Academic pathway for boards certification.

Majority fellowships do NOT allow Board Certification after completion of fellowship without residency training in an ACGME accredited residency training program.

Orthopedic Surgery Training and Experience – Required prior to Part 1 Written exam:

All applicants must have completed both a PGY-1 program or accredited internship and an Orthopedic Surgery residency program approved by the Accreditation Council of Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), or the Royal College of Physicians and Surgeons of Canada (RCPSC). The ABPS accepts ALL medical residencies approved by the RCPSC, including approved residencies outside Canada.

Academic Pathway (if residency completed outside of US or Canada)

An Orthopedic surgeon who completed his or her graduate medical education outside of the United States or Canada and does not meet the requirement above may be eligible, provided he or she has been engaged as a full-time teaching faculty member in an ACGME accredited orthopedic surgery residency program for a minimum of four continuous years immediately preceding application and meets all other eligibility requirements.

Applicants qualifying under 1. A. above must submit documentation of satisfactory completion of an orthopedic surgery residency outside the U.S. or Canada verified by the Program Director and institution, and letters from the applicant’s current Department Chair and Program Director verifying the resident teaching experience.

Other Resources:

https://ecfmg.org/

https://www.aamc.org/services/eras-for-institutions/program-staff

https://freida.ama-assn.org/

https://www.ama-assn.org/education/international-medical-education

https://www.ama-assn.or/resident-students/residency/non-acgme-open-residency-fellowship-positions

https://www.uclahealth.org/pathology/requirements

https://www.aafprs.org/Professionals/Development/Fellowship_Programs/ERF/Fellowship_Programs.aspx

https://www.absurgery.org/default.jsp?policycredforeign

https://www.theabr.org/diagnostic-radiology/initial-certification/alternate-pathways/international-medical-graduates