A note from the founder of Pathology Resident Wiki[edit | edit source]

I often receive questions from international medical graduates about how to obtain a pathology observership rotation in the USA or how to apply for pathology residency in the USA. As an American medical graduate, I lack personal experience with these things, but I wanted to provide a resource so I can more easily answer these questions. Dr. Pallavi Patil, a pathology resident at Brown University, wrote up a nice guide with info and advice on these topics, which she kindly offered to share here on this page. If you have additional info or suggestions to add, please do so, but please do not remove any info from this page. In particular, there is a great need for a list of which programs accept international medical graduates for pathology observership rotations and/or for full year fellowships; if you know of programs that do this, please add them to the list below. Dr. Patil and I hope this becomes a resource that international medical graduates can utilize to better assist their pursuit of obtaining training in the USA. - Jerad Gardner, MD 4/9/2018


Applying for Residency[edit | edit source]

This guide contains general information about pathology residency application- observerships, application timelines, interviews, match etc for international and american medical graduates, with additional focused information for international medical graduates interested in pursuing pathology. The nature of the residency application process in the United States is unique and takes planning and advance preparation to be done the right way to increase chances of success. Particularly for international medical graduates as they have to appear exams often from home countries and have to travel to the States for observerships and some of the exams. Lack of planning and preparation could leave a lot of aspects to chance. The essential ingredients of a good application though are: planning, good USMLE scores, observership/internship/research experience in the United States, and letters of recommendation from pathologists in the United States or pathologists who are known to people in institutes you are planning to apply. The first thing to start with is a firm decision to proceed with trying for residency because of the amount of time, effort and money required to complete till you get a residency position. This write up contains information accumulated from experience that could make your preparation easier and increase chances of success. Does not include information that can be found on http://www.ecfmg.org/ for certification, exam applications, scheduling etc. - Pallavi Patil MD

Opinions are the authors' and do not reflect those of the institution.

Starters[edit | edit source]

Getting medical school transcripts, MSPE, ECFMG verification needs to be started at the outset, essentially, because some medical schools may not be familiar with the process or have formats. The documents are sent back and forth by international mail if the medical school does not have the online medical school web portal. You may want to see online USMLE forums for the latest online discussions that may give you an idea of current changes, which specialties are competitive, where to get observerships, etc. As online forums do not have vetted information, it needs to be used carefully.

You need to be ECFMG certified usually by August end, as the applications are sent out to programs starting September 15. To be ECFMG certified you need to have Step 1, Step 2 CK, and Step 2 CS. Each exam depending on your medical school knowledge takes an average of 2 months smart preparation of around 5 to 6 hours of study everyday. The results of each exam take 4 weeks to come out usually, and the Step 2 CS has a schedule that can viewed online about time frame when results would are delivered depending on your Step 2 CS exam dates. All your results should be in by July, so you could be ECFMG certified by August end as it takes one month for ECFMG certification after your last result comes in. The ERAS takes about 2 weeks to make documents available after they have been uploaded to your profile, so your letter of recommendation should ideally be in by August end too, for your materials to be available to programs in mid-September. Step 3 can be given anytime up to March, as programs require your results only after match day for your work visa. There may be some programs prefer candidates who pass Step 3, and you could convey that it is your plan to do so. It is always better to do the Step 3 before starting residency if you can, in order to focus on pathology and work.

Plan observerships and Step 2 CS[edit | edit source]

For American Medical graduates a pathology elective in your own medical school and/or prospective program of interest is recommended, to get an idea of the nature of the practice of pathology. It also helps to know the daily work schedule, large variety of specialties, interact with residents, and to confirm your interest in the field. This is helpful as then programs will know you have an idea about pathology and are less likely to drop out or change to another specialty, which is a factor in considering residency applicants. Applying for observerships, particularly for international medical graduates requires advance planning, as getting time slots that can get difficult and are usually booked 6 months to a year in advance. This is particularly important to plan for the Step 2 CS. Sometimes Step 2 CS is sometimes challenging particularly if you are a pathologist or do not have exposure to ways of communication in the United States. It is better to apply for observerships first and schedule the Step 2 CS after you have spent a month or two in the United States, so you get accustomed to communication here. The most popular exam centers among international medical graduates are in the South and West of the US, the warmer weather could be one of the reasons. Often you may find good study partners or friends who have passed the Step 2 CS to help to practice Step 2CS in person or on Skype. Step 2 CS can be challenging and passing it could become a real hurdle to applying for residency. If you want to be very careful and increasing chances training courses ranging from 1 day to a few days could be taken while in the United States or online. I did not want to spend too much money on doing the physical courses and it did not fit in my schedule either, by the time I realized I should take one. I did Skype sessions with C3NY, which were very cost effective and very useful to me to pass the communication skills part of CS.

It helps to do observerships in large institutes as well as in programs that consider observers for prospective residency positions. There are many programs that consider international medical graduates for residency positions and you may be able to get an idea by looking up the program website for current residents. This also sometimes could give you an idea of the profile of candidates the program like to take for residency. For e.g. PhD, fresh graduates, experience in pathology etc.

Some of the institutes that have well established observership programs include: Mount Sinai Medical Center International Observership Course, Cleveland Clinic Florida, Cleveland Clinic Ohio Center for International Medical Education, Johns Hopkins, Danbury Medical Center, Allegheny Observership Program, Brown University, Cedars Sinai Medical Center, Hemepath visiting pathologist at MD Anderson. Observerships can also be obtained at St. Luke’s-Roosevelt, Pennsylvania Hospital, Wayne State, and it also sometimes works or never hurts to find out by sending an enquiry to program co-coordinators or individual pathologists in particular institutes you may be interested in.

During the first week of your observerships it is important to observe the ways of communication and practices in the workplace. In order to be able to get letters it is important to be enthusiastic, show interest, knowledge, and be amicable. Doing a case report or review article with your mentor enables them to write more strongly about you and your work. In case you are able to stay longer in a certain place, you may volunteer for research opportunities or enquire about them when you apply for observerships.

Three letter of recommendations are required and having all three or at least two from Pathologists in the United States or pathologists who are known to people in institutes you are planning to apply goes a long way in strengthening your application.

USMLE scores[edit | edit source]

Getting a very good score makes the chances of getting a residency position very high. Books like first aid and USMLE world are very good combination to do smart self study or focused reading. Many successful applicants do well with self study without spending a lot of money on tuitions. The very practical structure of USMLE questions and study material makes it very interesting to read and practice. In fact, it makes you a well rounded physician as you are now equipped with extra skill sets of problem solving and taking care of your patients. Many applicants study till they get high scores on self-assessment exams before they give the USMLE. The NBME self-assessment exam is most popular for this purpose. The CCS portion of the Step 3 of the USMLE can be challenging and the most popular study material for the same is Archer full length CCS workshops. Step 3 is required for getting a work visa, however requiring the work visa puts limitations on the number of options you may have for residency positions and even future fellowships. The other option of student visa requires you to do a waiver job that can be hard to get or work in the home country for two years.

Application[edit | edit source]

It is always best to try get your application complete and apply to programs on the very first day when ERAS sends out applications. You have to get ERAS token to apply, information on ERAS website. However, if you are a strong applicant with very good scores and good letters, applying as late as second week October may work. It still works to apply by end of September, applying after September can greatly diminish the number of interviews you may get.

Interviews[edit | edit source]

Accepting all interviews is very important, as getting a residency if very multifactorial and does not always depend on your scores, letters, or profile. A very good number of interviews is ten, wherein the chances of getting selected into a residency are extremely high. Do not get disheartened with one or less than five interviews, as candidates have matched with only one interview. Asking questions in interviews is best to ask about weather, commutes, places to stay, etc. Hours, vacation time, teaching, preview time, etc., are usually informed by residents or faculty during the interview. Travelling can be very tiring and interview day can be very stressful, but remember this is the one chance you present yourself. Appearing enthusiastic, cheerful, friendly and giving reasons of why you would like to be there helps. Writing thank you and follow up emails after the interview to the people you met with on interview day is important. After your interview it helps to inform the programs about additional accomplishments like publications. The most important email to write about during the first week of January to all programs you interviewed is to inform them about your interest in the program and that you would like to be there. And wait for the match day!

Did not match[edit | edit source]

Do not get disheartened, as there is SOAP (Supplemental Offer and Acceptance Program). Although getting spots through SOAP for international graduates can be very hard. Even after the SOAP some programs may have unfilled spots due to various reasons including unfilled through SOAP, some candidates do not get visas, etc. It is best to keep checking for possible vacancies. If you are still left to apply for next year, remember the combination of planning, good scores, US letters and experience; and try to figure out where your preparation was deficient. Getting low scores on USMLE cannot be rectified, but is a tough task to get into residency by compensating low scores by doing volunteer research, getting publications and excellent recommendations.

Pathology Programs that Accept International Observers/Rotators[edit | edit source]

A list of pathology residency programs that usually accept international medical graduates for elective/observership rotations.

  • Mount Sinai Medical Center International Observership Course
  • Cleveland Clinic Florida
  • Cleveland Clinic Ohio Center for International Medical Education
  • Johns Hopkins
  • Danbury Medical Center
  • Allegheny Observership Program
  • Brown University
  • Cedars Sinai Medical Center
  • Hemepath visiting pathologist at MD Anderson.
  • St. Luke’s-Roosevelt
  • Pennsylvania Hospital
  • Wayne State


Pathology Fellowships that Accept International Graduates who have NOT completed pathology residency in the USA[edit | edit source]

Pathology residents in training at residency programs in the USA are eligible to apply to essentially any USA pathology fellowship program; this is true regardless of whether they completed medical school in the USA or at an ECFMG approved international medical school. However, pathology residents or in-practice pathologists who did their pathology residency training outside of the USA may not be eligible for some fellowship programs in the USA. This is a list of pathology fellowship programs that allow international applicants who have not completed residency training in the USA.

  • Brown University International Visiting Fellowship Program in Women's and Perinatal Pathology
  • International Breast Pathology Fellowship Memorial Sloan Kettering Cancer Center
  • University of Pennsylvania Hospital International Dermpathology Fellowship
  • Ackerman academy International Dermpathology Fellowship
  • Boston University Dermpathology Fellowship
  • Medical College of Wisconsin one year observership


Links to other useful info[edit | edit source]

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