Section
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Common Program Requirement
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Attachments
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GME Check Off
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III.A.2.b).(1)
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Assessment by the program director and fellowship selection committee of the applicant’s suitability to enter the program, based on prior training and review of the summative evaluations of training in the core specialty.
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Summative Evaluations
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III.A.2.b).(2)
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Review and approval of the applicant’s exceptional qualifications by the GMEC or Education Subcommittee
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GMEC Approval:
___________________
Date
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III.A.2.b).(3)
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Satisfactory completion of the United States Medical Licensing Examination (USMLE) Steps 1, 2, and, if the applicant is eligible, 3,
USMLE scores:
Step 1 ___________ number of attempts ____________
Step 2___________ number of attempts ____________
Step 3 ___________ number of attempts ____________( if applicable)
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USMLE Scores
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III.A.2.b).(3)
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Applicant is eligible, for USMLE Step 3?
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Yes
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No
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III.A.2.b).(4)
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For an international graduate, verification of Educational Commission for Foreign Medical Graduates (ECFMG) certification; and,
ECFMG Certificate: Date _______
Number _____________________
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ECFMG
Certificate
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III.A.2.b)
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Explanation of Exceptionally Qualified Applicant: Explanation should include the following information:
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Completed a non-ACGME-accredited residency program in the core specialty, and (2) demonstrated clinical excellence, in comparison to peers, throughout training.
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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 subspecialty; (b) demonstrated scholarship in the specialty or subspecialty; (c) demonstrated leadership during or after residency training; (d) completion of an ACGME International-accredited residency program.
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Exceptionally Qualified Applicant Explanation
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* * * * * *
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Program is responsible for the H1B visa processing and cost of approved applicants
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