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Fifth Pathway

Many foreign medical schools require students to participate in an internship or to fulfill social service obligations after the completion of the didactic portion of their education before the M.D. degree can be awarded. The Fifth Pathway Program was developed by the Council on Medical Education of the American Medical Association (AMA) to expedite the return of citizens who are studying medicine abroad to the United States. Under this program, students who have completed the academic curriculum at a foreign medical school may substitute a year of supervised clinical training at a U.S. medical school for the internship or social service obligation required by the foreign medical school.The clinical training offered by participating U.S. medical schools is comparable to the clinical or junior internship offered to students in the United States during the fourth year of medical school. After the successful completion of these clinical studies, Fifth Pathway participants may enroll in a graduate medical training program without receiving a formal degree from the foreign medical school. Students my enroll in a graduate medical program by participating in the National Resident Matching Program (NRMP) or through individual negotiations with a particular residency program.

To be eligible for the program, U.S. citizens must meet the following prerequisites:

Completion of undergraduate premedical work at an accredited U.S. college, the quality of which must be acceptable for matriculation at a U.S. medical school.

Matriculation at a medical school outside the United States, Puerto Rico, or Canada, which is listed in the World Directory of Medical Schools published by the World Health Organization.

Completion of all formal requirements of the foreign medical school except the internship and/or social service obligation.

Achievement of scores satisfactory to the sponsoring medical school on a screening examination, preferably administered nationally and acceptable to the Council on Medical Education. The student's academic records and skills will be evaluated by the faculty to identify any deficiencies to be addressed by the supervised clinical program. The Council on Medical Education has urged all state boards of medical examiners to consider successful participants in the Fifth Pathway Program for licensure on the same basis they now consider foreign medical graduates with ECFMG certification. However, not all states recognize Fifth Pathway participants as eligible candidates for licensure. Program participants should be aware that the M.D. degree is often a prerequisite for licensure in many states.

For further information on schools which participate in the program or those which consider Fifth Pathway participants for licensure, please contact the following address:

Content provided by the:

Council on Medical Education

American Medical Association

515 North State Street

Chicago, IL 60610

(312) 464-4662



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