Specialized Professional Study

In the United States, dental study usually begins after four years of undergraduate study. Universities do not have undergraduate programs in dentistry; students planning to study dentistry can major in any subject, but should have a minimum number of prerequisite undergraduate courses in the biological sciences, chemistry, physics, and mathematics, as well as in the humanities and the behavioral and social sciences.

First Professional Degree

The first professional degree in dentistry, titled either the doctor of dental surgery (D.D.S.) or the doctor of dental medicine (D.M.D.) degree, requires four years of study — two years emphasizing the basic medical sciences, and two years providing a clinical orientation. To practice, graduates must also meet requirements of the state in which they plan to see patients, including satisfactory scores on the National Board Dental Examination and a state clinical examination.

Admission to a U.S. dental school is highly competitive, with about twice as many applicants as positions available. Although anyone is eligible to apply, foreign nationals rarely gain admission to a U.S. school of dentistry without having completed at least two years of postsecondary study at a U.S. institution. In one recent year, out of 4,268 first-year dental students, 342 were foreign nationals. Chances of obtaining admission to private dental schools are somewhat higher than those of admission to state-supported dental schools, because public institutions generally give admissions preference to the state residents whose taxes support their programs. The American Dental Education Association (website at http://www.adea.org/) publishes an annual guide to dental schools that includes useful information and statistics on admission requirements. Your EducationUSA advising center may have this resource and other reference material to help you get information on particular schools and evaluate your qualifications.

Application requirements for dental school include a strong undergraduate academic record, proficiency in the English language, and a score on the Dental Admission Test (DAT) judged satisfactory by the individual dental school. The DAT examines proficiency in mathematics, biology, chemistry, organic chemistry, reading, and perceptual motor abilities. It is regularly offered in the United States. Occasionally, it can be scheduled in other countries — a U.S. admissions officer or predental adviser must request such administration at least three months before a scheduled test date. For further information, contact the Dental Admission Testing Program, Department of Testing Services, American Dental Association, 211 East Chicago Avenue, Suite 1846, Chicago, IL 60611-2678, USA; Telephone: 312-440-2689, extension 2689; E-mail: education@ada.org.

Postgraduate Training

After receiving the D.D.S. or equivalent, dentists may apply for postgraduate training at hospitals or dental schools. Some programs lead to a master's degree, and doctoral study may also be available. These degree programs typically prepare graduates for teaching or research careers.

A university or a hospital may sponsor non-degree residency programs with a clinical focus. General practice residencies are highly competitive, and typically only about 4 percent of the students enrolled are foreign nationals. Specialty residencies tend to admit a considerably larger proportion of internationally educated dentists. These residencies offer training in dental public health, endodontics, oral and maxillofacial pathology, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics, or prosthodontics.
No one process exists to qualify internationally trained dentists seeking to study in the United States. One common requirement is that applicants must pass one or both parts of the National Board Dental Examination. Some specialty areas, such as oral surgery and periodontics, require that dentists complete at least the last two years of professional study at a U.S. university and earn a first professional degree at a dental school accredited by the American Dental Association. (About half of U.S. dental schools offer admission at an advanced level for internationally educated dentists wishing to complete a U.S. first professional degree.) State licensure and national board certification may also be required in some cases. Dental schools are more likely than hospitals to consider international applicants who do not have a U.S. license.

Short-term Educational Opportunities

Dental schools and hospitals frequently offer postgraduate continuing education courses lasting from a few days to a few weeks. These courses provide updates on specific topics and are open to international dentists. A few schools will arrange special programs for visiting internationally-educated dentists.

In the United States, medical study generally follows completion of a bachelor's degree. Admission to medical study is very competitive. Less than half of U.S. citizen applicants are accepted to medical school, and typically less than 3 percent of international applicants are accepted. In one recent year only 155 of the 16,221 students who entered medical school were foreign nationals, and most of them were individuals who had completed their undergraduate education in the United States. Because medical schools, particularly public medical schools, are funded largely by taxes raised in the states where they are located, admissions preference is usually given to residents of that state. Some state-supported schools will consider only U.S. citizens and permanent residents for admission.

First Professional Degree

Medical school usually lasts four years and students graduate with the Doctor of Medicine (M.D.) degree. Study combines classroom experience with observation and clinical work. Admission requirements include an undergraduate degree, preferably from a U.S.-accredited institution. Degrees in almost any discipline are acceptable as long as the student's course load includes the required minimum number of prerequisite courses in the biological sciences, chemistry, mathematics, behavioral and social sciences, and humanities. Additional requirements include an excellent undergraduate academic record; fluency in English; extracurricular activities such as work experience and volunteer commitments; and a satisfactory score on the Medical College Admission Test (MCAT), a standardized entrance examination administered around the world on computer. More information on the MCAT can be found by contacting the Association of American Medical Colleges (AAMC) at http://www.aamc.org/students/mcat/start.htm or the American College Testing Program, MCAT Program Office, P.O. Box 4056, Iowa City, IA 52243, USA; Telephone: 319-337-1356; Fax: 319-337-1122.

Students interested in studying toward an M.D. degree should carefully consider the level of difficulty of entrance requirements, length of time involved (four years of undergraduate study plus another four years of medical school), and recognition of a U.S. medical degree and licensing qualifications in their home country to determine if medical study is appropriate for them. The Association of American Medical Colleges (website at http://www.aamc.org/) publishes an annual guide to medical schools that includes useful information and statistics on admission requirements. Your EducationUSA advising center may have this resource and other reference material to help you get information on particular schools and evaluate your qualifications.

Postgraduate Training

Many foreign nationals who receive their first degree in medicine (M.D.) in their home country choose to continue their graduate medical education in the United States. To be eligible to practice medicine in the United States, all physicians, regardless of whether they were educated in the United States or outside the United States, must:
• receive the first professional medical degree from a medical school accredited by the Liaison Committee on Medical Education;
• complete a period of residency or graduate medical education;
• pass state licensure examinations.

Obtaining ECFMG Certification

U.S. graduate training for physicians generally involves completing a prescribed period of clinical training in a chosen medical specialty, usually called a residency. The Accreditation Council for Graduate Medical Education (ACGME) accredits such programs. While entry to residencies is quite competitive, international physicians have better chances to pursue U.S. study at this level than at the first professional level.

To obtain residency positions or other training involving patient contact, graduates of medical schools outside the United States must pass a certification program administered by the Educational Commission for Foreign Medical Graduates (ECFMG). This certification program is designed to assure both the U.S. public and directors of residency programs that applicants from foreign medical schools have qualifications comparable to U.S. medical school graduates. All graduates of medical schools outside the United States and Canada (including U.S. citizens who have graduated from medical schools not accredited by the Liaison Committee on Medical Education) must meet ECFMG certification requirements.

For ECFMG certification, you will have to:
• Submit documents showing graduation from a medical school listed at the time of graduation in the then current edition of the World Directory of Medical Colleges.
• Submit documents showing completion of all educational requirements to practice medicine in the country where your medical education was completed. Physicians who are nationals of the country where they were educated must also have a license to practice medicine in that country. • Pass both the basic medical science (Step 1) and clinical science (Step 2) sections of the U.S. Medical Licensing Examination (USMLE). These are computer-based examinations administered at testing centers worldwide. Further information is available from information and advising centers or from the USMLE website at http://www.usmle.org/.
• Pass the Clinical Skills Assessment (CSA), which is a test evaluating spoken English ability and clinical proficiency. The CSA is currently administered at the ECFMG Clinical Skills Assessment Center in Philadelphia, Pennsylvania, in the United States. Physicians are eligible to take the CSA only when they have completed all other ECFMG testing requirements successfully.
• Achieve an acceptable score on the Test of English as a Foreign Language (TOEFL), which is a computer-based English language proficiency test administered at testing centers worldwide. Further information is available from EducationUSA advising centers or from the TOEFL Web site at http://www.toefl.org/.

ECFMG can provide an information booklet, updated annually, that contains further details on the certification process. Contact the Educational Commission for Foreign Medical Graduates, 3624 Market Street, 4th floor, Philadelphia, PA 19104-2685, USA; Telephone: 215-386- 5900; Fax: 215-387-9963; Web site: http://www.ecfmg.org/.
In addition to ECFMG certification, some states require that foreign medical graduates pass a third medical licensing examination, the USMLE Step 3, prior to taking part in a residency. This test is administered only in the United States.

Locating a Residency

ECFMG certification does not guarantee placement in a residency program. Indeed, in some years, only small percentages of international medical graduates who gained ECFMG certification have been placed in residency positions.

International medical graduates applying for residencies must have ECFMG certification before beginning a residency, but they may initiate correspondence with a program before they receive certification. Information on residency programs can be found on-line in the American Medical Association's (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA), located
at http://www.ama-assn.org/ama/pub/category/2997.html. Information is also published by the AMA in print and on CD-ROM annually as the Directory of Graduate Medical Education. Many information and advising centers have a copy of this book, or an order form may be requested from the AMA, Order Dept. OP416798, P.O. Box 7046, Dover, DE 19903-7046, USA; Fax: 312-464-5600.
When corresponding with residency programs, be sure to obtain information on such issues as salary, length of appointment, elements of the program, hours of duty and responsibilities, and provision of health and professional liability insurance.

Application must be made to individual programs, and, in addition, applicants must generally participate in the National Resident Matching Program (NRMP) or one of several other computerized application programs in which residency programs in particular specialties participate. An increasing number of medical specialties are requiring use of the Electronic Residency Application System (ERAS), administered for international medical graduates by ECFMG. To receive an ERAS application form, applicants should contact the ECFMG ERAS Program, P.O. Box 13467, Philadelphia, PA 19101-3467, USA; E-mail: erashelp@ecfmg.org; Telephone: 215-386-5900; Fax: 215-222-5641.

To take part in the NRMP, physicians must pass all ECFMG examinations by January 1 of the year in which they plan to enter the residency. The NRMP allows each applicant to submit a list of their preferred residencies, which are then matched with the preferences submitted by residency programs. For further information, see ECFMG's bulletin, or contact the NRMP, 2501 M Street, N.W., Suite One, Washington, DC 20037-1307, USA; Telephone: 202-828-0566; Web site: http://www.aamc.org/nrmp.

ECFMG-certified foreign physicians who are matched with residency positions usually are eligible to receive sponsorship from the ECFMG for exchange visitor (J-1) visas. The period for which J-1 status is valid varies with the medical specialty chosen, with each specialty board determining the appropriate length of time for graduate clinical training in that specialty. After completion of the stipulated training period, exchange visitor physicians must leave the United States. They are not eligible to petition to apply to return to the United States in immigrant, temporary worker, or trainee status, or as an intra-company transferee, until they have resided in their home country, or country of last permanent residence, for two years.

Alternatives Not Requiring ECFMG Certification

Graduate Academic Education

Foreign medical graduates can apply directly to graduate academic programs in medically related fields that do not involve patient care. Such programs do not require ECFMG certification. Application procedures are similar to those for graduate programs in non-medical fields. A few examples of medically related fields of study include radiology, immunology, molecular biology, genetics, neuroscience, pathology, and physiology. Foreign medical graduates may also apply for research grants in the health sciences. Hospitals, universities, and independent research centers are possible sites for research.

Short-term Opportunities

Medical centers, hospitals, and medical associations frequently offer conferences or short-term courses, lasting from a few days to a few weeks to, occasionally, several months. Such opportunities are open to foreign medical graduates without ECFMG certification as long as they do not involve direct patient contact. Some medical centers, particularly larger research and teaching institutions, may also be able to arrange individual training for international physicians on request. Such exchanges, again, cannot involve direct patient contact but they can provide valuable opportunities for consultation, observation, and comparison of facilities. There are specific offices, called by a variety of names, including International Services, at some medical centers that arrange such visits. Visits may also be arranged directly with U.S. colleagues.

ECFMG International Fellowships in Medical Education

This program brings selected international medical school faculty members to teach and study in a U.S. medical school for between six months and one year. Eligible areas of study include educational methodology, curriculum design, evaluation systems, medical school governance, and the development of basic and clinical science departments. ECFMG generally arranges a match with a U.S. medical school. All applications must include the endorsement of the candidate's home country medical school. Fellowships are not intended to support a formal curriculum leading to a degree. For further information, contact ECFMG, International Fellowships in Medical Education, 2401 Pennsylvania Avenue, N.W., Suite 475, Washington, DC 20037, USA; Telephone: 202-293-9320; Fax: 202-457-0751.

Basic study for the nursing profession in the United States takes place at the undergraduate level. The professional-level "registered nurse" (R.N.) has a bachelor's degree in nursing and must fulfill state licensure requirements to practice. Each U.S. state has its own criteria and regulations for licensure; however, every state uses the same licensing examination, known as the NCLEX-RN, which must be passed before a license is awarded. Most states also require nurses educated outside the United States to be certified by the Commission on Graduates of Foreign Nursing Schools (CGFNS) before taking the NCLEX-RN.
Certain graduate programs in nursing require state licensure or CGFNS certification, depending on level of patient contact and the laws of the state where the program is offered. Another option in many states is a special limited license for educational purposes. Check licensing requirements carefully with individual programs to see if you qualify for this option. CGFNS certification will also be required if you apply for either a temporary nonimmigrant visa (H-1A) or a permanent visa.
To obtain a CGFNS certificate involves a credential review and an examination. You can be registered for the CGFNS Exam if CGFNS determines that you:
• are currently registered as a first-level general nurse in the country where you were educated;
• have completed an upper secondary school education, separate from nursing education;
• have graduated from a government-recognized general nursing program lasting at least two years;
• have received theory and clinical practice instruction in medical, surgical, obstetric, pediatric, and psychiatric nursing.
The CGFNS Exam tests nursing knowledge and is given approximately three times a year at sites around the world. Candidates for certification must also demonstrate English language proficiency as measured by the Test of English as a Foreign Language (TOEFL) (Website: http://toefl.org/). For information on the CGFNS certification program, contact your nearest U.S. educational information or advising center or CGFNS, 3600 Market Street, Suite 400, Philadelphia, PA 19104- 2651, USA; Telephone: 215-349-8767; Website: http://www.cgfns.org/.
A variety of options for advanced, specialized nursing education exist in the United States, including university master's and doctoral programs as well as non-degree certificates and continuing education programs, which are usually very brief, offered by universities, hospitals, associations, and other sources. Specializations include nursing administration, nursing education, nurse midwifery, psychiatric nursing, gerontological nursing, public health nursing, and many others.

Related Links
Commission on Graduates of Foreign Nursing Schools
http://www.cgfns.org/
National League for Nursing
http://www.nln.org/
Nursing Schools and Scholarships Search Engine
http://www.free-4u.com/nursing/

Veterinary school is generally entered following completion of a bachelor's degree program. Admission to U.S. veterinary schools is extremely difficult for students from other countries to achieve because of intense competition for a limited number of places. Competition for veterinary study is even more rigorous than that for study in medicine.

Only 27 schools of veterinary medicine exist in the United States. Of these, 25 are largely state-financed, with tax money from state residents supporting the school. Therefore, applicants from that state are generally given first preference. Only about a third of all those applying to U.S. veterinary schools are accepted by any one of the schools that they apply to, and the number of international applicants accepted is extremely small.

Most veterinary colleges participate in the Veterinary Medical College Application Service (VMCAS), which allows applicants to submit a common application for multiple schools. The primary consideration for admission is the quality of the undergraduate record. More than half of veterinary schools also require the Veterinary Aptitude Test, with some schools accepting the Medical College Admission Test or Graduate Record Examination. For information on VMCAS, contact the service at 1101 Vermont Avenue, N.W., Suite 411, Washington, DC 20005, U.S.A.; Telephone: 202-682-0750; Email: vmcas@aavmc.org.

One alternative to veterinary school is to enter a graduate program in animal sciences. Competition for these programs is less intense. Graduates of animal science programs are not certified for veterinary practice but may be qualified for a range of positions in agricultural industries, government, or university research and teaching.

U.S. veterinary schools offer a four-year program. Graduates receive the first professional degree, the doctor of veterinary medicine (D.V.M. or V.M.D.).

Postgraduate Training

Several alternatives for postgraduate training in the United States exist for foreign-trained veterinarians with the equivalent of the D.V.M. Veterinary schools offer postgraduate academic programs leading to a master's or doctoral degree. These programs are not designed to lead toward clinical practice, but rather to teaching positions in veterinary schools, employment by pharmaceutical companies, or research careers.

Another postgraduate option is residency training leading toward board certification in a specialty such as veterinary ophthalmology or veterinary pathology. Such residency training, also affiliated with veterinary schools, takes three years and involves a combination of academic and clinical experience. Short-term training and exchanges with U.S. veterinary schools and related organizations may also be arranged in some cases.

To practice veterinary medicine in most of the United States, internationally trained veterinarians must hold certification from the American Veterinary Medical Association's Educational Commission for Foreign Veterinary Graduates (ECFVG). In all states, veterinarians must also be licensed. For more information, contact the American Veterinary Medical Association, 1931 North Meacham Road, Suite 100, Schaumburg, IL 60173, USA; Telephone: 847-925-8070; Fax: 847-925-1329; E-mail: avmainfo@avma.org; Website: http://www.avma.org/.


Related Links

Association of American Veterinary Medical Colleges
American Veterinary Medical Association
National Board of Veterinary Medical Examiners

The legal system in the United States, on the federal level and in almost all states, is based on the British system of common law. One state, Louisiana, has a system modeled on the French legal code.

First Professional Degree

Juris doctor (J.D.) students studying for the first professional degree in United States law receive an education that is very specific to the United States legal system. As such, a J.D. is usually inappropriate for foreign students. This does not mean that international students are disqualified from a J.D. level education.

The U.S. first professional degree, the juris doctor (J.D.), provides an education strongly focused on preparation for U.S. practice, with little opportunity for comparative or specialty study. For this reason, and because preparation in U.S. law will not easily transfer toward practice in other countries, the J.D. is usually inappropriate for foreign nationals. Although law schools offer individual courses that emphasize particular subject areas such as environmental law or taxation, there are no J.D. programs concentrating on any single specialty.

J.D. degree programs involve three years of study, and are entered following four years of undergraduate study in any major. Competition for admission is intense for both U.S. and international students. Requirements generally include fluency in English, an excellent undergraduate academic record, and a satisfactory score on the Law School Admission Test (LSAT). (See http://www.lsac.org/ for LSAT registration information.) To practice in the United States, graduates must also pass the bar examination and other requirements of the state where they wish to work.

Graduate Legal Education

The master of comparative law (M.C.L.), also known as the master of comparative jurisprudence (M.C.J.), is a particularly appropriate degree program for international lawyers. Recognizing that legal systems in many countries differ from common law as practiced in the United States, these programs acquaint lawyers from other countries with U.S. legal institutions and relevant specialties of U.S. law. Another graduate option is the master of laws (L.L.M.), a degree offered in a variety of specialties or as a self-designed program, with appropriateness for the international practitioner varying from program to program. Programs in international law or international business law may also be of interest.

Almost all master's programs in law last one year and admit students only for the fall semester. Programs can be planned according to the interests of the student. During study, international lawyers have the opportunity to observe courts and government agencies in the United States. Entrance requirements include a first degree in law, a strong academic background, letters of reference, a statement of purpose and/or writing samples, and a high level of English proficiency as demonstrated by the Test of English as a Foreign Language (TOEFL) for students whose law degree was not in the English language. Most graduate law programs do not require standardized admissions tests.

Doctoral programs in law also exist. They admit only a small number of promising applicants, usually from among those who have completed a master's program at a U.S. law school and who plan to enter a career as a law school faculty member. Financial assistance may be more readily available to law students intending to continue towards a doctoral degree than to those seeking only a one-year master's program.

Short-Term Legal Education

Many U.S. law schools offer programs, particularly in the summer, either designed for or appropriate for international lawyers. These usually last between one week and two months. Professional associations and private training organizations offer similar programs. Your nearest EducationUSA advising center may be able to provide information on other options, such as tours to visit U.S. legal institutions.