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The "Fifth Pathway" Statement:

  A pathway for entrance to approved programs of graduate medical education, other than those existing under previous policies, become available as of July 1, 1971 for students who have fulfilled the following conditions:
  • Have completed, in an accredited American College of University, undergraduate premedical work of the quality acceptable for matriculation in an accredited U.S. medical school evaluated by measures such as college grade point averages and scores achieved on the Medical College Admission Test.
  • Have studied medicine at a medical school, located outside the United States, Puerto Rico, and Canada, which is listed in the World Directory of Medical Schools published by the World Health Organization.
  • Have completed all of the formal requirements of the foreign medical school except internship and/or social services. Those who have completed all of these requirements including internship and/or social service are not eligible.

Students who have completed the academic curriculum in residence in a foreign medical school and who have fulfilled the above conditions may be offered the opportunity to substitute for an internship and/or social service required by a foreign medical school an academic year of supervised clinical training prior to entrance into the first year of approved graduate medical education. The supervised clinical training must be provided by faculty of an undergraduate program in medical education accredited by the Liaison Committee on Medical Education, and should be conducted in closely affiliated hospitals to assure that those who completed such programs are reasonably comparable to the school's regularly graduated students. The medical school should insure that the constellation of resources is adequate for the conduct of its Fifth Pathway without jeopardizing its other academic programs.

Before beginning the supervised clinical training, said students must attain a score satisfactory to the sponsoring medical school on a screening examination, preferably nationally administered, acceptable to the Council on Medical Education and have their academic records and skills evaluated by the faulty to identify individual academic deficiencies to be remedied by completion of the supervised clinical program.

Said students will have completed successfully the supervised clinical training upon judgment by the medical school's faculty on the basis of a final evaluation comparable to that used in judging regularly enrolled students for award of the MD degree. They are then eligible to enter the first year of approved graduate training programs without completing social services and/or internship obligation required by the foreign country and obtaining ECFMG certification.

The Council on Medical Education has recommended to all state boards of medical examiners that they consider for licensure all candidates who have completed successfully the supervised clinical training on the same basis as they now consider foreign medical candidates who have received ECFMG certification.

Policy Statement of the Council on Medical Education:
  • Adopted June 12, 1971,
  • Modified May 23, 1973,
  • Modified March 22, 1975,
  • Modified September 8, 1979
  • Modified June 11, 1981
Acceptance of Fifth Pathway Programs
September 1, 1992 :
The following summary, based upon available information, is intended as a general guide to the acceptance of a Fifth Pathway certificate as part of an application for licensure.

States Indicating Acceptance:












Puerto Rico*


Mississippi* **

Rhode Island**

District of Columbia**


South Dakota








Nevada* **



New Hampshire*



New Jersey**



New Mexico**

Virgin Islands


New York



North Carolina* **

West Virginia**


North Dakota**





States Indicating They Will Not Accept:

Alaska, Arkansas, Delaware, Guam, Maine, South Carolina, and Wyoming.

* at discretion of Board
** must have passed FMGEMS or ECFMG examination

Applicants for licensure must meet relevant requirements, for instance residency training and passing a licensing examination.

New York
Peter Nicholas, MD
Associate Dean for Students Clinical Years
Mount Sinai School of Medicine
The City University of New York
Fifth Avenue and 100th Street
New York, New York 10029
(212) 241-6691 or (718) 830-1335
New York
Dolores M. Ercole
Fifth Pathway Program
New York Medical College
Sunshine Cottage
Valhalla, New York 10595
(919) 993-4000 or (919) 993-4489
Puerto Rico (Fluency in Spanish necessary)
(Preference for Puerto Rico Residents)
Leila N. Tormes, MD
Director, Fifth Pathway Program
University of Puerto Rico School of Medicine
Caguas Regional Hospital
G.P.0. Box 5729
Caguas, Puerto Rico 00625
(809) 744 5696
Rhode Island
Rhode Island Residents Only
Kathryn Massone
Manager of Admission and Financial Aid
Brown University
Division of Biology and Medicine
Providence, Rhode Island 02912
(401) 863-2149
Download MD Application Forms (PDF file)