International Training & Visas

• For general information on the process for certification by the American Board of Surgery, see About ABS Certification under For the Public.
• The American Board of Surgery does not offer reciprocity with certification in other countries. Surgeons who have completed some or all of their surgical training outside the U.S. and wish to become certified by the ABS must first enroll and complete training in an accredited U.S. or Canadian residency program.

Credit for Foreign Graduate Medical Education

• The ABS does not grant credit directly to residents for surgical education completed outside the U.S. or Canada. The ABS will consider granting partial credit for foreign graduate medical education to a resident enrolled in a U.S. ACGME-accredited general surgery or integrated vascular surgery residency program, but only upon request of the program director. Preliminary evaluations will not be provided before enrollment in a residency program, either to the resident or program director.
• The program director is the primary judge of the resident's proficiency. If a program director believes a resident to be a candidate for credit, the resident should be assigned to the PGY-2 or PGY-3 level when entering the program so the appropriate level of clinical skills can be assessed. Program directors should make the request for credit only after having observed the individual for at least six months and only once all required documentation is available.
• See the respective Credit for Foreign Graduate Medical Education Policy for general surgery or integrated vascular surgery for complete details, including all required documentation. Requests for more than one year of credit must be submitted by March 15 with all documentation. The ABS only grants credit toward general surgery or integrated vascular surgery training.

Canadian Residents

• Surgeons who have completed all their training in Canada may apply for ABS certification upon completion of a residency program accredited by the RCPSC (RCSPC). Applicants must have completed all of the requirements in a program accredited by the RCSPC or in combination with a U.S. program accredited by the ACGME. No credit for postgraduate surgical education outside the U.S. and Canada will be granted to applicants who complete a Canadian program. Applicants from Canadian programs must comply with ABS requirements for certification.

International Rotations

The ABS will accept in certain circumstances rotations completed outside of the U.S. or Canada toward its general surgery, independent and integrated vascular surgery, pediatric surgery, and complex general surgical oncology training requirements. If a program director wishes to credit training abroad toward ABS requirements, they must fully justify the reasons for it and receive approval in advance from both the ABS and the ACGME.

No such rotations will be permitted in the first year (PGY-1) of general surgery and vascular surgery residency training. For the ABS to consider international rotations in the PGY-5 chief year, the program must include documentation of ACGME approval of chief rotations in the PGY-4 year. The ABS is unable to consider these requests without this documentation. Rotations must be at least two weeks in length and must comply with ACGME requirements for the applicable specialty to be considered for credit.

To request approval:

• these experiences must be approved in advance by both the ABS and the applicable Review Committee of the ACGME;
• a letter should be sent by fax or email to both the ABS and the specialty-specific ACGME Review Committee. The letter must be signed by both the program director and the designated institutional official (DIO), and must contain the information outlined in the International Rotation Application Process for the applicable specialty; and
• the program will receive separate approval letters from the ABS and the ACGME; both must be received prior to implementation of the international rotation.

ECFMG Certificates

• A certificate issued by the Educational Commission for Foreign Medical Graduates (ECFMG) is required for ABS certification for all international medical graduates. The certificate must be valid indefinitely for all international medical graduates who complete an ACGME-accredited residency program. International medical graduates who complete a Canadian residency accredited by the RCSPC will have an ECFMG certificate with a "valid until" date. The valid until date must be after the date of application to the ABS.

J-1 Visas

• The U.S. Department of State has designated the ECFMG as the visa sponsor for all J-1 exchange visitor physicians who participate in clinical training programs.
• Prior to April 2021, applicants who had completed their training programs and required a visa extension to take an ABS examination were asked to write the ABS with the specifics of their situation to obtain a letter of support. Also prior to April 2021, program directors were required to formally request a letter of support from the ABS on behalf of individual trainees who were enrolled in a non-standard fellowship but did not have prior ECFMG approval.
• In April 2021, the ECFMG, the American Board of Medical Specialties (ABMS®), and the Accreditation Council for Graduate Medical Education (ACGME®) announced a change in the process for recognition of non-standard training as it relates to the J-1 visa program administered by ECFMG.
• Under the new model, the ACGME will offer recognition of Sponsoring Institutions that offer non-standard training programs for exchange visitor physicians. The recognition is being designed to ensure that institutions are providing appropriate oversight of the non-standard training program(s) they offer.
• This change has been codified by the U.S. Department of State. The ABMS-member boards have no further obligation to ECFMG’s non-standard process and are no longer being called on for letters of recognition. Instead, the ECFMG has been authorized to rely on the ABMS member boards in providing recognition for non-standard disciplines.
• More information on the current recognition process is available on both ECFMG and ACGME websites:

• Non-Standard Clinical Training (ECFMG)
• Pending Transition to ACGME Recognition for Sponsoring Institutions (ECFMG)
• Non-Standard Training (NST) Recognition(ACGME)

For questions regarding international training and visas, please contact the ECFMG.