Application and Selection Process To apply to one of the ACGME accredited fellowships, you must be an anesthesiologist eligible for certification or fully certified by the American Board of Anesthesiology (ABA) before fellowship training begins. You will also need to obtain an Illinois Permanent License prior to training. If you would like to be considered for a fellowship position, please send the following application materials to the appropriate coordinator listed below:
Fellowship Application (See Next Page)
A current curriculum vitae
Two letters of recommendation from anesthesiologists with whom you have worked during your residency training
A letter of recommendation from your anesthesiology training program director or chair
A copy of your MSPE (dean’s letter) and medical school transcripts
Performance Evaluations from last year of residency
The results of your two most recent ABA In-training and USMLE Steps I-III examinations.
Brief statement explaining your interest in pursuing a fellowship position.
Inquiries and application materials should be sent to the individual fellowship coordinators:
Multidisciplinary Pain Medicine Fellowship- Kristie Edwards, kedwards@nmff.org, 312-695-0116
Critical Care Medicine Fellowship- Angela Gipson, agipson@nmff.org, 312-926-2537
Pediatric Anesthesia Fellowship- Courtney Hardy, MD, chardy@luriechilderns.org, 312-227-5170
Obstetrical Anesthesia Fellowship- Sean Jones, sjones@nmff.org, 312-472-3585
After the fellowship program director has received and reviewed all of the above-mentioned materials, he or she will notify the coordinator the status of your application and whether or not you will be invited to an interview.
Illinois Department of Financial & Professional Regulations (IDFPR) Applicants must obtain a Permanent Illinois Medical License before starting their fellowship training. Licensing information and application can be found at www.idfpr.com. In order to apply for a permanent license, the applicant must have taken the USMLE Step III. Please be aware that it may take up to 60 days for IDFPR to process and grant a permanent license.
International Medical Graduates (IMGs) IMGS can only apply to the Neurosurgical and Regional Fellowships since the fellowships do not have a subspecialty board. All international medical graduates must be certified by ECFMG before starting their fellowship training. Please refer to www.ecfmg.org for information about eligibility for the examination, fees, application, scheduling, and preparation. Fellowship applicants must submit documentation with an English translation. Photocopies of all examination results, letter/score results, and visa/citizenship papers must bear official seals and include dates and certificate numbers. If the applicant possesses a current visa, the status must include entry and expiration dates. IMGs must possess an ECFMG certificate before applying for a medical license.
To learn more about the Department of Anesthesiology fellowship programs and benefits, please visit:
http://www.feinberg.northwestern.edu/anesthesiology/Education/fellowships/ To contact Northwestern’s Office of Graduate Medical Education:
240 E. Huron Street, Suite 1-201
Chicago, Illinois 60611
312-503-7975
http://gme.northwestern.edu/contact.htm To read about benefits offered by Northwestern McGaw Medical Center:
http://mcgaw.northwestern.edu/current-housestaff/housestaff-manual/privileges-and-benefits To view a copy of the fellowship contract:
http://mcgaw.northwestern.edu/current-housestaff
Date of Application:
Date program to begin:
Personal Data
Name: Last
First
Middle
Social Security no.
- -
Mailing Address: Number and Street
City
Mailing address current until:
State
Zip code
Home phone
( ) -
Cell phone
( ) -
Phone current until:
E-mail Address
Cell phone
( ) -
Permanent Address: c/o Name
Permanent phone
( ) -
Mailing Address: Number and Street
City
State
Zip code
Date of birth (required for state license application)
Citizenship
International Medical Graduates specify type of visa you hold
Fellowship Program
Please select the fellowship program to which you are applying from the dropdown menu:
Fellowship Program:
Education
Institution
Dates Attended
Degree conferred
Include full name and location
From Mo./Yr.
To Mo./Yr.
Type
Date
Mo./Yr.
Undergraduate
Medical School
Graduate work (doctoral or master’s)
Graduate work (doctoral or master’s)
Graduate Medical Education
Postgraduate experience (residency and fellowship):
Dates attended
All current and previous years of postgraduate medical education must be verified by the institution at which training occurred.
From Mo./Yr.
To Mo./Yr.
Name of Program Director
PGY I Type
Name of program and institution
PGY II Type
Name of program and institution
PGY III Type
Name of program and institution
PGY IV Type
Name of program and institution
PGY V Type
Name of program and institution
During any prior graduate medical education, were you ever disciplined or placed on probation by licensing body, institution, or training program? Y/N If yes, please include an explanation with your application.
Other Medical Experience
Include experience such as private practice, hospital and staff appointments, research and military
Type
Location
Dates
Type
Location
Dates
Type
Location
Dates
Personal Statement
Please e-mail an autobiographical statement explaining how you became interested in the fellowship(s) you have chosen. Remember to sign your name and include the date. If applicable, please include in your statement:
Information about time gaps from the date of conferral of medical degree to present
Health information or other particulars that you may wish to discuss with the fellowship program director
Curriculum Vitae
Please e-mail your current curriculum vitae with your fellowship application.
Board Certifications
Please list your board certifications(s) and year certified:
1. Board certification:
Year:
2. Board certification:
Year:
Photograph
Please e-mail a digital photograph with your application.
Letters of Recommendation RequestedInclude full name and address of institutions
Program director or chair
1.
Faculty member
2.
Faculty member
3.
Examinations Taken Photocopies of original documents and scores must accompany the application
U.S./Canadian/international medical graduates
International medical graduates only
USMLE
Score
Step 1
Step 2
Step 3
ECFMG
Certificate issue date No.
Date Taken
TOEFL Date Score
Licensure
State
Temporary
Permanent
CSA Date Score
No.
Date Granted
Expiration date
Visa
Licensure
State
Temporary
Permanent
Current status Type
No.
Date Granted
Expiration date
No.
In-training exams
Score
Score
Entry Date Expiration date
(2 most recent scores)
Date taken
Date taken
Have you ever been convicted of a felony? Yes No If yes, please include an explanation with your application.
Please check the box and type your name and date below if you agree with the following statement:
The information I have given in this application is current and complete to the best of my knowledge.
