More information is needed. I also have no idea WTF you're talking about--spell out your acronyms and explain what an 'expected of 40' (assuming it's a test score) so we can help you more.
In America, becoming a doctor (surgeon) looks like this:
-4 years of undergrad schooling at a 4-year university
-4 years of postgraduate schooling at a medical school
At this point you are technically a doctor (MD or DO at the end of your title) but not licensed to practice independently w/o supervision. That's where residencies come in--think of them of a proving ground
--------
-residency of varying lengths at a hospital/clinic, for example Emergency Medicine in America is 3 or 4 years, in Canada it's 5.
a. Most surgeons do a general surgery residency (usually 5 years), then an additional residency for their speciality. Let's say you want to be a trauma surgeon. You'd do 5 years of general surgery residency, then 2 years of trauma surgery residency.
-fellowships at a hospital for (usually) 2 years.
a. This is where you gain even more experience in your speciality. I would venture to say it's more common for surgeons to enter a fellowship. You do some research and take on some cases. This is not mandatory and many doctors will opt to go straight to practice.
Feel free to check out the American College of Surgeons website (facs.org) for more info. Good luck
