I'm not a American medical student, but I have noticed that most of the people on this international forum are and so I have found it very interesting to learn about the route that many of you will have to take in order to practice back in the US. I think that I am right (but please correct me if I'm wrong) in my understanding that the USMLE and CSA are required for licensure in the US and that the score is also a factor in applying for post-graduate programs (residency i think?). If this is correct (albeit simplified greatly) than I'm still a little confused about something. If residency is essentially post-graduate study and work in order for the doctor to be able to specialize in a given medical discipline, then what would happen with a doctor who comes to the US and has already undergone complete post-graduate training and has practiced in his given specialty for a number of years? I understand that they would be required to take the USMLE and CSA for licensure, but what next? Would a highly skilled neurosurgeon from France or England with 15 years of experience in his field really be expected to enter into post-graduate level work? I find it a bit strange (and arrogant) that such a qualified doctor would be asked to retake training under the guidance of doctors who may not even be as skilled or experienced as he is. Is this really the procedure that qualified physicians would have to endure? Also what is a fellowship and does this in some way relate to doctors such as those I have asked about?