Oregon Health & Science University, Dept. of Diagnostic Radiology
Alternate Pathway Fellowship Application

General Application Instructions

Thank you for your interest in the Alternate Pathway at Oregon Health & Science University (OHSU). Please review and follow these instructions carefully.

Application Form: Complete all pages of this OHSU Alternate Pathway Fellowship Application (Sections 1-7) by typing directly into the form fields below. Once completed, use your browser's Print function and select "Save as PDF" to create a PDF file for submission. Incomplete applications will not be considered.
Supporting Documents (attach to application): Curriculum Vitae (CV), Medical Student Performance Evaluation (MSPE) or transcripts from your medical school, ECFMG certificate, USMLE Step 1, 2, and 3 official transcripts, and three letters of recommendation. Letters must be sent directly from the letter author to walshau@ohsu.edu. One of these letters must come from your current supervisor. If you completed training within the last 5 years, a letter from your residency program director is also required.
Personal Statement: Complete directly on Section 6 of the application. Must address: Why the Alternate Pathway, Why OHSU, Future career plans. Your statement must fit within the designated space.
Submission: Email this application form and all supporting documents to Alternate Pathway Fellowship Coordinator, Audrey Walsh, at walshau@ohsu.edu before the deadline of November 16, 2025.
Verification: Applicants should be prepared to provide independent verification of case volumes, training, and credentials upon request.

Section 1 - Applicant Information

Full Legal Name:

Degree(s):

Earliest date of availability (required):

Diagnostic Radiology Board Certification in Home Country: (List your certification(s) in the following format: Certifying Board – Certification Name; Location; Dates; Status. Include subspecialty certifications if applicable. If you are not yet board certified, please explain why and indicate your anticipated date of certification.)

Current training or work position:

Contact Information

Present Address:

Home Address (if different):

Email Address:

Telephone (mobile):

Date of Birth:

Place of Birth:

Country of Citizenship:

Visa Type/Number (if applicable):

Medical School, Year of Graduation:

Other Degrees:

Examinations

USMLE (or equivalent):

(List your examination scores and percentiles in the following format: Score: XXX, Percentile: XX%.)

Step 1:

Step 2:

Step 3:

Other Exams (e.g., PLAB, specialty boards):

Licenses

Licenses (past and present): (List your licenses in the following format: Location, License Number, Current Status. If not applicable, enter N/A.)

ECFMG Certification Number, Valid Through Date:

Section 2 – Training and Medical Employment History

Internship: (List your internship or equivalent training in the following format: Institution Name, City, Country; Specialty; Month Year – Month Year. If not applicable, enter N/A.)

Residency: (List your residency training in the following format: Institution Name, City, Country; Specialty; Month Year – Month Year. If not applicable, enter N/A.)

Fellowship(s) (if any): (List your fellowship training in the following format: Institution Name, City, Country; Subspecialty; Month Year – Month Year. If not applicable, enter N/A.)

Staff/Faculty Positions (if any): (List your staff or faculty positions in the following format: Job Title, Institution Name, City, Country; Month Year – present or end date. If not applicable, enter N/A.)

Section 3 – Academic and Professional Activities

Research Experience: (List major research projects. Include your role, institution, and dates.)

Publications: (List key publications. Full CV should provide complete details.)

Teaching Experience: (List teaching activities including medical trainees, lectures, and other teaching roles.)

Conference Presentations / Educational Exhibits: (List presentations and exhibits. Include title, meeting name, and date.)

Leadership / Administrative Roles: (List leadership positions such as Section Chief, Program Director, Society Memberships, and Committee Work.)

Special Skills: (List technical expertise, advanced modalities, languages relevant to medicine, etc.)

Section 4 – Case Volume Experience

(Estimate your case volume experience across all training. Select the appropriate range for each modality.)

Radiography

Chest X‑ray:

< 1,000 1,000–2,000 2,000–5,000 > 5,000

Ultrasound

Abdomen/Pelvis US:

< 200 200–350 350–700 > 700

Women's Imaging

Mammography:

< 150 150–300 300–600 > 600

Nuclear Medicine

PET:

< 15 15–30 30–60 > 60

Non‑PET (bone scan, thyroid, renal, HIDA, etc.):

< 30 30–60 60–120 > 120

Procedures

Image‑guided Biopsy/Drainage:

< 10 10–25 25–50 > 50

Additional Question

Clinical Practice Description: (Please describe your current or most recent clinical practice and activities over approximately the past year. Include details such as the type of practice setting (academic, private, rural, urban, etc.), the types and approximate volumes of imaging studies you interpret, the procedures you perform (with typical frequency), and any dedicated time for academic, administrative, or other professional responsibilities.)

Section 5 – Subspecialty Year Preferences

(Arrange the following subspecialty fellowships from your most preferred (1) to least preferred (8). Select each subspecialty once.)

Additional Questions

As we consider a proposed four-year plan, are there particular fellowships you consider especially important to include? Briefly explain. Use only the space provided.

As we consider a proposed four-year plan, are there particular fellowships in which you would not feel comfortable training or practicing? Briefly explain. Use only the space provided.

Section 6 – Personal Statement

(Provide a concise personal statement addressing: Why the Alternate Pathway, Why OHSU, and your Future Career Plans. Your statement must fit within the space provided and character limit.)

0 / 2300 characters

Section 7 – Attestation

I hereby certify that the information provided in this application and in any supporting materials is true, complete, and accurate to the best of my knowledge. I understand that misrepresentation or omission of information may be grounds for disqualification or dismissal from the program.

I acknowledge that OHSU may require independent verification of case volumes, credentials, or other information provided in this application.

Applicant Name:

Signature:

Date: