<p>International surgical fellowships offer senior trainees the opportunity to experience alternative health systems and learn novel cutting-edge techniques. They might also offer trainees exposure to a job market that they had not considered before. Obtaining a surgical fellowship in a reputable North American institution has been the chosen pathway for generations of Irish surgical trainees, yet it is not always a straightforward pathway. The following manuscript highlights the necessary preparation and key steps required to be a successful candidate in the search for a fellowship. It details some key pieces of advice surrounding the application and interview process and provides some guidance on how to choose a programme that will best suit your needs and meet your expectations.</p>