语言要求，怎样申请，是否要mcat?

I search the net and find the following information:

What is a pathway?

A pathway is an approved avenue to residency training at a U.S. hospital, which completes a medical student’s education. Before 1971, there were four pathways:

Graduation from a U.S. medical school
Certification by the Educational Commission for Foreign Medical Graduates (ECFMG)
Full and unrestricted licensure by a U.S. licensing jurisdiction
Passing the Spanish language licensing examination in Puerto Rico.
But in 1971, a new pathway was created – the Fifth Pathway.

What is the Fifth Pathway?

An avenue by which students who have attended four years at a foreign medical school may complete their supervised clinical work at a U.S. medical school, become eligible for entry to U.S. residency training, and ultimately obtain a license to practice in the U.S.

Who can qualify for a Fifth Pathway?

Only students who:

Graduated from an accredited American college or university;
Studied medicine at a medical school located outside the United States that is listed in World Health Organization's World Directory of Medical Schools and which requires a year or more of internship/social service (beyond the four years of medical school) before receiving a medical degree;
Completed all formal requirements of their foreign medical school EXCEPT the final year(s) of clinical work/social service.
How are Fifth Pathway students different from International Medical Graduates?

Fifth Pathway students do NOT graduate from a foreign medical school. They leave early, and complete a final year of medical training in the U.S.
Fifth Pathway students receive NO medical diploma from the U.S. medical school sponsoring their Fifth Pathway year of clinical education. They receive a ‘Certificate of Completion,’ which is accepted in lieu of a diploma in virtually all U.S. licensing jurisdictions.
The Fifth Pathway certificate IS the Fifth Pathway physician’s medical credential. Program policy is governed by the AMA, which also serves as the national, primary source credential verification for these physicians.