Medical education in the United States
From SCOME Wiki
Medical education in the United States includes educational activities involved in the education and training of medical doctors in the United States, from entry-level training through to continuing education of qualified specialists.
Participants of the Medical Education sessions at the 55th August Meeting of IFMSA in Zlatibor (Serbia) in 2006 have compiled flipcharts about different medical education systems.
Among those was the following flipchart about the medical education in the United States.
A typical outline of the medical education pathway is presented below, however medicine is a diverse profession with many options available. For example, some doctors work in pharmaceutical research, occupational medicine (within a company), public health medicine (working for the general health of a population in an area), or join the armed forces.
Admission into medical school usually requires either three years of undergraduate study or a four-year post-secondary bachelor's degree from an accredited college or university, depending on medical institution. Most require that the applicant have attained a bachelor degree prior to matriculation. Admissions criteria may include overall performance in the undergraduate years and performance in a group of courses specifically required by U.S. medical schools, the score on the Medical College Admission Test (MCAT), application essays, letters of recommendation (most schools require either one letter from the undergraduate institution's premedical advising committee or a combination of letters from at least one science faculty and one non-science faculty), and interviews.
Most commonly, the bachelor degree is in one of the biological sciences, but not always; in 2005, nearly 40% of medical school matriculants had received bachelor's degrees in fields other than biology or specialized health sciences . All medical school applicants must, however, complete year-length undergraduate courses with labs in biology, general chemistry, organic chemistry, and physics; some medical schools have additional requirements such as biochemistry, calculus, and English.
A student with a bachelor's degree who has not taken the premedical coursework may complete a postbaccalaureate (postbacc) program. Such programs allow rapid fulfillment of prerequisite course work as well as grade point average improvement. Some postbacc programs are specifically linked to individual medical schools to allow matriculation without a gap year.
Several universities across the U.S. admit high school students to both their undergraduate colleges and the medical schools simultaneously; students attend a single six-year to eight-year integrated program consisting of two to four years of an undergraduate curriculum and four years of medical school curriculum, culminating in both a bachelor's and M.D. degree or a bachelor's and D.O. degree.
Once admitted to medical school, it takes four years to complete a Doctor of Medicine (M.D.) degree Doctor of Osteopathic Medicine (D.O.) degree or a Doctor of Podiatric Medicine (D.P.M.). The course of study is divided into two roughly equal components: pre-clinical and clinical.
Preclinical study generally comprises the first two years and consists of classroom and laboratory instruction in core subjects such as anatomy, biochemistry, physiology, pharmacology, histology, embryology, microbiology, pathology, and neurosciences. Once students successfully complete preclinical training, they generally take step one of the medical licensing boards, the USMLE, COMLEX or NBPME.
The clinical component usually occupies the final two years of medical school and takes place almost exclusively on the wards of a teaching hospital or, occasionally, with community physicians. The students observe and take part in the care of patients under the supervision of residents and attending physicians. Rotations on clinical services such as internal medicine, surgery, pediatrics, obstetrics/gynecology, podiatrics and psychiatry are the foundation of this curriculum, but many specialty electives may be chosen as well. During the fourth year, most medical students take step two of the medical licensing boards (USMLE). Upon completion of medical school, the student gains the title of doctor and the degree of MD, but cannot practice independently until completing at least an internship and also Step 3 of the USMLE.
Many medical schools also offer joint degree programs in which some medical students may simultaneously enroll in master's or doctoral-level programs in related fields such as a Masters in Business Administration, Masters in Health Care Administration, Masters in Public Health, JD, MALD, and Masters in Health Communication.
During the last year of medical school, students apply for postgraduate residencies in their chosen field of specialization. These are more or less competitive depending upon the desirability of the specialty, prestige of the program, and the number of applicants relative to the number of available positions. All but a few positions are granted via a national computer match which pairs an applicant's preference with the programs' preference for applicants.
Historically, post-graduate medical education began with a free-standing, one-year internship. Completion of this year continues to be the minimum training requirement for obtaining a general license to practice medicine in many states. However, because of the gradual lengthening of post-graduate medical education, and the decline of its use as the terminal stage in training, most new physicians complete the internship requirement as their first year of residency.
Notwithstanding the trend toward internships integrated into categorical residencies, the one-year "traditional rotating internship" (sometimes called a "transitional year") continues to exist. Some use it to re-apply to programs and/or into which they were not accepted, while others use it as a year to decide upon a specialty. In addition, five states still require osteopathic physicians to complete a traditional rotating internship before residency.
Each of the specialties in medicine has established its own curriculum, which defines the length and content of residency training necessary to practice in that specialty. Programs range from three years after medical school for internal medicine to five years for surgery to six or seven for neurosurgery. This does not include research years that may last from one year up to a completion of a PhD. Each specialty incorporates an internship year to satisfy the requirements of licensure. All specialties hold a board exam (either written or written and oral) at the completion of training in order to confer "Board Certification" in that specialty.
Some highly specialized fields require formal training beyond residency. Examples of these include cardiology, endocrinology, oncology after internal medicine; cardiothoracic surgery, pediatric surgery, surgical oncology after general surgery. There are many others for each field of study. The training programs for these fields are known as fellowships and their participants are fellows to denote that they already have completed a residency and are Board Eligible or Board Certified in their basic specialty. Fellowships range in length from one to three years and are granted by application to the individual program or sub-specialty organizing board.
The physician or surgeon who has completed his or her residency and possibly fellowship training and is in the practice of their specialty is known as an attending physician or consultant. Each specialty has requirements for practitioners to undertake continuing medical education activities.