Medical education in the United States
From Wikipedia, the free encyclopedia
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.
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.
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[edit] Medical school
In the United States a medical school is a four year institution with the purpose of educating doctors in the fields of conventional medicine or osteopathic medicine.
[edit] Admissions
Admission into medical school usually requires either three years of undergraduate study (very rare) or a four-year bachelor's degree from an accredited college or university, depending on the medical institution. Nearly all medical schools require the applicant to have attained a bachelor's 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.
Beyond objective admissions criteria, many programs look for candidates who have had unique experiences in community service, volunteer-work, international studies, and research. The application essay is the primary opportunity for the candidate to describe her/his reasons for entering a medical career. The essay requirements are usually open-ended to allow creativity and flexibility for the candidate to draw upon their personal experiences/challenges to make her/him stand out amongst other applicants. If granted, an interview serves as an additional way to express these subjective strengths that a candidate may possess.
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 [1]. 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[2] 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.
While not necessary for admission, several private organizations have capitalized on this complex and involved process by offering services ranging from single-component preparation(MCAT, essay, etc.) to entire application review/consultation.
[edit] Program
Once admitted to medical school, it takes four years to complete a Doctor of Medicine (M.D.), or Doctor of Osteopathic Medicine (D.O.). The course of study is divided into two roughly equal components: pre-clinical and clinical. Both allopathic (M.D.) and osteopathic physicians (D.O.) have equal rights and an equal scope of practice in the United States, with some osteopaths supplementing their practice with principles of osteopathic medicine in addition to the mainstream allopathic methods.
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, pathophysiology, and neurosciences. Once students successfully complete preclinical training, they generally take step one of the medical licensing boards, the USMLE or the COMLEX.
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-based physicians. The students observe and take part in the care of patients under the supervision of resident and attending physicians. Rotations are required in internal medicine, surgery, pediatrics, family medicine, obstetrics/gynecology, neurology, and psychiatry. Beyond these, a variable number of specialty electives are required. During the fourth year, most medical students take Step 2 of the medical licensing boards (USMLE or COMLEX). Upon completion of medical school, the student gains the title of doctor and the degree of M.D. or D.O., but cannot practice independently until completing at least an internship and also Step 3 of the USMLE or COMLEX.
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.
[edit] Internship
During the last year of medical school, students apply for postgraduate residencies in their chosen field of specialization. These vary in competitiveness 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 most 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 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.
[edit] 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 to four years if a PhD degree is pursued. Each specialty training program incorporates an internship year to satisfy the requirements of state licensure.
[edit] Fellowship
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; reproductive endocrinology/infertility, maternal-fetal medicine, gynecologic oncology after obstetrics/gynecology. 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. Fellowships often contain a research component.
[edit] Continuing education
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.
