Medical Education in the United States
From Wikipedia, the free encyclopedia (November 2009)
Medical education in the United States includes educational activities involved in the education and
training of medical doctors (D.O. or M.D.) 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.
Medical school
In the United States a medical school is an institution with the purpose of educating physicians in the
United States in the field of medicine. Admission into medical school may not technically require
completion of a previous degree; however, applicants are usually required to complete at least 3 years
of "pre-med" courses at the university level because in the US medical degrees are classified as Second
entry degrees. Once enrolled in a medical school, the course of study is divided into two roughly equal
components: pre-clinical (consisting of didactic courses in the basic sciences) and clinical (clerkships
consisting of rotations through different wards of a teaching hospital). The degree granted at the
conclusion of the four years of study is Doctor of Osteopathic Medicine (D.O.) or Doctor of Medicine
(M.D.) depending on the medical school; both degrees allow the holder to practice medicine after
completing an accredited residency program.
Internship
During the last year of graduate medical education, 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 postgraduate 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
residency training programs, such as in neurology and ophthalmology, do not include an internship year
and begin after completion of an internship or transitional year. 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,
osteopathic physicians "are required to have completed an AOA-approved first year of training in order
to be licensed in Florida, Michigan, Oklahoma and Pennsylvania."
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 seven to eight years for
neurosurgery. This does not include research years that may last from one to four years if a Ph.D. degree
is pursued. Each specialty training program either incorporates an internship year to satisfy the
requirements of state licensure, or stipulates that an internship year be completed before starting the
program at the second post-graduate year (PGY-2).
Fellowship
Many highly specialized fields require formal training beyond residency. Examples of these include
cardiology, endocrinology, oncology after internal medicine; cardiothoracic anesthesiology,
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. In some specialties such as pathology and radiology, a
majority of graduating residents go on to further their training. 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.
Board certification
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. Physicians then must pass written
and oral exams in their specialty in order to become board certified. Each of the 26 medical specialties
has different requirements for practitioners to undertake continuing medical education activities.