medical education explained
The journey from college student to practicing physician can take
11-15 years or more.
- Undergraduate degree (4-5 years)
- Medical school (4 years; graduate officially becomes a medical doctor, but not licensed to practice)
- Residency (3-7 years; then licensed to practice)
getting into medical school
Medical school applicants first get their bachelor's degrees at a college or university (Premedical education). They don't have to complete a science-related degree, but they must compile at least 32 semester credit hours (or 48 quarter credit hours) of specific undergraduate science courses, including chemistry, physics and biology. As a consequence, many applicants pursue a science major, probably because it makes it easier to fulfill both their major and premedical requirements at the same time.
During their junior year or at the start of their senior year of college, applicants take the Medical College Admissions Test (MCAT), a standardized multiple-choice test of verbal reasoning, physical sciences, biological sciences, and writing skills.
Most students apply to medical school at the start of their senior year in college, but some apply later in life, after having had a career in some other area. On average, each applicant applies to 11 medical schools. They submit an application form, a personal statement, letters of recommendation, a college transcript and their MCAT score. If the applicant passes the first hurdle—most commonly a review of grade point average (GPA) and MCAT score—the medical school invites the applicant for an interview. Medical schools make their final decisions based on the "complete package": submitted materials, the interview, and the applicant's commitment to medicine.
Back to top
undergraduate vs. graduate medical education
The term undergraduate medical education refers to the four years of medical school. Despite being a college graduate, the medical student is considered an "undergraduate" in terms of completing the work needed for a medical degree.
After completing a medical degree, the student must complete a residency program before he or she can be licensed as a physician. Some fields of medicine require additional subspecialty training beyond residency, which is known as fellowship training. Training at the residency and fellowship levels is referred to as graduate medical education. You might think of it as apprenticeship training in the profession of medicine—it provides medical school graduates with the additional hands-on experience they need to become a more seasoned doctor.
Back to top
medical school: the basic science years
The first two years of medical school are primarily dedicated to basic medical education: the study of the basic sciences of medicine. During that time, students also start practicing basic clinical skills—such as taking patient histories and performing physical examinations—and learn about professionalism and ethics. Faculty members who teach courses may be clinicians with MDs or researchers with PhDs, depending upon the subject matter.
medical school: the clerkship years
During the final two years of study, the focus of medical education shifts to the clinical curriculum. Medical students move onto the hospital wards and into clinics to function as junior members of the medical team. Closely supervised by practicing physicians or residents, they begin to diagnose and treat patients, putting into practice the basic science knowledge and skills learned during the first two years. At the end of their second year, medical students take the first part of a three-part national test, the United States Medical Licensing Examination (USMLE), which tests their fundamental knowledge in the medical sciences.
third year
During their third year, students experience all the key fields of medicine as part of their clinical clerkships.
Students, or clinical clerks, learn to improve their history and physical examination skills, write orders on charts, write progress notes, present patients verbally to their medical team and faculty, discuss cases with patients’ families and do procedures.
Core clerkships required of third-year students at the University of Washington School of Medicine include a 12-week rotation in internal medicine and six-week rotations in family medicine, pediatrics, psychiatry, obstetrics and gynecology, and surgery.
At the end of their third year, students take the second part of the USMLE examination.Back to top
fourth year
During the fourth year, students complete their last required clerkships, four-week rotations in a surgery subspecialty, emergency medicine, neurology and rehabilitation medicine. They also go through a number of elective rotations, which take the form of either a consultative elective or a subinternship.
The consultative elective is one in which students respond to consultation requests sent to a subspecialty service by physicians. They are the first to evaluate their patients and present their findings and impressions to the subspecialty attending physician or fellow before giving that information to the original requesting physician.
Subinternships involve students acting as interns. They work on the wards, as they did in their third year, but with added responsibilities. Students work more directly under the supervision of a more senior-level physician than before and are given more leeway in decision-making and charting.
During the first part of the fourth year, students also apply to residency programs. This is done through the National Residency Matching Program (NRMP), an organization made up of key academic medical oversight agencies and medical student associations. The process is similar to that of applying to medical school—students send an application form, a personal statement, letters of recommendation, and USMLE test scores to the residency programs of their choice and go through a round of interviews. Both students and residency programs submit a ranking list, and students are matched with the highest-ranked residency program that has also listed them as desirable and acceptable.Back to top
residency and fellowship training
Residency lasts three to seven years depending on the field of medicine chosen by the new doctor. Fellowship training—specialized training beyond the residency years—adds another two to three years to the process. It is similar to residency training, but with an added emphasis on conducting research. As residents and fellows proceed through training, they assume more independence and more supervisory responsibility in the training of more junior residents and medical students.
There are several terms used to describe residency. Internship refers to the first year of residency training, and interns are first-year residents. Other terms also identify a resident by his or her current year of training. For example, a resident in the first year of training is either PGY-1 (postgraduate year one) or an R-1 (Resident-1).
At the end of the first year of residency training, each resident takes the third and final part of the USMLE test. Upon passage of all three parts of the test and completion of adequate time in residency training, the doctor can receive a license to practice medicine. For most states, the minimum required residency training is two years, but a few require completion of just one year of residency training. At the end of their training, residents and fellows also take a national certifying examination administered by their specialty boards to become certified physicians in a particular field or subspecialty.
Back to top
continuing medical education
Once physicians complete their residency and/or fellowship, they must complete a certain amount of continuing medical education (CME) to maintain their licenses. Similarly, most branches of medicine require certified physicians to undergo recertifying examinations every 10 years. These education requirements ensure that physicians maintain current in their fields.
Back to top
Dr. George Novan on what to study:
If you'd like to see a larger version of this video, click here.
Dr. George Novan on residency:
If you'd like to see a larger version of this video, click here.
