Medical Education

The path to a career in medicine in the United States is well defined. Aspiring physicians must earn an undergraduate degree, complete four years of medical school, participate in a minimum of three years of graduate medical training, and pass three national examinations for licensure. Becoming a physician also demands a desire to work with people; intellectual, emotional, and physical stamina; and an ability to think critically to solve complex problems.

Preparation for one of the world's most highly respected careers often starts in high school by taking courses in biology, chemistry, and physics. Preparation continues during college, with particular attention to the courses needed for admission to medical school. Although the specific number of credits required for admission to medical school varies, the minimum college course requirements include one year of biology, two years of chemistry (one year of general/inorganic chemistry and one year of organic chemistry), and one year of physics, all with adequate laboratory experiences. Medical schools may require or strongly recommend taking mathematics and computer science courses in college, though only a small number demand a specific sequence of mathematics courses. Candidates for admission to medical schools are also expected to have a solid background in English, the humanities, and the social sciences.

There is an expectation that aspiring physicians will participate in health-oriented research and in volunteer activities to demonstrate their commitment to the profession. These types of extracurricular activities provide opportunities to explore ones' motivations, specific interests, and aptitude for a career in medicine.

Typically, the process of applying to medical school begins during the junior year of undergraduate study. One of the first steps is to take the Medical College Admission Test (MCAT) in the spring of the junior year. The MCAT is a standardized test designed to measure knowledge in the biological and physical sciences, the ability to read and interpret information, and communication skills. Students indicate which medical schools they want to receive their MCAT scores.

The American Medical College Application Service (AMCAS) facilitates applying to medical school by centralizing the submission of information and supporting materials. Of the 125 medical schools in the United States, 114 participate in AMCAS. Students submit one set of application materials and one official transcript to AMCAS, which in turn distributes the information to participating institutions as designated by the applicant. Deadlines for receiving applications are determined by the individual medical schools. Applications to non-AMCAS medical schools are submitted directly to those institutions in accordance with their individual requirements and deadlines.

Admission committees, composed of faculty members from the basic and clinical sciences departments, screen and prioritize the applications. Academic ability and personal qualities are used to discern applicants' qualifications for medical school. Academic ability is measured in terms of grades on undergraduate courses (with emphasis on the required science courses) and MCAT scores. College grades and MCAT scores are considered the most important predictors of medical school performance during the first two years. Most students admitted to medical school have above average (3.0 and higher) undergraduate grade point averages. An undergraduate major in the sciences is not a mandatory requirement for admission to medical school. Most admission committees look for well-rounded individuals and strive to admit a diversified class. The importance of MCAT scores to admission decisions varies by institution.

Admission committees also look for evidence of maturity, self-discipline, commitment to helping others, and leadership qualities. Candidates' personal statements, letters of evaluation, and the breadth and variety of extracurricular activities in health-related settings are used as indicators of personal attributes. Many medical schools have specific programs for recruiting and enrolling minority students to help increase the number of underrepresented minorities who practice medicine. Interviews with faculty members also provide information about the applicant's personal background and motivation to become a doctor.

Each medical school decides the number of students that will be admitted each year. Some medical schools accept high school graduates into combined bachelor's and medical degree programs, or combined medical and graduate degree programs.

Medical school applicants are urged to submit applications for financial assistance in conjunction with applications for admission. Loans, primarily sponsored by the federal government, are the major source of financial aid for medical school. Some schools offer academic scholarships.

For the 1998–1999 academic year, the American Association of Medical Colleges (AAMC) reported that 41,004 individuals applied to medical school. AMCAS participants applied to an average of 11.5 AMCAS-participating schools. Among first-time applicants, 45.9 percent (27,525) were accepted to a medical school. AAMC data further indicates that 6,353 candidates were accepted to two or more medical schools in 1998. Medical schools start issuing acceptances to the entering class by March 15 each year.

Medical schools typically provide four years of medical education, with the goal of preparing students to enter three-to seven-year programs of graduate medical training, which are referred to as residency programs. Medical school programs leading to the medical degree (M.D.) generally consist of two years of study in the basic sciences and two years in the clinical sciences. The basic sciences include anatomy, biochemistry, physiology, microbiology, pharmacology, pathology, and behavioral sciences. Clinical education begins in the third year with required clinical clerkships in internal medicine, pediatrics, family medicine, obstetrics and gynecology, surgery, and psychiatry. During six-to twelve-week rotations, students learn how to take a medical history, conduct a physical examination, and recognize familiar disease patterns. Students are allowed to shape their own course of study during the fourth year with elective courses in the clinical specialties or research. Most medical schools strive to integrate basic science and clinical science instruction throughout the four-year curriculum.

In addition to written examinations and direct observations of performance, Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE) are also used to measure the acquisition of medical knowledge. Medical students take Step 1, which measures understanding and ability to apply key concepts in the basic sciences, after completion of the second year of medical school. Passing Step 1 is a requirement for graduation at the majority of medical schools. Step 2, which is taken at the beginning of the senior year, evaluates medical knowledge and understanding of the clinical sciences. More than half of all American medical schools require passing Step 2 as a condition for graduation.

The Liaison Committee on Medical Education (LCME) monitors the quality of education that is provided by American medical schools that award the medical degree. Similar accrediting bodies exist for schools of osteopathic medicine and schools of podiatry.

Students apply to graduate medical programs through the Electronic Residency Application Service (ERAS), a centralized computer-based service that transmits applications, personal statements, medical school transcripts, and Dean's Letters to residency program directors. Students register their first, second, and third choices for residency placements through the National Resident Matching Program (NRMP). The NRMP provides an impartial venue for matching applicants and programs. The "match" facilitates placements by establishing a uniform procedure for communication between students and residency directors, and for announcing residency selections. Matches are usually announced in March of the senior year of medical school.

Graduate medical education programs (residencies) provide extensive, direct patient-care experiences in recognized medical specialties. Three-year residencies in family practice, emergency medicine, pediatrics, and internal medicine are typical. Several other specialties require one year of general practice followed by three to five years of advanced training. Participation in an accredited residency program and passing the USMLE Step 3 are requirements for licensure in most states.