Medical Education FAQ [1/2] (misc.education.medical FAQ) [v2.6]
Eric P. Wilkinson, M.D.
Misc-education-medical-archive-name: faq/part1
Posting-Frequency: 14 days
Last-modified: 2002/7/17
Version: 2.6
URL: http://www.memfaq.com/
Maintainer: Eric P. Wilkinson, M.D. <er...@wilkinson.com>
Welcome to the misc.education.medical Frequently Asked Questions list
(FAQ), also known as the Medical Education FAQ. This article answers
questions commonly asked on the misc.education.medical newsgroup,
which discusses medical education (MD and DO training issues). It is
crossposted to several groups with readers interested in medical
education. This document should always be available on the World
Wide Web at:
or through the hypertext FAQ archives at:
The FAQ should also be available via anonymous FTP at:
<ftp://rtfm.mit.edu/pub/usenet/misc.education.medical/>
and is posted regularly to the following Usenet newsgroups:
misc.education.medical soc.college.grad soc.college.admissions
sci.med news.answers sci.answers soc.answers misc.answers
Comments about the FAQ itself are invited and can be sent to me at
<er...@wilkinson.com>. Suggestions for improvement and corrections of
inaccurate information are especially welcome. If you have a
question that is not answered in this FAQ article, try asking it on
misc.education.medical.
IMPORTANT NOTE
If you are looking for answers to questions about medical conditions
or procedures, the proper newsgroups to read and post to are the
sci.med.* groups. If you are seeking medical advice, consult a
licensed physician. The newsgroup misc.education.medical is for
discussions of medical education only.
ACKNOWLEDGMENTS
This article is not the work of one; many individuals have
contributed to this FAQ. Special thanks go to James Bright, who
maintained the "version 1" FAQ from the early days of the newsgroup
in 1994 until July 1998, and Sandeep Dave, who created the newsgroup
in June 1994 and compiled the first FAQ answers.
Contributors to the current FAQ include: Natalie Belle; Tim Cramm;
Scott Goodman; Chris Kahn; Ryan Maves; Kris McCoy; Greg Nee; John
Nguyen; Dave Russo; Eric Wilkinson; and Timothy Wu.
DISCLAIMER
This article is provided as is without any express or implied
warranties. While every effort has been taken to ensure the accuracy
of the information contained in this article, the maintainer and
contributors assume no responsibility for errors or omissions, or for
damages resulting from the use of the information contained herein.
------------------------------
Subject: 0. Contents
1) The Journey to Medical School -- Before Applying
1.1) What is an MD?
1.2) What is a DO?
1.3) What are the prerequisites for medical school?
1.4) What is the MSAR?
1.5) State school or Ivy League for undergrad?
1.6) Which major should I choose?
1.7) Is admission to medical school competitive?
1.8) Do I have to do research?
1.9) Do I have to have clinical experience?
1.10) How old is too old?
1.11) How high does my GPA need to be?
1.12) I completed college without finishing the pre-med
requirements, and I want to apply to medical school.
What do I do now?
1.13) What are some good sources of information about medical
school and medicine?
2) The MCAT
2.1) What is the MCAT?
2.2) How important is the MCAT in the admission process?
2.3) What material is on the MCAT?
2.4) When should I start studying for the MCAT?
2.5) How should I study for the MCAT?
2.6) Should I take a review course?
2.7) Can you tell me about Stanley Kaplan vs. Princeton Review?
2.8) Are there any other options for review courses?
2.9) When should I take the MCAT?
2.10) Does it matter whether I take the MCAT in April or August?
2.11) What is a good MCAT score?
2.12) Are different sections of the MCAT more or less
important than other sections?
2.13) My MCAT score was not stellar. Is it advisable to
take the MCAT twice? Three times?
2.14) Should I go ahead and apply with my current MCAT
score, or should I wait until I take the test again?
2.15) How do medical schools interpret multiple MCAT attempts?
2.16) I heard that you can take the MCAT as "practice"
but not have your score count. I could use the practice;
is this a good idea?
2.17) Can I decide not to release my MCAT scores and then later
decide to release them after I have seen my score?
3) Applying to Medical School
3.1) What is the timeline for admissions?
3.2) Where can I find a list of medical schools?
3.3) What is AMCAS/AACOMAS?
3.4) How many schools should I apply to?
3.5) Which schools should I apply to?
3.5a) What are good sources to help me choose?
3.6) How expensive is it to apply?
3.6a) Is there any way to make the application process cheaper?
3.7) Should I apply to DO schools?
3.8) What is a secondary/supplementary?
3.9) What is an MD/PhD program?
3.9a) What are the different sources of funding for MD/PhD programs?
3.10) Should I enroll in a combined BS/MD program?
3.11) What are combined MD/MPH and DO/MPH programs?
3.12) Can you tell me about combined MD/MBA programs?
3.13) Can you tell me about combined MD/JD programs?
3.14) What are PAs?
3.15) Should I consider going to a foreign school?
4) The Interview Process
4.1) How can I prepare for my interview?
4.2) What should I wear to the interview?
4.3) Should I bring anything to the interview?
4.4) What will I be asked?
4.5) "Why do you want to be a doctor?"
4.6) What questions should I ask?
4.7) Should I do anything after the interview?
4.8) What does "waitlisted" mean? What does "hold" mean?
4.9) What if I don't get accepted?
4.10) How should I choose what school to go to?
4.11) What should I do during the summer before medical school?
5) Medical School Curricula
5.1) How long is medical school?
5.2) What classes are there in medical school?
5.3) How are students graded/evaluated in medical school?
5.4) What are "rotations"?
5.5) What are the "must have" textbooks?
5.6) What is PBL?
5.7) Is there any free time in medical school?
5.8) What is the USMLE?
5.9) What is a good USMLE score?
5.10) What is AOA?
6) Paying for Medical School
6.1) How expensive is medical school?
6.2) How can I pay for medical school?
6.3) Can you tell me about Armed Forces scholarships?
6.4) Can you tell me about Public Health Service scholarships?
6.5) Can I really borrow more than $10K/yr in Unsubsidized
Stafford Loans?
7) Residency and Beyond
7.1) What are the different medical specialties?
7.2) What is a residency?
7.2a) What is an internship?
7.2b) What is a "preliminary" year? A "categorical" year?
7.3) What is the Match?
7.4) What is the NRMP?
7.5) Are there specialties that don't use the NRMP?
7.6) What is a fellowship?
7.7) How many hours do interns/residents work?
7.7a) Aren't there limits on this?
7.8) What does "board certified" mean?
7.9) What does FACP/FACS/FACOG/etc. mean?
7.10) What is an IMG/FMG?
7.11) What is the ECFMG? The CSA?
7.12) What is CME?
------------------------------
Subject: 1. The Journey to Medical School -- Before Applying
1.1) What is an MD?
An MD, or Doctor of Medicine, most simply is a person who has
graduated from a medical school. An MD can have many and varying
roles in the community. First, an MD is a caregiver, a person turned
to by members of the community in times of physical, psychological or
emotional weakness. MDs treat not only the body but also the mind and
the spirit, often delving into the emotional, psychological or social
reasons behind a physical illness. MDs treat people in inpatient
settings, in the operating room, outpatient clinics, and in emergency
room visits.
Not all MDs, though, deal with patients in such a direct manner.
Pathologists deal with diseased tissues taken from the patient as well
as clinical laboratory and blood bank settings. Radiologists deal
with images of the patient produced and enhanced by various imaging
technologies. Some MDs choose to concentrate their efforts solely on
research, developing new equipment, vaccines, drugs, or discovering
the underlying causes of disease. MDs can devote their time to
teaching, both in a classroom setting (in a medical school, for
example) and in the community (teaching preventive methods to
community members, teaching CPR or first aid, or administering
vaccines).
Becoming an MD opens up to you a vast number of possibilities for
using your medical training. MDs serve the community in many more
ways than just seeing patients, prescribing drugs, or performing
surgery. If you say to yourself, "I'm not a people person, so I'd
make a lousy doctor," keep in mind that there are ways to use your
interest in medicine to benefit the community without seeing
patients on a day-to-day basis.
1.2) What is a DO?
Doctors of Osteopathic Medicine (DOs) are the legal and professional
equivalents of Doctors of Medicine (MDs). They are licensed to
practice medicine in all 50 states and use all conventionally
accepted therapeutic modalities such as surgery, radiology, and
drugs. They are eligible to enroll in all federal programs, managed
care and insurance plans, serve as commissioned medical officers in
all branches of armed services, and serve as public health officers,
coroners, insurance examiners, and team physicians. In other words,
they practice complete medicine and surgery. Only DOs and MDs can
do this.
DOs represent about 5% of the country's physicians and provide care
for approximately 10% of the patients. This is because higher
proportions of osteopathic medical graduates enter into primary care
residencies after graduation compared to their MD counterparts.
Andrew Taylor Still, MD founded osteopathic medicine in the late
1800's in response to what he thought was poor medical practice at
that time. He based osteopathic medicine on the following
principles:
1) The structure of the body and its functions work together,
inter-dependently.
2) The body systems have built-in repair processes which are
self-regulating and self-healing in the face of disease.
3) The circulatory system provides the integrating functions for
the rest of the body.
4) The musculoskeletal system contributes more to a person's health
than only providing framework and support.
5) While disease may be manifested in specific parts of the body; other
parts may contribute to a restoration or a correction of the disease.
The preparation and training of DOs is nearly identical to the
training of MDs. Admission prerequisites and curricula are very
similar. DOs can sit for the MD boards if they are interested in
pursuing a MD residency after graduation.
The primary difference in their education is that DO students
complete an additional 200-300 hours of training in osteopathic
manipulative medicine (OMM). OMM is a modality used primarily to
treat musculoskeletal problems and overlaps in its scope with
physical therapy and manual medicine techniques. Also, DO schools
place more emphasis on producing primary care physicians than do
some MD schools. This means that during their clinical years,
students at DO schools spend more time rotating through primary care
specialties such as family medicine, pediatrics, obstetrics and
gynecology, internal medicine, and psychiatry. Nevertheless,
specialty training isn't out of the question for DOs. Many DOs seek
and obtain residencies in surgical and non-surgical specialties.
For more information, see the American Association of Colleges of
Osteopathic Medicine at <http://www.aacom.org>.
1.3) What are the prerequisites for medical school?
All medical schools require a baccalaureate (BA, AB, BS, or
equivalent) degree, with rare exceptions. The usual course
prerequisites for both MD and DO schools are:
1 year of Biology or Zoology (with lab)
1 year of Inorganic Chemistry (with lab)
1 year of Organic Chemistry (with lab)
1 year of Physics (with lab)
Some schools require english, humanities, calculus, or biochemistry
as well. Check the book "Medical School Admission Requirements" (cf
1.4) for each school's particular requirements.
The one year of Physics need not be calculus-based, although many
colleges offer only the calculus-based class.
There is disagreement over whether prerequisites may be taken at
community or junior colleges. To be sure, contact the individual
schools to which you plan to apply.
Many students finish their undergraduate degrees without completing
the medical school prerequisites. Some of these students choose to
take the courses at their local public college or university, while
others enroll in more formal "post-baccalaureate" programs, where the
classes are taken full-time over approximately a year.
1.4) What is the MSAR?
The book "Medical School Admission Requirements," or "MSAR," is often
considered the premedical student's "bible." Published by the
Association of American Medical Colleges (AAMC), it contains
information on premedical requirements for each of the MD schools in
the US and Canada, as well as information and statistics about
admissions, financial aid, and minority student issues. Many
questions not answered in this FAQ will be answered in the MSAR. It
is revised each April, so make sure you get the most recent edition.
You should definitely get this book if you are considering medical
school. You can buy a copy at your local college bookstore, from an
online bookstore, or direct from the AAMC at:
<http://www.aamc.org/publications/resources.htm>.
1.5) State school or Ivy League for undergrad?
In general, whether you attend a well-known school or a relatively
invisible school is not important. What is important, however, is
doing well at whichever school you decide to attend. One thing you
may want to keep in mind is that doing well at a prominent
institution goes a lot farther than doing well at a lesser-known
state college. Choose what you are most comfortable with, not what
you think the medical schools want to see.
1.6) Which major should I choose?
According to the Association of American Medical Colleges, a
premedical student may select any major he or she chooses, provided
that he or she completes the prerequisites for medical study (cf
1.3). The most important thing is to select a major you enjoy, as
this would allow you to master the subject. Medical school
admissions committees want to see students who master their major
fields of concentration in college, and many medical schools enjoy
receiving applications from students who have studied areas outside
of the sciences. Acceptance statistics broken down by major are
provided in the MSAR (cf. 1.4).
1.7) Is admission to medical school competitive?
Medical school admissions has always been competitive, as there are
always more applicants than there are seats. In recent years,
however, admissions has become even more competitive as the AAMC has
logged a record increase in applications which hit a peak of
approximately 45,000 applications during the 1995-1996 cycle, which
represents a ratio of about 3 applicants for every medical school
seat. Since then the number of applications filed has slowly
declined.
1.8) Do I have to do research?
Absolutely not, but doing research does help to demonstrate
analytical skills in scientific investigation which are helpful for
practicing physicians. There are many medical students who have
never stepped inside a lab outside the prerequisite lab courses, but
at the same time, many people feel that with increased competition
for medical school seats, research experience is a much-needed notch
on the applicant's belt.
1.9) Do I have to have clinical experience?
Gaining clinical experience as a premedical student is rather
important as it can show that your decision to want to go to medical
school is well-rooted, and not coming out of left field. Gaining
clinical experience, however, means different things to different
people. Simply volunteering at your local hospital may not be
sufficient, as these volunteer opportunities often have you do tasks
very unrelated to medicine (e.g. filing, faxing, copying). Look for
"Health Career Opportunity Programs," or other such internships
designed for premedical students, so that your valuable premedical
time is not wasted in a second-rate program. If your school has a
"premedical internship" program, take advantage of it.
1.10) How old is too old?
It may not be too late. Students in their 30s and 40s are admitted
to many medical schools. Anecdotes about students in their 50s have
been posted on misc.education.medical. When making your plans, keep
in mind that the shortest amount of time from entering medical
school until exiting the shortest residency (general internal
medicine, general pediatrics, or family practice) is 7 years.
1.11) How high does my GPA need to be?
Perhaps every premedical student has heard tales of the 3.9 GPA Phi
Beta Kappa applicant getting into every medical school he or she
applied to, and of the 2.5 GPA student applying to medical school
without a prayer, but there is a little more to the GPA issue than
just getting above a certain mark. GPAs will vary depending on the
competitiveness of your school, so if you attend a world-renowned
institution such as Harvard, your GPA will be calculated based on
competition with an intense student body.
If you attend Acme State University, where there is a major in
bartending, your GPA will be calculated based on competition with a
slightly less intense student body. Generally, however, a 2.3 at
Harvard is still pretty bad and probably not as good as a 4.0 at
Acme State, and we can guess that perhaps the Harvard student is not
going to get into medical school. So what are the generalities we
should look at when determining whether our GPAs are good enough for
medical school? Some premedical advisors say that if your GPA is
3.3 at a good school, you have a 20% chance for admission. Others
will say having a 3.5 to 3.6 is the requisite GPA, but if you keep
it as high as you can, you should have no problem (so try to keep it
above 3.3!).
1.12) I completed college without finishing the pre-med requirements,
and I want to apply to medical school. What do I do now?
There are a couple of options. You can enroll at a local college or
university as a non-degree student and simply take the
prerequisites. Additionally, you might consider enrolling in a
formal post-baccalaureate pre-medical program offered by many of
colleges and universities in response to an increasing number of
students changing careers into medicine. A comprehensive list of
"post-bacc" pre-med programs can be found at
<http://www.aamc.org/students/considering/postbac.htm>.
1.13) What are some good sources of information about medical
school and medicine?
RECOMMENDED AUTHORS OF BOOKS ABOUT MEDICINE
Lewis Thomas, MD
Sherwin Nuland, MD
David Hilfiker, MD
Perri Klass, MD
Oliver Sacks, MD
Robert Marion, MD
David Ewing Duncan
BOOKS ABOUT MEDICAL SCHOOL ADMISSIONS
There are many books on this subject (too many to list), and
quality varies widely. For an exhaustive list, try doing a search
on "medical school" at an online bookstore.
DOCUMENTARY
The PBS television show NOVA aired a documentary about the training
of seven medical students at Harvard Medical School, following them
from anatomy lab through residency. Highly recommended. "MD: The
Making of a Doctor" may be ordered from WGBH-Boston, item #WG2207,
by calling 1-800-255-9424. It costs $19.95.
An update on the "Making of a Doctor" physicians was recently
completed, called "Survivor MD." It is a 3-hour special and can be
ordered from WGBH at the number above for $29.95.
WEB
"Official" sites on the World Wide Web (many of these are referenced at
other points in the FAQ):
Association of American Medical Colleges (AAMC) <http://www.aamc.org>
Liaison Committee on Medical Education (LCME) <http://www.lcme.org>
National Board of Medical Examiners <http://www.nbme.org>
Federation of State Medical Boards <http://www.fsmb.org>
United States Medical Licensing Examination (USMLE)
<http://www.usmle.org>
American Association of Colleges of Osteopathic Medicine (AACOM)
<http://www.aacom.org>
American Medical Association (AMA) <http://www.ama-assn.org>
USENET
The Usenet newsgroup for discussing medical school and medical
education is misc.education.medical. Medicine is discussed in the
sci.med.* hierarchy of newsgroups.
------------------------------
Subject: 2. The MCAT
2.1) What is the MCAT?
The Medical College Admissions Test, or MCAT, is the standardized
admissions test required by nearly all U.S. medical schools (some
combined BS/MD programs that accept students directly from high
school do not require the MCAT). The test consists of four
sections: Verbal Reasoning (scored 1-15), Physicial Sciences (scored
1-15), Biological Sciences (scored 1-15), and an essay section
(scored J-T, with T being the highest). The test takes one long
Saturday to complete and is offered twice a year, usually in mid
April and in late August. Official information about the MCAT,
including registration information, may be obtained online from the
Association of American Medical Colleges (AAMC), at
<http://www.aamc.org/students/mcat/start.htm>.
2.2) How important is the MCAT in the admission process?
The MCAT is very important. A high MCAT score by itself will not
get you into medical school, but a low MCAT score may keep you out.
Unfortunately, an otherwise qualified applicant may not even be
granted an interview if his or her MCAT scores are not high enough.
Once an interview is granted, each applicant is evaluated
individually in determining acceptance or rejection. In most cases
the MCAT still is just as important as other parts of the
application in making the final decision.
2.3) What material is on the MCAT?
The official MCAT registration materials include a syllabus that
spells out the subject matter tested in detail. Below is a summary:
* The verbal reasoning test is virtually identical to similar tests
found on other standardized exams (such as LSAT, GRE, or even SAT),
except it typically contains two or three science-oriented passages.
* The essay section consists of two timed half-hour essays. In each
essay you are asked to interpret an open-ended ambiguous statement.
* The physical sciences test covers inorganic chemistry and physics.
One full year (two semesters) each of inorganic chemistry and physics
sufficiently covers all the tested material.
* The biological sciences test covers a variety of biology topics
(about 50% of test) and organic chemistry (about 50% of test). One
full year of organic chemistry plus lab is sufficient to cover the
organic chemistry material on the MCAT.
2.4) When should I start studying for the MCAT?
Nearly all students require at least two months of regular review to
cover all the necessary material. Many students require longer.
However, preparation really begins as soon as you start college--by
doing your best in your undergraduate science courses and reading
broadly to prepare for the verbal reasoning section. You can then
spend the final 2 or 3 months reviewing and solidifying the
information you have already learned. It is unlikely that you will
learn and understand a lot of new material in the final months
leading up to the MCAT.
2.5) How should I study for the MCAT?
Basically, whatever study methods have served you well in the past
should also help you prepare for the MCAT. For example, if you read
your textbooks heavily in class, then review your textbooks. If you
used study sheets or notecards in your classes, then review those.
A few other tips:
* It is important to be quite disciplined and to make the time
necessary for review. Most pre-medical students find they don't have
the time for MCAT review unless they make a concerted effort to make
the time.
* For more structured review, consider buying a review book (such as
the Kaplan MCAT Comprehensive Review with CDROM, edited by Rochelle
Rothstein) or taking a review course (see below)
* No matter what you do, take lots of timed practice tests. Practice
MCAT tests are available directly from the AAMC, in any book store, or
through review courses.
2.6) Should I take a review course?
That depends. If you are overwhelmed by the thought of MCAT review,
and if you like structure and learn well in a classroom environment,
then a review course is not a bad idea. When used properly, review
courses are an expensive, effective way to prepare for the MCAT.
They offer structured, comprehensive review, teacher-student
interaction, numerous practice tests and test- taking strategies,
and comprehensive, well-written review materials. However, do not
enroll in a review course just for the materials. Equally good
materials (such as the Kaplan Comprehensive Review, cf. 2.5) may be
purchased in the bookstore for a whole lot less money.
2.7) Can you tell me about Stanley Kaplan vs. Princeton Review?
Stanley Kaplan <http://www.kaplan.com> and Princeton Review
<http://www.review.com> are the two largest standardized test review
companies in the United States. Opinions differ as to which company
offers a better review course for the MCAT. Traditionally, the
Kaplan course focused more on detail and offered more review
materials, while the Princeton Review course focused more on "the
big picture" and offered more student-teacher interaction. However,
Kaplan has recently decreased its class-size, and Princeton Review
recently increased the amount and detail-level of materials offered.
Today the two courses really are more similar than they are
different. The biggest factor in determining the quality of either
course is the quality of its teacher. If you want to take a review
course, it helps to ask around locally to see which courses have a
better reputation in the local area.
2.8) Are there any other options for review courses?
Yes. Many colleges offer structured review courses for the MCAT.
Ask your local pre-med advisor for details. Also, if you happen to
live in California, MCAT review courses offered by the Berkeley
Review <http://www.berkeley-review.com> have an excellent
reputation.
2.9) When should I take the MCAT?
You should take the MCAT at least one year prior to the date you
wish to begin medical school. However, do not take the test until
you have completed the necessary pre-requisite courses: one year
each of biology, inorganic chemistry, organic chemistry, and
physics. Many students take the April MCAT while they are
concurrently taking prerequisite courses (usually Physics II,
Organic Chemistry II, and/or an advanced biology course). This is
not a bad strategy: virtually all of the material tested on the MCAT
will already be covered by the time April rolls around -- and the
material should be fresh in your mind, since you have just learned
it.
2.10) Does it matter whether I take the MCAT in April or August?
If you are prepared for the exam, it's probably best to take it in
April. Taking the test earlier allows you to complete your
application early in the season--and the earlier you submit your
application, the better. Also, If you are applying under an early
decision program, you *must* take the April MCAT of that year (or
any time prior) so that test scores are available in time for early
interviews. Of course, there is also an advantage to taking it in
August: it allows you more time to study. You can take the exam in
August and still apply for the same application season, but you'll
be running a tight time-schedule. Keep in mind that it takes
approximately 8 weeks for scores to get back to the schools.
2.11) What is a good MCAT score?
Traditionally a good score is "double digits" (10 or better) on each
test, and a score of at least "N" on the essay. You can get into
medical school with lower scores, depending on the rest of your
application and on the medical school. For your state medical
school, a total score of 27 or higher, with no individual score less
than 8, is probably sufficient. It is important to have a well
balanced MCAT score, with no individual score markedly lower than
the rest of the test. For example, a score of 8,8,8 (total 24) is
generally considered superior to a score of 10,10,5 (total 25).
2.12) Are different sections of the MCAT more or less important than
other sections?
Yes. The essay section is less important than the other sections.
Your essay score is impressive if it is extremely high (S or T) and
is detrimental if it is extremely low (J or K). However, any score
in between has little or no impact on your application. Be sure to
demonstrate your writing abilities to medical schools by composing a
well-written personal statement essay.
2.13) My MCAT score was not stellar. Is it advisable to take the MCAT
twice? three times?
Yes--as long as you improve your score! Taking the MCAT multiple
times is only helpful if a significant score improvement is
reflected in each attempt. However, it is preferrable to study as
hard as possible and be prepared so that you do an excellent job on
your first attempt. Who wants to take this test multiple times,
anyway?
2.14) Should I go ahead and apply with my current MCAT score, or should
I wait until I take the test again?
If you received greater than 27 on your first attempt, it is
advisable to apply with your current score and not take the test
again. If you received less than 24, you should probably take the
test again, prepare harder next time, and try to improve your score.
The range of 24-27 is a grey zone: whether to take the test again
depends on the rest of your application and on where you are
applying. Note that these are just guidelines. You must consider
your own individual situation to arrive at a final decision. Also
note: if you take the MCAT in April and are dissatisfied with your
scores, you can go ahead an apply anyway and still retake the test
in August for the same application year. It's better to submit your
application early than to submit it in the fall.
2.15) How do medical schools interpret multiple MCAT attempts?
Medical schools consider them favorably, as long as you improve your
score. Most medical schools will consider the highest overall MCAT
score in evaluating your final application.
2.16) I heard that you can take the MCAT as "practice" but not have your
score count. I could use the practice; is this a good idea?
No. At the end of the exam, you must decide whether or not to
release your scores. It is almost always advisable to have your
scores released. The only good reason not to release scores is if
you know you did poorly by some fluke; for example, if you filled in
all the bubbles incorrectly. Deciding not to release your scores on
a whim is not advisable.
2.17) Can I decide not to release my MCAT scores and then later decide
to release them after I have seen my score?
Yes, however, medical schools will be informed that you originally
did not release your scores and later decided to release them. This
allowance is actually a new rule recently instituted by the AAMC.
Because the rule is new, it is unclear how medical schools will view
an MCAT score that was originally not released. Common sense says
that medical schools will not view this favorably, and that it is
not a good idea to exercise this option.
------------------------------
Subject: 3. Applying to Medical School
3.1) What is the timeline for admissions?
AMCAS (cf 3.3) begins accepting applications on June 1. After
receiving your application and school transcripts, you will receive
a Transmittal Notification from AMCAS, which means that schools have
been sent your central application. After evaluating your
application, schools can choose to have you continue the process by
completing a supplementary application (cf 3.8) and after further
evaluation, an interview (cf Section 4). Some schools are on a
"rolling admissions" system where applicants can hear about an
admissions decision fairly soon after interviewing. Other schools
wait until late in the season to send decision letters. More
information can be found in the MSAR (cf 1.4), the AMCAS application
materials, and school admissions brochures.
3.2) Where can I find a list of medical schools?
The MSAR (cf 1.4) has a list of all of the medical schools in the US
and Canada accredited by the Liaison Committee on Medical Education
(LCME) <http://www.lcme.org>. On the Internet, you can find this
same list at <http://www.aamc.org/meded/medschls/start.htm>.
3.3) What is AMCAS/AACOMAS?
AMCAS, the American Medical College Application Service, is a
centralized program which works much like the "Common Application"
that you may have seen in high school (for applying to college).
Run by the Association of American Medical Colleges (AAMC), it
consists of a form you fill out like an application, which is sent
to AMCAS, processed, and then distributed to those medical schools
you wish to apply. In the past several years a computer-based
version, AMCAS-E, has been developed. See the AMCAS web page at
<http://www.aamc.org/students/amcas/start.htm>. AACOMAS, the
American Association of Colleges of Osteopathic Medicine Application
Service, is a similar service for osteopathic medical programs run
by the AACOM <http://www.aacom.org>.
3.4) How many schools should I apply to?
Depends. If you're 4.0 and 40+ on the MCAT, then probably you could
apply to only one or two and get away with it. There are stories of
people who applied to 50 or 60 schools and didn't get into any.
Most people apply to around 10, more if they feel their folder is a
little weak, less if they think they've got a pretty solid record.
3.5) Which schools should I apply to?
Your best bet is to think about where you'd like to go to school and
apply there. Remember: Wherever you go, not only will you be
spending the next 4 years there, but also the odds are pretty good
that you will do your residency there as well. So don't pick
someplace you'd never want to live. Always apply to your state
school, if you have one; most (if not all) state schools give
preference to people who are state residents, and every little bit
of help counts. You should have 2-3 schools that are a real
stretch--places you don't think you could get in to but places you'd
love to go. Try to find 1-2 places that you think you have an
excellent shot at; your state school usually goes here. And in the
middle, 6 (or more) places that you think you'd be competitive at.
Finally, don't discount D.O. schools (cf 3.7).
3.5a) What are good sources to help me choose?
Your primary source should be your college's pre-medical advisor.
Make an appointment with him/her early on--sophomore or junior year
would be best. Make sure he/she pulls your transcripts, etc. before
you show up. The two of you can talk about your strong and weak
points, what you could do to boost your chances, and which schools
you should apply to. Also keep in mind that most pre-medical
advisors send a letter along with your applications, so getting to
know him/her will help get a more accurate letter for your file.
The Internet is a good source. Most medical schools have web sites
that give lots of information, application requirements, etc. In
addition, post any questions, concerns, fears, or despairs to the
misc.education.medical Usenet group. It's populated by lots of
grizzled veterans who have been through this process (sometimes more
than once) and can help you avoid the pitfalls.
Another essential source is the MSAR (cf 1.4).
3.6) How expensive is it to apply?
The AMCAS fee is about $45 for the first school, and $25 for each
additional school. When your AMCAS is processed, most schools will
request "supplementary" information, and filing this will cost an
additional $60-$125. The AACOMAS fee is practically the same, and
the cost for filing supplementary materials at osteopathic medical
schools is also anywhere from $60 to $125. Add in costs for the
MCAT, flying to schools for interviews, hotels, and other expenses,
and the total application cost can rise into the thousands of
dollars depending on how many schools you apply to.
3.6a) Is there any way to make the application process cheaper?
You can request from AMCAS a fee waiver, which covers the cost of
AMCAS filing and supplementary filing fees for up to 10 medical
schools. Fee waivers are based on financial need, and many schools
will waive their supplementary application fee (cf 3.6) if you have
an AMCAS fee waiver. The MCAT also offers a fee waiver program.
3.7) Should I apply to DO schools?
Osteopathic medical schools have a reputation for "looking past the
numbers" in their admissions process. Consequently, the average
accepted MCAT scores and GPA are a bit lower at DO schools. If
you're an academically borderline candidate, but have a competitive
application overall, your chances for admission might be higher at
DO schools. Because most DO schools emphasize primary care
medicine, they look very closely at an applicant's motivation for
pursuing medicine and prior life experience. The average age of
matriculation tends to be higher at DO schools than MD schools.
Students who want to practice an osteopathic approach to patient
care are especially sought after; this means demonstrating an
interest in hands-on medicine and a commitment to a holistic
understanding of patient care issues, especially time spent with a
DO.
There are two important points to consider if you're thinking of
applying to DO schools. First, DOs are minority physicians in the
profession of medicine. If you are uncomfortable being different,
think that you'll always have to prove something because you're not
an MD, or are likely to become frustrated having to explain what a
DO is to new patients, then DO schools might not be right for you.
Second, you might have a harder time competing for some of the
"brand-name" MD residencies. Many competitive MD residencies don't
regard the additional training DO students receive as applicable to
their particular area of medicine, and with keen competition for
slots among MD applicants, they feel obliged to take their own
first. There are DO specialty residencies in everything ranging
from aerospace medicine to otolaryngology, but these residencies
tend to be concentrated in the eastern and mid-western United
States. Some students find the geographic limitations of these
residencies unattractive.
In short, some students have compared the kind of medical education
DO schools offer to the kind of undergraduate education that smaller
liberal arts colleges offer. Both stress generalist skills and
training. Like the smaller undergraduate colleges, the research
programs at DO schools tend to be smaller. Consequently, the basic
science faculty is usually more professionally involved in medical
education than research. However, it is difficult to make accurate
generalizations because there is much variety in curricular programs
offered by both MD and DO schools. There are primary care oriented
MD schools and research oriented DO schools. The most prudent
advice is to look at the curriculum and educational focus of each
medical school on a case by case basis.
3.8) What is a secondary/supplementary?
Secondary (also called supplementary) applications come in a variety
of forms and typically are utilized only by schools using the AMCAS
application (MD programs), or schools using the AACOMAS application
(DO programs) rather than their own application. Depending on the
school, they may request no more than a check and signature to
complete processing of your application, or they may ask you to
provide additional information such as SAT scores and respond to
several essay questions.
A number of schools "screen" applicants prior to sending secondary
applications. This means that based on information (essay,
biographical data, MCAT scores and GPA) provided by the applicant's
AMCAS or AACOMAS application, the school decides whether or not to
send a secondary application to the applicant. Screening of
applications at the secondary stage is not done by all schools; many
schools have all applicants complete all application materials and
then decide who to interview based on information contained in the
primary and secondary applications.
Information on application fees and whether a school uses secondary
applications may be found in the MSAR (cf. 1.4).
3.9) What is an MD/PhD program?
Students that are enrolled in combined MD/PhD programs pursue the MD
and the PhD degrees concurrently. Students can select from a number
of fields in which to complete the PhD. Although this field is
typically a biomedical science (e.g., biochemistry, immunology),
students in the past have combined their medical studies with
research in engineering and the humanities. Combined programs
typically require 7-9 years to complete. The first two years are
typically spent on the basic science portion of the M.D. curriculum.
The next three to five years are spent on full time PhD work. The
final two years of the combined program are spent on the clinical
portion of the MD curriculum. MD/PhD programs are eclectic by
nature, however, and the course of study can be very individualized.
Combined MD/PhD programs were initiated to train a cadre of academic
medical scientists who could make fundamental scientific discoveries
and then translate these discoveries into tools and knowledge that
could be used at the bedside. It is important to note that "doing
it all", from the lab bench to the patient bedside, is extremely
difficult. Both caring for patients and running a research program
are full time jobs in and of themselves! Most MD/PhDs focus on
either lab research or patient care to stay abreast of their fields
and to remain competitive with their peers. With that caveat,
however, MD/PhD training has some benefits.
Some good reasons to pursue an MD/PhD
- You want to focus on clinical research and practice, but would
like rigorous research training
- You want to focus on research, but want the perspective provided
by clinical training
Bad reasons to pursue an MD/PhD
- You want extra letters after your name
- You want to save money (in the long run, you probably won't!)
Ultimately, the decision to pursue an MD/PhD is a personal one.
Think about the career goals you envision for yourself and whether
they can be achieved with a single degree. Consider talking with
MD/PhDs who have careers similar to that which you envision for
yourself. Information on programs may be found at
<http://www.aamc.org/research/dbr/mdphd/programs.htm>.
3.9a) What are the different sources of funding for MD/PhD programs?
1. Medical Scientist Training Program (at official NIH MSTP schools)
2. Other NIH funds (e.g., Human Genome Training Grant)
3. School-Specific Funds (e.g., Franklin's scholars program at UPenn)
4. Funds from special interest groups (e.g., funds for the study of
alcoholism)
5. Howard Hughes Medical Institute Funds
3.10) Should I enroll in a combined BS/MD program?
BS/MD programs, or, more appropriately, college/MD programs, allow a
high school student to apply to both college and medical school
during the college application process. If accepted, the student is
assured a place in a medical school class, assuming she performs at
an acceptable level. While many of these programs only allow
specific majors, some will allow any major, including those which
award the BA.
Thirty-six of these programs currently exist all across the United
States, in sixteen states and the District of Columbia. Program
length generally varies from six to eight years, although the
University of Wisconsin-Madison does allow extension to nine years.
Admissions guidelines vary widely. Some schools specifically state
entrance requirements (e.g., the University of Medicine and
Dentistry at New Jersey (Newark) expects that their applicants will
be in the top five to ten percent of their class with a minimum
combined SAT of 1400). Most schools require program students to
take the MCAT during their junior year of college. Many require
particular SAT II/Achievement tests, particularly those in chemistry
and mathmatics.
In essence, these programs are appropriate for the student who has
already explored the field of medicine and is positive that it is
appropriate for him. While admissions criteria vary widely, they
all insist that the student be academically superior. As not all
programs allow students to leave once they have matriculated into
the program, the student must be sure that medicine is the right
choice; those with any doubts are advised to consult their college
or guidance counselor and consider applying to medical school
"normally" in college if they then decide it is the correct choice.
For more current information about combined college/MD programs,
browse the Association of American Medical Colleges' web site at
<http://www.aamc.org/students/applying/programs/collegemd.htm>.
Students may also wish to read the AAMC's guide for high school
students considering medical careers at
<http://www.aamc.org/students/start.htm>.
3.11) What are combined MD/MPH and DO/MPH programs?
MPH stands for Masters in Public Health. Public health is an
interdisciplinary science of disease prevention. Physicians who
work in public health are called preventive medicine specialists.
The MPH is the professional degree for those interested in a career
in public health or preventive medicine; MPH degree programs usually
require approximately 50 additional semester hours of coursework in
areas such as biostatistics, epidemiology, health behavior, and
health economics. Many programs offer opportunities for
specialization in areas such as toxicology, environmental health,
epidemiology, and health administration.
It is not uncommon for medical schools to offer dual degree programs
for medical students seeking public health training. This may add
an additional year or two onto medical school. Usually students in
dual degree program complete the first two years of medical school
and then proceed to their MPH work before finishing the last two
years, though some break up school between the third and fourth
years. Some programs allow students to take MPH classes in addition
to their medical school classes to shorten the length of the
program.
For more information, see the web sites for the American College of
Preventive Medicine <http://www.acpm.org> and the American Public
Health Association <http://www.apha.org>.
3.12) Can you tell me about combined MD/MBA programs?
Ten schools offer the combined MD/MBA program. They are: UCLA,
U. of Chicago-Pritzker, U. of Illinois at Urbana-Champaign,
Dartmouth, Wake Forest, Case Western, Allegheny, Jefferson, U of
Pennsylvania, and Vanderbilt. This list of schools, with direct
links to them, can be found at
<http://www.aamc.org/students/applying/programs/mdmba.htm>. Many
programs run as two years of medical school, one year of graduate
(MBA) school, then a return to medical school for the final two
years of medical curriculum and completion of MBA material, for a
total of five years. However, there are variances in application
processes and program details. For example, UCLA opens its program
only to third-year UCLA medical students, who then take a year off
for the MBA program and complete the MBA program during the fourth
year of medical school. Application procedures vary by school, so
your best bet is to contact the admissions department directly and
ask for information on the program.
3.13) Can you tell me about combined MD/JD programs?
Seven schools offer the combined MD/JD program. They are: Yale,
U. of Illinois at Urbana-Champaign, U. of Chicago-Pritzker, Southern
Illinois U., Duke, Penn, and West Virgina U. This list of schools,
with direct links to them, can be found at
<http://www.aamc.org/students/applying/programs/mdjd.htm>. Program
details are highly variable. One common method of integrating the
two programs is to have the student complete two years of medical
school, two years of law school, then complete law school during the
final two years of medical school for a total of six years.
Applications are generally accepted both from first-time applicants
and current students from each individual program; however, as
always, the best information about a particular school can be
obtained by contacting the school's admissions office.
3.14) What are PAs?
Physician assistants, or PAs, provide medical care under the
supervision of licensed physicians. For information regarding the
PA profession and educational programs, see the web page of the
American Academy of Physician Assistants (AAPA) at
<http://www.aapa.org>. Another resource is the Usenet newsgroup
alt.med.phys-assts.
3.15) Should I consider going to a foreign school?
Attending a foreign medical school is a tricky situation. On the
one hand, you have the opportunity of attending medical school and
graduating with a M.D. degree, but on the other hand, your
opportunities for practice in the U.S. are severely limited.
Because of legislation, International Medical Graduates
(IMGs)--students who obtain their M.D. outside the U.S.--are being
scapegoated for the country's oversupply of physicians and their
acceptance into U.S. residency training programs is being scaled
back. This means that the IMG who does enter the US for residency
training generally must score very high on the USMLE and the new
Clinical Skills Assessment (CSA) examination, which is only
administered to IMGs (cf 7.10, 7.11).
The education may or may not be inferior, depending on the foreign
school you wish to attend, but whatever the case, attending a
foreign school is going to be expensive. Student aid from the
U.S. may not be so easy to come by, and you may have to spend more
time in school because of the difference in curricula. Take, for
example, the system of medical education in Australia versus the
United States. In the US, students go through four years of
undergraduate college to earn a Bachelors degree and then go on for
another four years in medical school for the medical degree. In
Australia, students go into a medical program as high school
graduates and earn a Bachelors in Medicine and a Bachelors in
Surgery in six years. This means that a US college graduate who
wishes to attend medical school in Australia will have to spend an
additional two years because of the medical curriculum in Australia,
which translates into higher costs.
Think about your decision to apply to a foreign medical school
carefully. Not all are reputable, and boasting a World Health
Organization (WHO) listing is not at all impressive. Not all
foreign medical schools offer a solid medical education, which of
course does not preclude those that do. Speak to your premedical
advisor and, if possible, any students at the schools that you
consider.
------------------------------
[end of Part 1]
Eric P. Wilkinson, M.D.
Misc-education-medical-archive-name: faq/part2
Posting-Frequency: 14 days
Last-modified: 2002/7/17
Version: 2.6
URL: http://www.memfaq.com/
Maintainer: Eric P. Wilkinson, M.D. <er...@wilkinson.com>
[This is Part 2 of the misc.education.medical FAQ.]
------------------------------
Subject: 4. The Interview Process
4.1) How can I prepare for my interview?
You should do research on the school itself. Learn a little about
the city it is in, the programs offered, grading policies, and
instruction method (Problem Based Learning or traditional or mixed).
Look at the school's information packet and their web site. If
you're interested in doing research in a particular field during
medical school, find out which faculty at the school are doing
research in that area. The more you read about the school, the more
questions you will have to ask your interviewer.
In preparing for the questions you will be asked (cf 4.4),
definitely consult the Medical School Interview Feedback Page begun
by Graham Redgrave: <http://www.interviewfeedback.com>.
4.2) What should I wear to the interview?
Dress professionally in your style. This simply means to dress like
you would if you were a doctor, but do not lose all of your
personality (i.e. if you are a guy with long hair, don't cut it; if
you normally have a mustache, leave it...you are not trying to
produce a standard image, you want to be yourself).
4.3) Should I bring anything to the interview?
Bring a list of any questions you wish to ask (you will probably
forget most of them if you try to memorize them). Always have a pen
and paper on you. Find out what the weather will be like and bring
a coat if necessary. Bring your application to look over between
interviews.
4.4) What will I be asked?
This is largely dependent on the school and on the interviewer (in
other words, on chance). Be prepared to answer questions about
"defining" moments in your life--elaborating on what you do for fun,
what your favorite activity is, what sports you play, and just about
anything that interests you.
Some schools still drill you though, so beware (these interviews can
truly be draining). Stress interviews (empty rooms with phones
ringing, being asked to open windows that are nailed shut) are very
rare. If you've done research, and it's on your application, be
prepared to discuss it.
Many students have recorded their interview experiences at the
Medical School Interview Feedback Page:
<http://www.interviewfeedback.com>.
Some commonly asked questions:
The favorite--Tell me about yourself.
Where do you see yourself in 10 years? (often asked)
What does your family think about this?
What is the biggest problem facing medicine today?
What are the disadvantages/downsides of a career in medicine, besides
no time?
What are you looking for in a medical school?
What do you think about "insert current hot topic here"?
(HMO, PPO, Doctor-assisted suicide, ethical/moral issues of cloning,
other financial issues in health care delivery)
What field of medicine are you interested in?
What do you like to do that isn't science related?
What will you do if you do not get accepted somewhere this year?
What are your strengths/weaknesses?
And, perhaps the most popular...
4.5) "Why do you want to be a doctor?"
If you want to say "to help people," please just make that an
introduction to a much deeper soliloquy! You can tie this answer to
personal experiences (i.e. things you may have seen while
working/volunteering in the medical field, or possibly an illness
that you or a family member went through).
The key is to come across as someone who has genuinely thought
through the decision.
4.6) What questions should I ask?
Ask anything you want about the school. Many times faculty or
students may not know the answer, but will be willing to find out
and get back to you. A good source of questions to ask is the
Association of American Medical Colleges' pamphlet "31 Questions I
Wish I Had Asked," available at
<http://www.aamc.org/students/applying/about/31questions.htm>.
4.7) Should I do anything after the interview?
Sending a thank you note is purely optional, and some consider it an
outdated practice. Others feel that acknowledging time spent on
your behalf is just common courtesy. One suggestion is to follow up
with the admissions office, expressing your interest in the school.
4.8) What does "waitlisted" mean? What does "hold" mean?
The terms "wait list," "acceptance range," "hold," and any others
synonymous with these all mean that the class was full, but you have
been placed on a ranked list. If spots open up, people on the wait
list will be moved up and offered seats in the class. In general a
school will accept twice as many people as its class size when all
is said and done. Also, even though waitlists ARE ranked, they do
not have to pull from them in order, so if something about you
really stands out (such as a follow up letter stating how impressed
you were with the school and how much you would like to become part
of their institution), you can increase your chances of getting in
off the wait list.
4.9) What if I don't get accepted?
Try again. Trying 2 times seems to be the norm these days but after
3 times you might want to consider doing something else (there have
been some people who have finally been accepted after applying 4+
times, but they are the exception rather than the norm). The most
important thing to do is to consult each school as to why you were
rejected or not taken off of the waitlist and ask what you can do to
improve your chances. Follow their advice.
4.10) How should I choose what school to go to?
This depends on several factors. Important ones include location
and what the school "typically" produces. In other words, if you
want to specialize, it may not be in your best interest to go to a
state school where most of the class goes into family practice.
Financial issues are also a factor, as state-funded schools are
often much less expensive than private schools.
Going to a school with an established reputation may be of benefit,
especially when applying for residencies, fellowships, and positions
in academic medicine. If you feel that you may end up in an
academic position, or are considering a very competitive specialty,
you may consider going to a "name" school.
If you narrow it down to two schools which are virtually identical,
go to the one that feels right--that might be your best choice. How
do the students at the school feel? Are they treated well?
4.11) What should I do during the summer before medical school?
Nothing at all. Take a deep breath.
------------------------------
Subject: 5. Medical School Curricula
5.1) How long is medical school?
In the United States, medical school is generally four years in
length. You spend the first two years predominantly in the
classroom and lab, and the last two years predominantly in the
hospital.
5.2) What classes are there in medical school?
The classes in medical school vary from place to place. But there
are some that everyone takes in their first two years, no matter
where they are:
Gross Anatomy
Biochemistry
Pathology
Behavioral Science
Pharmacology
Physiology
Microanatomy/Histology
Microbiology
Physical Diagnosis (or some kind of intro to the patient class)
Medical Ethics
The amount of lab work varies from class to class and school to
school, although some classes (like gross anatomy) feature as much
lab work as you have time for.
5.3) How are students graded/evaluated in medical school?
Again, depends on the school. Many schools still have the standard
A/B/C/D/F scale of grading. The rest go on the pass/fail scale or
some variation of it. Many schools have an "honors" grade which
reflects performance in an upper percentile of the class for that
course.
The grading scale can change as you advance in your studies. For
example, some schools have letter grades the first two years and
then pass/fail grades the last two (or letter grades the first three
and pass/fail the last year only).
The grades themselves are objective the first two years - based
almost entirely on written exams, oral exams, and practical (or lab)
exams. In the third and fourth years, grades depend in large part
on evaluations by other members of your hospital team - the
attending physician(s), the resident(s) and/or the intern(s). There
are also written/oral exams in the last two years, and the relative
importance of exams vs. evaluations varies greatly from rotation to
rotation.
5.4) What are "rotations"?
Rotations are the blocks of time you spend on the different services
in the hospital. Most schools have a set of required rotations and
let you choose from a vast field of elective rotations to fill out
the rest of your third and/or fourth year. The required rotations
everywhere:
Surgery
Internal Medicine
Psychiatry
Pediatrics
Obstetrics and Gynecology (Ob/Gyn)
Generally you will spend a total of about 10 months doing these five
rotations. Some schools make you take all required rotations in the
third year, and some let you spread them out so that you can take
electives in the third year, thereby allowing you to take some
electives that may help you narrow down your possible choice of
specialty for residency.
There are some rotations that are required at all but a few schools:
Family medicine
Neurology
Orthopedics
A typical third year might look something like this:
Surgery - 2 months
Pediatrics - 2 months
Neurology - 1 month
Family Medicine - 1 month
Ob/Gyn - 6 weeks
Psychiatry - 6 weeks
Internal Medicine - 3 months
As far as electives go, generally there are several ways you can go.
You can take "away" rotations - rotations arranged to spend at other
hospitals (ideally the hospitals where you think you might like to
do your residency). Generally, schools will let you do a month or
two away. When considering away rotations, keep the following
tidbits in mind:
1) Most residency applications are due by October or November, and
most residency committees start making decisions on who to interview
by the end of November at the very latest. Therefore, for an away
rotation to really help you sway the people at the hospital you
visit, it must be done in the first few months of the fourth year
(keeping in mind that USMLE Step II is usually at the end of August
of that year). September and to a lesser extent October tend to be
the most popular months to schedule away rotations.
2) At most schools, there are a lot of hoops to jump through to get
an away rotation approved. You have to determine that the hospital
you want to go to actually has an open slot in the rotation you want
during the month you want to be there. Once you've gotten that
info, there are lots of forms and signatures needed--deans and
chairmen from both schools, grading papers, course content papers,
etc. The point of all this is: once you decide to take an away
rotation, get started on planning it because it takes a month or two
to get everything straightened out.
The electives you do at your home school tend to fall in these
categories:
1) Electives in what you think will be your residency specialty
2) Electives in things you think will help you in residency (a lot of
people take things like cardiology, radiology or emergency medicine
because they provide valuable training for the intern year)
3) Electives in things that interest you
4) Electives your friends are taking
5) Electives that are easy (generally includes things like
ophthalmology, dermatology, and lots of odd little electives that
will turn up on the list at your school; at my school we could do a
month sitting in the blood bank drawing blood from people, or do a
month learning what the different lab tests are and what they mean)
5.5) What are the "must have" textbooks?
The only absolutely essential, "must have" textbook is the "Atlas of
Human Anatomy," by Frank H. Netter, M.D. (now in its 2nd edition).
Beyond that, your textbook purchases should reflect:
a) the recommended texts of your school - not all texts cover the
same subjects to the same depth, and you might miss out on a
professor's pet area that he loves to test heavily because it's so
insignificant that a different book barely touches on it (thus a
gentle reminder to try to learn what your professors consider
themselves to be experts in, because those things will always be on
the tests). Also, remember that your required texts will all be on
reserve in the library (usually in multiple copies) - so if you
really feel you need to read one chapter, you can always just borrow
the library copy and read it.
b) the course materials given out in each class - some classes
feature thick, comprehensive syllabi that cover each lecture
specifically and that make the purchase of an outside textbook
pointless. And some schools have note-taking services that "can"
lectures - basically giving you a typed transcription of the entire
lecture, complete with copies of overhead materials. As with the
syllabi, a good set of cans renders a textbook moot. Not all
schools allow the canning of lectures, but if they are offered you
should absolutely sign up and get them.
c) your personal study preferences - how do you study best? Some
people love to read the texts. Some people like lectures and don't
read much at all. Determine where you fall in the scheme of things
and plan your purchases accordingly. Even if a text is great
(example - the Robbins pathology text), generally the book will be
dry reading and very long, and if you are not the kind of person who
learns well from books like that, then your money is better spent
elsewhere.
5.6) What is PBL?
PBL stands for "Problem Based Learning." Basically, there are two
basic types of curricula in medical schools today: PBL and so-called
"traditional" learning. Traditional learning is the basic stuff you
had in college--lectures and plenty of 'em, labs, classes taught as
discrete entities (gross anatomy, pathology, pharmacology, etc.).
PBL represents a more integrated way of presenting the materials.
Lectures are kept to a minimum; instead, the emphasis is on small
group learning, teamwork and problem solving. Groups meet and are
given clinical situations in keeping with the current subject
material. These situations can involve anatomy, pathology,
pharmacology, etc. all at the same time. The group then solves the
problems using available resources (library, computers, etc.) and
discusses their solutions. In this way they learn the body as it
is--a set of interrelated systems--instead of in discrete chunks.
That said, PBL is not for everyone. Some people prefer the
lectures. Some schools offer only PBL, some only traditional, and
some give you an option of which you would prefer. Contact the
schools you are interested in and ask them about their curricula.
5.7) Is there any free time in medical school?
There is as much free time as you want there to be. In spite of
what you might hear, medical students don't study ten hours a night
AND go to every lecture AND go to every lab AND read journals just
for interest AND work on a cure for cancer. At the beginning, sure,
you'll feel this overwhelming fear that everyone is ahead of you and
you will make the lowest grade and somehow people will find out and
point and laugh at you. So you'll study like crazy right up until
that first gross anatomy test that you'll take on no sleep in some
caffeine-induced trance. After that, though, you'll learn what your
best study methods are and how best for you to use your time. After
that, you'll discover that there is plenty of free time to have a
family life, have friends, go to parties, form a bowling team in
your second year and win the league championship after defeating the
five-time defending champions in the playoffs (which a group of
students from my school - myself included - did).
In the clinical years, your free time depends on your rotation.
Surgery tends to lend itself to hospital work and sleep only.
Psychiatry tends to give you more free time than you could possibly
fill. The others fall someplace in the middle.
5.8) What is the USMLE?
In spite of its resemblance to the words "U SMILE," it's not a happy
thing. USMLE stands for United States Medical Licensing
Examination, and the website may be found at <http://www.usmle.org>.
There are three parts to it (the first two parts consisting of a
one-day, eight-hour exam and the third part consisting of a two-day
exam), and in virtually every state you must pass the parts in order
to get licensed. The examination is now offered on computer at
testing centers, and may be taken whenever the student wishes. See
the USMLE web site for more information.
The parts are:
Step I, taken after your second year
Step II, taken in your fourth year
Step III, taken at the end of your internship year
5.9) What is a good USMLE score?
A good score is one that is (a) passing and (b) passing, a fact that
the USMLE apparently realized because rumor has it they are going to
make the exams pass/fail in the near future. For now, keep in mind
that the national average (which has been rising, probably through
artificial means) has been around 215 in 1997-98. The cut-off for a
"good" score once was 200 (when 200 was set as the statistical mean,
or 50th percentile score). Now, though, "good" scores start around
215 and go up from there. And yes, it is sad but true that some
residency programs use USMLE Step I scores as a preliminary cut-off
point for sending out secondary applications and/or interview
requests. Generally the programs that do this tend to be the more
competitive ones - surgery, orthopedics, ENT, neurosurgery, etc.
5.10) What is AOA?
Alpha Omega Alpha, or "AOA," is a national medical honor society that
was founded in 1902 to promote and recognize excellence in the medical
profession. Most, although not all medical schools have a chapter of
AOA. Each school's chapter selects a small group of students to join
the society, generally in their junior or senior years. "Junior AOA
status," or being selected as a junior, is considered superior to
"senior AOA status."
In order to meet the minimum requirements of the national society,
students must be in the top 15% of their class academically, and
possess leadership and community service attributes. Academic
activities such as research, performance in clerkships and electives
and extracurricular program participation are generally included in
the selection criteria.
Individual chapters may also elect to induct outstanding alumni,
faculty and house staff to AOA. Induction ceremonies are generally
held just before graduation and are highly specific to the
individual chapters.
Having AOA on your curriculum vitae is considered an asset when applying
in the very competitive post-graduate programs such as dermatology and
surgical subspecialties.
[Maintainer's note: Stanford, the University of Connecticut, and
Harvard are the schools that do not have AOA. If you are aware of
other schools that do not have a chapter, please let me know.]
------------------------------
Subject: 6. Paying for Medical School
6.1) How expensive is medical school?
Very. According to the AAMC's Medical School Admissions
Requirements, the range of tuition and student fees for 1996-1997
first-year students was:
Range Median Mean
Private, Resident: 8,152-31,925 24,925 23,835
Private, Nonresident: 16,403-31,925 25,224 25,407
Public, Resident: 2,908-20,129 9,107 9,921
Public, Nonresident: 10,680-51,669 21,129 22,153
Keep in mind that these figures represent only tuition and
fees. Other expenses include room and board, books, equipment,
transportation, insurance, and personal expenses. In all, these
additional expenses can easily be up to $15,000 per year.
6.2) How can I pay for medical school?
The first consideration is to reduce your expenses. The less
expensive schools tend to be public schools within your state. If
you don't have a medical school in your state, you may be eligible
to attend other state schools as an in-state resident through an
exchange program such as WICHE, the Western Interstate Commission
for Higher Education, which allows students from Alaska, Montana,
and Wyoming to apply to and attend any western medical school as a
state resident (with the exception of the University of Washington).
Another major expense that can be reduced, if you qualify, is the
cost of application. Be sure to apply for an AMCAS fee waiver (if
you qualify), which can save you hundreds of dollars.
Unfortunately, reducing expenses still leaves, in most cases, tens
of thousands of dollars to pay. The most common way to pay this is
via loans, particularly federal Stafford loans and private
alternative loan programs. While some Stafford loans may be
subsidized (the government will pay the interest while you are in
school), there is a limit to the amount you can borrow. Other loan
programs are often offered by the various schools.
Grant aid (aid you don't have to repay) is not common. Most schools
offer a minimal amount of merit- and/or need-based grant aid. There
are also two programs that will cover the entire cost of school plus
give you a stipend. The first, the Medical Scientist Training
Program, is a highly competitive government-subsidized program
designed to recruit students interested in earning both an M.D. and
a Ph.D. The second, the Uniformed Services University of the Health
Sciences, is the military's medical school. In return for years of
service to the military, your education is paid for in addition to
your receiving a commission in the military and the concomitant
salary and benefits.
Another possibility for covering your expenses is to obligate
yourself to later service. Two examples of this type of program are
the Armed Forces HPSP and the Public Health Service program, both of
which provide payment for medical school in return for a commitment
to serve in either the military or in underserved public health
regions, respectively.
Finally, be sure to search the Web and other sources for private
scholarship sources. You may be eligible for free money or favorable
loans due to your extracurricular activities, ethnicity, religion,
heritage, or any number of other factors. Your school's financial aid
office will be happy to suggest sources to you as well as discuss means
of payment.
6.3) Can you tell me about Armed Forces scholarships?
The Armed Forces Health Professions Scholarship Program (HPSP) is a
scholarship between two to four years in length offered to students
in schools of medicine, osteopathic medicine, dentistry, and
optometry. HPSP students receive full tuition, school-related
expenses, and a stipend as benefits. The stipend is currently (as
of 8/98) around $912/month, paid in two parts on the 1st and 15th
days on each month by direct deposit. Expenses are reimbursed by
the submission on an itemized form with receipts and a signed
approval letter from your school stating that the expenses you claim
are reasonable ones for your curriculum; typically, most texts and
equipment (i.e., stethoscopes, lab coats) are paid without any fuss.
Tuition is paid directly to your school.
Basic requirements for the HPSP are that you are a U.S. citizen and
meet the qualifications for commissioning as a military officer.
There is an application and interview process which takes place at
about the same time as med school apps. (Of course, you do have to
actually get into med school in order to receive it.) The HPSP is
offered through the Navy, Army, and Air Force (the Marine Corps is
part of the Department of the Navy and is served by Naval docs, and
the Coast Guard is staffed by docs from the Public Health Service).
In return, you owe as many years of service to the military as you
received in support. Residency does not count towards this payback
time. What you actually wind up doing, of course, varies according
to your specialty; there isn't a huge need for pediatric
neurosurgery about the average aircraft carrier, for example.
What are the advantages to this little Faustian bargain? Well, for
starters, there are the financial benefits. The more frugal
students will emerge from med school debt-free, and those who live a
little higher on the hog will owe relatively small student loans.
Salary during residency is about $10,000/yr greater in the military
(in the neighborhood of $40,000 for interns, $50,000 for more senior
residents). Even post-residency, you won't starve; average
attending salaries vary by specialty, rank, and years of service,
but most wind up in the neighborhood of $100,000/yr as junior
attendings (typically O-4 in rank: a lieutenant commander in the
Navy, a major in the other two). You are automatically commissioned
as an O-1 while a med student (ensign in the Navy, 2nd lieutenant in
the other two) and are promoted to O-3 on graduation
(lieutenant/captain). There are some pretty entertaining places to
work in the military that you might not the chance to work near in
the future: Europe, Asia, and so forth. And of course, medicine is
medicine: patients can be much the same no matter where you work,
and in any case the majority of patients in the military system are
not actually active duty troops but retirees and dependents.
Benefits can be nice as well: 30 days paid vacation each year, no
overhead, and full medical/dental coverage.
Military residencies, by the way, are generally quite good. When
considering your training site come application time, you do want to
think about issues like patient volume, didactics, and so forth,
just as in any residency, but board pass rates for military
residency grads have been uniformly excellent, and people have
gotten into fine fellowships with minimal difficulty.
(Incidentally, if you do a civilian fellowship as an active duty
officer, the military will still pay you as an attending. Which is
pretty sweet.)
Now for the downside. You are sacrificing a few years of your life,
in a sense. Although a flexible mindset and a willingness to
compromise will help you get a good posting, not everyone in the
Navy gets to go to Italy or San Diego. Internship and residency are
relatively separate entities and require separate applications, not
only for fields like anesthesia but even for fields with categorical
internships like internal medicine or general surgery. Not only
that, there is a risk that you will have to spend a couple of years
away from training between your R-1 and R-2 years as a general
medical officer, or GMO. This risk is greatest in the Navy overall
but present in the Army and Air Force; it is also greater if you
plan on pursuing a more specialized field like neurosurgery or
anesthesia. Medicine, peds, and family med residents are more
likely to complete their training uninterrupted. GMO tours vary
between one to three years in length.
(A brief proviso on the whole GMO thing. An anesthesiology
attending at the National Naval Medical Center in Bethesda spent
three years as the medical officer aboard the USS Belknap in the
Mediterranean, and he loved it. After finishing his tour, he went
on to his residency at Mass General. So it's not the kiss of death.
Also, GMOs are a dying breed. The DoD is currently working out a
plan to abolish GMOs and staff those positions with
residency-trained docs. So stay tuned.)
The military is a startlingly bureaucratic organization which has
little ways of reminding you that it is, in fact, a branch of the
federal government. For physicians, though, military medicine is
actually not really different than working for a good HMO. Research
in military medicine is quite impressive, incidentally, although its
work is often very practical in orientation. There are good
research ties with the NIH and CDC, and most residencies are very
supportive of research (and may in fact require it of residents).
There are a certain number of people each year in the HPSP who defer
their commitment in order to do civilian residencies. The exact
number varies depending on the year, the specialty, and the needs of
the service. If you want to defer, it helps to have a good reason
(i.e., spouse's job) and to not be rude (e.g., "I want to defer
because military residencies are inferior").
If you want to postpone the decision about military service, there
is a financial assistance program (FAP) available to residents in
most specialties, wherein you get about $30,000/yr on top of your
civilian salary to repay loans (or buy a new car, possibly) in
exchange for an equivalent number of years of service.
6.4) Can you tell me about Public Health Service scholarships?
The Public Health Service offers a scholarship (The National Health
Service Corps, <http://bphc.hrsa.gov/nhsc/>) paying full tuition,
books, and supplies, and a monthly stipend, with the following
requirements:
1) You must enter a primary care-type of residency (medicine,
family med, peds) or at least something that's close (OB/GYN,
psych), or a residency combining two of the above fields. A main
limitation is that the residency not take more than 3 or 4 years.
After serving your commitment you can undergo further medical
training (i.e., fellowships).
2) You must serve one year in a federally-designated underserved
area of your choice for each year the NHSC paid your tuition
(minimum two years), be it an inner city (30% of sites) or a rural
cow town (70% of sites).
3) As of December 1998, the IRS has deemed ALL parts of the NHSC
scholarship as taxable, including tuition. So, if you go to a
school that costs $28,000 per year, taxes will leave you with about
$350 from your monthly $950 stipend. The NHSC has been trying to
get Congress to reverse the IRS's reading of the law, but to no
avail as of yet.
There are similar programs available through various state
governments and the Indian Health Service, some funded by the NHSC.
Physicians who have completed training in a primary care field are
eligible for Public Health Service positions, with opportunities for
loan repayment. Some feel that this may be a better choice, as you
are not locked into a primary care field without first going through
your medical school rotations. See the NHSC web site for more
information.
6.5) Can I really borrow more than $10K/yr in Unsubsidized
Stafford Loans?
With the phaseout of the HEAL program at all schools, the Department
of Education has now authorized increased unsubsidized Stafford loan
limits for Health Professions Students. This limit is now $30K/yr.
The Student Financial Aid Handbook section detailing these limits
may be found at:
<http://ifap.ed.gov/sfahandbooks/attachments/0102Vol8Ch3loanperiodamts.pdf>.
------------------------------
Subject: 7. Residency and Beyond
7.1) What are the different medical specialties?
A good source for learning about the different medical specialties
is the American Board of Medical Specialties <http://www.abms.org>,
an organization that coordinates and approves changes in board
certification policy in the different medical fields. A complete
list of the certifying boards and the general and subspecialty
certificates that they offer can be found on their web site. A list
of the major medical specialties can be found below. No effort has
been made to list subspecialties.
Allergy & Immunology
Anesthesiology
Colon & Rectal Surgery
Dermatolology
Emergency Medicine
Family Practice
Internal Medicine
Medical Genetics
Neurological Surgery
Neurology
Nuclear Medicine
Obstetrics & Gynecology
Ophthalmology
Orthopaedic Surgery
Otolaryngology
Pathology
Pediatrics
Physical Medicine & Rehabilitation
Plastic Surgery
Preventive Medicine (including Occupational Medicine)
Psychiatry
Radiation Oncology
Radiology
Surgery
Thoracic Surgery (including Cardiothoracic Surgery)
Urology
7.2) What is a residency?
Upon graduation from medical school, you become a "doctor" having
earned the M.D. or D.O. degree. However, this isn't the end of
formal medical training in this country. Many moons ago, back when
almost all physicians were general practitioners, very few
physicians completed more than a year of post-graduate training.
That first year of training after medical school was called the
"internship" and for most physicians it constituted the whole of
their formal training after medical school; the rest was learned on
the job. As medical science advanced and the complexity of and
demand for medical specialists increased, the time it took to gain
even a working knowledge of any of the specialties grew to the point
where it became necessary to continue formal medical training for at
least several years after medical school. This training period is
called a "residency," earning its moniker from the old days when the
young physicians actually lived in the hospital or on the hospital
grounds, thus "residing" in the hospital for the period of their
training.
During residency, you and your classmates practice under the
supervision of faculty physicians, generally in large medical
centers. Many primary care specialties, however, are based in
smaller medical centers. As you grow more experienced, you assume
more responsibilities and independence until you graduate from the
residency, and you are released to practice on your own upon an
unsuspecting populace.
The length of residency programs varies considerably between
specialties and even a little within individual specialties. In
general, the surgical specialties require longer residencies, and
the primary care residencies the least time.
Lengths of Some Residencies
---------------------------
All surgical specialties 5+ years
Obstetrics and Gynecology 4 years
Family medicine 3 years
Pediatrics 3 years
Emergency Medicine 3-4 years
Psychiatry 3 years
The AMA maintains a database of almost all of the residency programs
in the United States, called the Fellowship and Residency Electronic
Interactive Database Access (FREIDA) system. It is available at
<http://www.ama-assn.org/go/freida>.
Recently a new type of residency has emerged, the so-called
"combined residency." These residencies train physicians in two
medical fields, such as internal medicine-pediatrics, or
psychiatry-neurology. As these types of residencies are new, they
are relatively few in number; they provide an opportunity for the
physician to become "double-boarded" and receive board certification
in each of the two specialties. Usually these residencies last one
or two years less than the total years that would be spent doing
both residencies.
7.2a) What is an internship?
In the old days, all physician completed a one year "rotating
internship" after graduating from medical school. Such an
internship consisted of all the major subdivisions of medical
practice: Internal medicine, surgery, obstetrics and gynecology,
etc. The idea was to provide a broad spectrum of training to allow
the new physician to work in the community as a "general
practitioner."
Today, the closest thing we have to the rotating internships of old
is the "transitional year," also completed after graduating from
medical school. For a few specialties, a year of post-gradute
training is required before beginning a residency in that field.
Many who want to go into these fields fill that requirement with a
transitional year. Fields that require a year before beginning
residency include radiology, neurology, anesthesiology, and
ophthalmology.
In the current lingo, the first year of post-graduate training is
called "internship," and any medical school graduate in the first
year of post-graduate training is called an "intern" regardless of
what that first year of training consists. Most specialties do not
require a transitional year, but instead accept medical school
graduates straight out of medical school.
7.2b) What is a "preliminary" year? A "categorical" year?
An alternative to the transitional year for some is the "preliminary
year." Preliminary years come in two flavors, internal medicine and
surgery. Each of these preliminary years somewhat resembles the
rotating internships of old, but with a focus on either internal
medicine or surgery. Those programs that require a year of
post-graduate education before beginning residency may accept either
a transitional year or a preliminary year. Obviously, surgical
residencies will require that you do a preliminary surgery year
while some other specialties will prefer a preliminary medicine
year.
The other reason that a new M.D. would go into a preliminary year or
transitional year would be because he didn't match into the
specialty of his choice. The hopeful applicant then takes a
preliminary or transitional year in the hopes of improving his
chances and qualifications for the next year's residency match.
The term "categorical" is used largely to distinguish between the
interns who are doing a preiminary year and those who are already
accepted into the residency program. For instance, a general
surgery program may have 6 interns every year, but two of them may
doing surgery as a preliminary year. Those positions that are
already accepted into the whole surgical residency program are
called "categorical."
7.3) What is the Match?
The Match (also cf 7.4) is a way to bring together residency
applicants and residency programs in an organized fashion. After
applying to and interviewing at various residency programs in their
specialty of choice, students submit a "rank order list" which
specifies their preferences for programs in numerical order.
Residency programs submit similar lists. After all of the lists
have been received, a computer matches applicants and programs. At
noon Eastern time, on a fateful day in March of each year, all
applicants across the country receive an envelope telling them where
they will spend the next several years.
Controversy has surrounded the Match algorithm in recent years, due
to a slight preference for residency programs in a very small
percentage of cases. The algorithm has since been changed to favor
applicants' preferences.
There are several books about residency and the Match. "First Aid
for the Match" by Tao Le, et al., and "Getting into a Residency: A
Guide for Medical Students" by Kenneth Iserson, MD, provide insights
about how to prepare for the Match.
7.4) What is the NRMP?
The National Resident Matching Program (NRMP) is the official name
of the Match, which is run by the Association of American Medical
Colleges (AAMC). Its home page may be found at
<http://www.aamc.org/nrmp/>.
7.5) Are there specialties that don't use the NRMP?
Several specialties have their own matching programs. Neurology,
Neurosurgery, Ophthalmology, Otolaryngology, and Plastic Surgery,
along with several subspecialty fellowship programs in these fields,
have their matches coordinated through the San Francisco Matching
Program <http://www.sfmatch.org>.
Urology has its own matching program, coordinated by the American
Urological Association at
<http://www.auanet.org/students_residents/>.
The "Match Day" for these specialties occurs in January, instead of
March as for the NRMP. Consult the matching programs' web sites for
schedules.
7.6) What is a fellowship?
A fellowship is a period of training that you undertake following
completion of your residency, as a means to subspecialization. For
instance, a general surgeon can do a number of different fellowships
(e.g. cardiothoracic surgery, plastic surgery), a pediatrician can
complete a fellowship in pediatric endocrinology, etc. The list of
possible subspecialties is almost endless. A fellow is considered
somewhere in the hierarchy between residents and faculty. They are
paid like advanced residents, but nothing close to what a private
physician makes. People take fellowships for a number of different
reasons: The subspecialty may be what they've always wanted to do in
the first place, they may develop an interest in that field along
the way, and it's often a path to a faculty position in a residency
program and medical school. The length of fellowships also varies
some, but usually lasts three years or less.
7.7) How many hours do interns/residents work?
Intern and resident hours vary very widely depending on specialty,
hospital, and within hospitals between different departments. Some
specialties are well-known for their less demanding hours during
residency (and often afterwards as well). These "lifestyle" fields
include radiology, anesthesiology, and physical medicine and
rehabilitation (physiatry). Specialties whose residencies are
reputed for difficulty and lack of sleep are general surgery and
obstetrics and gynecology. Most of the other specialties fall
somewhere in between.
Surgical interns and often internal medicine interns routinely work
100+ hours a week, with some months requiring a brutal every other
night call schedule. This means, for instance, that you go to work
on Monday morning (around 5-6 am) work all day, stay in the hospital
all night (with varying amounts of sleep but usually 2-3 hours),
work the following day as well (hoping that you may get out early),
then go home for around 6 pm only to repeat the whole cycle again
the next day. On months such as these, if you have a spouse,
children, or pets, you won't see them. You can do the math to
figure out how many hours per week that amounts to. Most call
schedules for intern years run either every third or every fourth
night on call.
7.7a) Aren't there limits on this?
There are a few states that limit the number of hours that a
resident can work. Perhaps the most prominent state with a such a
law is New York.
New York's law, limiting residents to 80 hours per week, came about
largely due to the Libby Zion case. Libby Zion was a young woman
whose death in a NYC teaching hospital sparked an investigation into
the large amount of hours that residents work.
Nevertheless, many hospitals in New York still do not follow this
law and the state has performed "spot inspections" to attempt to
verify compliance. For an excellent discussion of this issue, read
the book "Residents: The Perils and Promise of Educating Young
Doctors" by David Ewing Duncan.
7.8) What does "board certified" mean?
Generally, to become certified by one of the boards recognized by
the American Board of Medical Specialties <http://www.abms.org>, a
physician must meet several requirements:
1) Possess an MD or DO degree from a recognized school of medicine
2) Complete 3 to 7 years of specialty training in an accredited
residency
3) Some boards require assessments of competence from the training
director
4) Most boards require the physician to have an unrestricted license
5) Some boards require experience in full-time practice, usually 2
years
6) Pass a written examination, and sometimes an oral examination
After certification, a physician is given the status of "diplomate"
in that specialty. Many boards require recertification at regular
intervals.
7.9) What does FACP/FACS/FACOG/etc. mean?
Before discussing this, it may be useful to delineate the
differences between organizations that physicians may be associated
with. Some definitions:
Association or Academy - A group for physicians in a particular
field, that often sponsors meetings and publishes journals.
Example: American Academy of Family Physicians.
Board - Organization that conducts periodic examinations for
physicians in a particular field, and offers "certification" (cf
7.8). The overseeing organization for all specialty boards is the
American Board of Medical Specialties <http://www.abms.org>.
Example: American Board of Internal Medicine.
College - Similar to an association, but membership is often tied to
board certification and experience. More of an honor than simple
association membership, doctors are often elected to "fellowship"
after recommendation by their colleagues. Example: American College
of Surgeons.
After a physician has received board certification in his/her field,
and has gained a set amount of experience in that field (usually a
specified number of years of practice), that physician can be
recommended for fellowship status in their specialty college. After
approval, the physician can then use their fellowship status on
stationery and business cards, i.e. Susan M. Avery, M.D.,
F.A.C.S. signifies that Dr. Avery has received fellowship status in
the American College of Surgeons.
7.10) What is an IMG/FMG?
Those who have graduated from medical schools outside of the United
States and Canada are called International Medical Graduates (IMGs)
or Foreign Medical Graduates (FMGs). Sometimes, US citizens who
have attended foreign schools are called USFMGs to distinguish them
from non-citizens.
There has been a move of late among some members of Congress, the
Accreditation Council for Graduate Medical Education (ACGME), and
the AAMC, in light of a perceived surplus of physicians in the US,
to reduce the number of Medicare-funded residency positions to 110%
of the number of graduating US medical school seniors. As of yet,
this has not been implemented.
7.11) What is the ECFMG? The CSA?
The Educational Commission for Foreign Medical Graduates (ECFMG)
<http://www.ecfmg.org> is an organization sponsored by the
Federation of State Medical Boards, the AAMC, the AMA, the American
Board of Medical Specialties, and others, that coordinates
certification of graduation, passing grades on the United States
Medical Licensing Examination (USMLE), and other information about
FMGs. Prior to applying to residency or fellowship programs in the
United States that are accredited by the Accreditation Council for
Graduate Medical Education (ACGME), an FMG must hold a certificate
from the ECFMG.
CSA stands for "Clinical Skills Assessment," a new requirement for
foreign-trained physicians seeking to obtain ECFMG certification.
Applicants face 10 simulated patients and be evaluated on their
ability to take a history, perform a physical exam and record a
written note. More information can be found on the ECFMG web site
at <http://www.ecfmg.org/csahome.htm>.
7.12) What is CME?
A physician's education does not end with medical school and
residency. Continuing Medical Education, or CME, allows physicians
to keep up with new developments in all medical fields. Physicians
earn "credits" for hours spent in various learning activities.
The American Medical Association (AMA) offers the Physician
Recognition Award (PRA) for doctors who complete 50 hours of CME
credit per year. The AMA's classification of CME is as follows:
Category 1: Formally organized and planned educational meetings,
e.g., conferences, symposia. Also includes residency.
Category 2: Less structured learning experiences, e.g.,
consultations, discussions with colleagues, and
teaching.
Other: Reading "authoritative" medical literature, e.g.,
peer-reviewed journals, textbooks.
Organizations that receive the nod from the Accreditation Council
for Continuing Medical Education (ACCME) <http://www.accme.org>, as
well as state medical societies and other groups recognized by the
AMA can provide "category 1" CME courses.
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