Medical Education FAQ [1/2] (misc.education.medical FAQ) [v2.1]
Eric Wilkinson
Misc-education-medical-archive-name: faq/part1
Posting-Frequency: 14 days
Last-modified: 1998/12/28
Version: 2.1
URL: http://www.stanford.edu/~epw/mem/faq/
Maintainer: Eric Wilkinson <e...@stanford.edu>
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:
<http://www.stanford.edu/~epw/mem/faq/>
or through the hypertext FAQ archives at:
<http://www.faqs.org/faqs/> or
<http://www.cis.ohio-state.edu/hypertext/faq/usenet/FAQ-List.html> or
<http://www.lib.ox.ac.uk/internet/news/>
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
<e...@stanford.edu>. 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: Tim Cramm, MD; Scott Goodman;
Chris Kahn; Ryan Maves; Kris McCoy; Greg Nee, MD; 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?
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 (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, clinic (outpatient) settings, and in emergency room
visits.
Not all MDs, though, deal with patients in such a direct manner. Some,
such as pathologists, deal with the diseased tissues taken from the
patient. Radiologists deal with images of the patient produced and
enhanced by various 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> or OsteopathicNet at
<http://www.osteopathic.net>.
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 a year or so.
1.4) What is the MSAR?
The book "Medical School Admission Requirements," or "MSAR," (Kimberly
S. Varner, ed., ISBN 1-5775-4007-7) 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/findinfo/aamcpubs/reqpubs/ordforms/oform.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, pediatrics,
or family medicine) 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/stuapps/appinfo/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.
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>
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/stuapps/admiss/mcat/info.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 "Betz Guide"--for 1999, "Complete Preparation for the MCAT" by
Aftab S. Hassan, ed., pub. Williams & Wilkins) 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 Betz
guide, 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/stuapps/admiss/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 the 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.
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/stuapps/appinfo/ba-md.htm>. Students may also wish
to read the AAMC's guide for high school students considering medical
careers at <http://www.aamc.org/stuapps/appinfo/guide.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>, the Student Movement of the
Medicine/Public Health Initiative <http://www.studentmphi.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/stuapps/appinfo/md-mba.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/stuapps/appinfo/md-jd.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 Wilkinson
Misc-education-medical-archive-name: faq/part2
Posting-Frequency: 14 days
Last-modified: 1998/12/28
Version: 2.1
URL: http://www.stanford.edu/~epw/mem/faq/
Maintainer: Eric Wilkinson <e...@stanford.edu>
[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 run by Graham
Redgrave at Johns Hopkins: <http://www.med.jhu.edu/meded_feedback/>.
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.med.jhu.edu/meded_feedback/>.
Some commonly asked questions:
The favorite--Tell me about yourself.
Where do you see yourself in 10 years? (this question is 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/stuapps/appinfo/31ques.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 - each part consists of a two-day, twelve-hour exam, and in
virtually every state you must pass the parts in order to get licensed.
The examination is being converted to computer format; Step I will now
only be one day long 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.
------------------------------
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://www.bphc.hrsa.dhhs.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). A searchable database of available positions in the NHSC is
available at <http://158.72.83.221/nhsc.air/DEFAULT-M3.HTM>. This list
is under constant change, so there is no guarantee that a position
available now will be available when you complete residency.
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?
It depends. If you attend a school that participated in the Health
Education Assistance Loan Program (HEAL), you may be eligible for higher
Unsubsidized Stafford Loan limits. During the 1997-1998 year, students
at these schools could borrow up to $30K/yr in unsubsidized loans.
Reports indicate that during the 1998-1999 year, students will be able
to borrow "up to need," possibly eliminating the need to borrow under
Alternative Loan Programs such as bank loans.
Be aware that many financial aid administrators and staff in financial
aid offices are unfamiliar with these changes (amazing, isn't it?), so
do your homework. Ask them if the school participated in HEAL loans,
and check your unsubsidized loan maximum.
The original "Dear Colleague" letter sent from the Department of
Education to financial aid officers explaining the increase may be found
at: <http://ifap.ed.gov/csb_html/drcollg.htm>. Follow the links to 1996
Publication Year, GEN category, Publication 96-14.
------------------------------
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/cgi-bin/freida-redir>.
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/match/>.
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/csa.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.
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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