MedEdits | Medical School Admissions Consulting

Saturday, February 21, 2009

Medical Education: The Basics

I recently wrote an article about medical education for an international advising organization that consists mostly of law and business consultants about the basics of medical education. While I wrote this article for that specific audience, I thought this would be a good read for those of you (and your parents) who want to know what is ahead:

When I considered what to write about for my contribution to the AIGAC newsletter, I kept in mind my primary audience. Realizing that most of you are law school and MBA types, I tried to put myself in your shoes (as any good doctor would) and consider what you might or might not know, or even be remotely interested in learning about medical admissions. As the daughter and sister of two Harvard Business School graduates, I have a perspective on the business world and some understanding of the differences between medicine and business as to higher education requirements. Long ago, as my brother and I considered our futures, I remember sitting around the dining room table and talking with our parents about our graduate educations and what they would cost. As we did the math, we realized that the cost of my brother’s two years of business school together with the likelihood of a high paying job following graduation seemed like a much better deal than my four years of medical school education followed by 3 to 7 years of low-paying post graduate training. As a physician, I would have skills that would provide me with job security, whatever the state of the economy, however. I also considered that medicine would give me a variety of paths from which to choose, such as research, patient care, education or business.

Ironically, with the turn the economy has now taken, my physician friends who used to resent the big bucks the MBA crowd was making are now gleeful about all the sales and bargains they can enjoy as their incomes remain stable. While others are concerned about decreased bonuses and losing their jobs, physicians retain their positions and career satisfaction.

But the advantages of a career in medicine compared with law or business come with many noneconomic as well as financial costs. Unlike most other professional schools, medical school requires that applicants take many challenging prerequisite courses, including biology, chemistry, organic chemistry and physics. They must also take the medical college admissions test, which tests their mastery of this basic science material. In addition to having outstanding grades, applicants must demonstrate significant experience in research, community service, clinical medicine and teaching. Despite these demands, medical school is fiercely competitive. In 2008, 42,231 applicants filed 558,053 applications, and 18,036 students matriculated at allopathic medical schools in the United States. I will do the math for you: only 42.7% of applicants matriculated at medical schools in the US. While medical schools are increasing enrollments to allow more people to attend (and to alleviate the predicted doctor shortage), many students are now enrolling at medical schools in the Caribbean because they cannot gain admission in the US.

So, you think, “whew!” If you get into medical school, you are golden. Well, not exactly. You still have most of the standardized tests to take along with navigating other important hurdles. While most schools now emphasize early clinical exposure, the first two years of medical school are geared towards learning about the basic medical sciences including anatomy, pharmacology and pathophysiology. At the end of your second year, students take the first of 3 “steps” of the United States Medical Licensing Exam (USMLE), which tests your mastery of this material. Students’ scores on this exam are a vital ingredient in their success in being accepted to residency. The third year of medical school is devoted primarily to “core clerkships” in required specialties, including pediatrics, internal medicine and surgery. And keep in mind that during this time students must not only perform well academically and clinically but also must be deciding what specialty to pursue for residency training.

In the summer between the third and fourth year of medical school, students start a new application process to obtain a residency position. Sometime during the third and fourth year, students also must sit for the second step of the USMLE, which consists of two parts -- a written portion and a practical portion (USMLE Step 2 Clinical Knowledge and USMLE Step 2 Clinical Skills). During the fourth and final year of medical school, students complete their rotations and obtain a postgraduate residency position.

A residency is, essentially, a paid apprenticeship. A resident’s role is twofold; he or she cares for patients but also learns while on the job. So, how competitive is residency? In 2008, there were 35,956 residency applicants for 25,066 first year positions. Also, some specialties are more competitive than others. There are three general types of residency applicants: medical students of US schools, medical students at Caribbean Schools and International Medical Graduates who went to school abroad and hope to train in the US so they can practice here. The residency application process is itself complicated.

During residency, time each week is devoted to teaching. So, while residency is very much a job, it still feels like being in school because so much of residency is about learning and gaining skills in your chosen specialty. During your first or second year of residency, you take the third and final step of the USMLE. Once residency is completed, you can go through yet another application process to obtain fellowship training. And, remember, once you complete your residency training, you must pass your specialty board exam, which tests your mastery of the specialty in which you trained and, if you pass it, qualifies you as being “board certified.”

As I write this summary, I am exhausted. The number of standardized tests is overwhelming and medical training is rigorous. But, let me say that medical education is interesting, inspiring and often fun. A career in medicine is just that – it is a career (and not just a job) that allows you to make valuable contributions to the lives of others on many levels. It also gives you the flexibility and freedom to move in many directions. The path may have been long and the tuition higher than what my comrades in law or business school had to pay, but I still believe that, for me and others who make the commitment, a medical education was, and is, a wise investment.