Medical school in the United States

Medical school in the United States is a four year graduate institution with the purpose of educating physicians in the field of medicine.


 * See alternative medicine for a discussion of non-conventional medical education.

Admissions
Admission into medical school requires a four-year bachelor's degree (with extremely rare exceptions possible) from an accredited college or university. Nearly all medical schools require the applicant to have attained a bachelor's degree prior to matriculation. Many applicants obtain further education before medical school in the form of Master's degrees, or other non science related degrees. Admissions criteria may include overall performance in the undergraduate years and performance in a group of courses specifically required by U.S. medical schools (pre-health sciences), the score on the Medical College Admission Test (MCAT), application essays, letters of recommendation (most schools require either one letter from the undergraduate institution's premedical advising committee or a combination of letters from at least one science faculty and one non-science faculty), and interviews.

Beyond objective admissions criteria, many programs look for candidates who have had unique experiences in community service, volunteer-work, international studies, research, or other advanced degrees. The application essay is the primary opportunity for the candidate to describe her/his reasons for entering a medical career. The essay requirements are usually open-ended to allow creativity and flexibility for the candidate to draw upon their personal experiences/challenges to make her/him stand out amongst other applicants. If granted, an interview serves as an additional way to express these subjective strengths that a candidate may possess.

Most commonly, the bachelor degree is in one of the biological sciences, but not always; in 2005, nearly 40% of medical school matriculants had received bachelor's degrees in fields other than biology or specialized health sciences. All medical school applicants must, however, complete year-length undergraduate courses with labs in biology, general chemistry, organic chemistry, and physics; some medical schools have additional requirements such as biochemistry, calculus, genetics, psychology and English.

A student with a bachelor's degree who has not taken the pre-medical coursework may complete a postbaccalaureate (postbacc) program. Such programs allow rapid fulfillment of prerequisite course work as well as grade point average improvement. Some postbacc programs are specifically linked to individual medical schools to allow matriculation without a gap year.

Several universities across the U.S. admit high school students to both their undergraduate colleges and the medical schools simultaneously; students attend a single six-year to eight-year integrated program consisting of two to four years of an undergraduate curriculum and four years of medical school curriculum, culminating in both a bachelor's and M.D. degree or a bachelor's and D.O. degree.

While not necessary for admission, several private organizations have capitalized on this complex and involved process by offering services ranging from single-component preparation (MCAT, essay, etc.) to entire application review/consultation.

In 2006, the average GPA and MCAT for osteopathic matriculants was 3.46 and 24.6 respectively, and 3.64 and 30.4 for allopathic matriculants. In 2006, 39,108 people applied to medical schools in the United States through the American Medical College Application Service. 17,370 of them matriculated into a medical school for a success rate of 44%.

Curriculum
Once admitted to medical school, it takes four years to complete a Doctor of Medicine (M.D.), or Doctor of Osteopathic Medicine (D.O.) degree program. The course of study is divided into two roughly equal components: pre-clinical and clinical.

Preclinical study generally comprises the first two years and consists of classroom and laboratory instruction in core subjects such as anatomy, biochemistry, physiology, pharmacology, histology, embryology, microbiology, pathology, pathophysiology, and neurosciences. Once students successfully complete preclinical training, they generally take step one of the medical licensing boards, the USMLE, or the COMLEX.

The clinical component usually occupies the final two years of medical school and takes place almost exclusively on the wards of a teaching hospital or, occasionally, with community-based physicians. The students observe and take part in the care of patients under the supervision of resident and attending physicians. Rotations are required in internal medicine, surgery, pediatrics, family medicine, obstetrics/gynecology, neurology, and psychiatry. Beyond these, a variable number of specialty electives are required. Additionally, students are generally required take a sub-internship rotation where they will perform duties at the intern level. During the fourth year, most medical students take Step 2 of the medical licensing boards (USMLE [for M.D.], or COMLEX [for D.O.]).

Many medical schools also offer joint degree programs in which some medical students may simultaneously enroll in master's or doctoral-level programs in related fields such as a Masters in Business Administration, Masters in Healthcare Administration, Masters in Public Health, JD, MALD, and Masters in Health Communication.

Upon completion of medical school, the student gains the title of doctor and the degree of M.D. or D.O., but cannot practice independently until completing at least an internship and also Step 3 of the USMLE (for M.D.) or COMLEX (for D.O.). Doctors of medicine and doctors of osteopathic medicine have an equal scope of practice in the United States, with some osteopaths supplementing their practice with principles of osteopathic medicine in addition to the conventional methods.

Grading
Medical schools use a variety of different grading methods. Even within one school, the grading of the basic sciences and clinical clerkships may vary. Most medical schools use the pass/fail schema, rather than letter grades; however the range of grading intervals varies. The following are examples of grades used with different intervals:
 * 2 Intervals = Pass/Fail
 * 3 Intervals = Honors/Pass/Fail
 * 4 Intervals = Honors/High Pass/Pass/Fail (or ABCF)
 * 5 Intervals = Honors/High Pass/Pass/Low Pass/Fail (or ABCDF)

Accreditation
All medical schools within the United States must be accredited by one of two organizations. The Liaison Committee on Medical Education, jointly administered by the Association of American Medical Colleges and the American Medical Association accredits M.D. schools, while the Commission on Osteopathic College Accreditation of the American Osteopathic Association accredits D.O. schools. There are presently 125 accredited allopathic medical schools and 23 accredited osteopathic medical schools (which have 26 locations).

Accreditation is required for students to receive federal loans. Additionally, schools must be accredited to receive federal funding for medical education.