Medical education in the United States



Medical education in the United States includes educational activities involved in the education and training of medical doctors (D.O. or M.D.) in the United States, from entry-level training through to continuing education of qualified specialists.

A typical outline of the medical education pathway is presented below; however, medicine is a diverse profession with many options available. For example, some doctors work in pharmaceutical research, occupational medicine (within a company), public health medicine (working for the general health of a population in an area), or join the armed forces.

Medical school
In the United States a medical school is a four year institution with the purpose of educating physicians in the field of medicine. Admission into medical school usually requires a bachelor's degree from an accredited college or university. The course of study is divided into two roughly equal components: pre-clinical (consisting of didactic courses in the basic sciences) and clinical (consisting of rotations through different wards of a teaching hospital). The degree granted at the conclusion of the four years of study is either Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.), depending on the medical school; both degrees allow the holder to practice medicine after completing an accredited residency program.

Internship
During the last year of medical school, students apply for postgraduate residencies in their chosen field of specialization. These vary in competitiveness depending upon the desirability of the specialty, prestige of the program, and the number of applicants relative to the number of available positions. All but a few positions are granted via a national computer match which pairs an applicant's preference with the programs' preference for applicants.

Historically, post-graduate medical education began with a free-standing, one-year internship. Completion of this year continues to be the minimum training requirement for obtaining a general license to practice medicine in most states. However, because of the gradual lengthening of post-graduate medical education, and the decline of its use as the terminal stage in training, most new physicians complete the internship requirement as their first year of residency.

Notwithstanding the trend toward internships integrated into categorical residencies, the one-year "traditional rotating internship" (sometimes called a "transitional year") continues to exist. Some use it to re-apply to programs into which they were not accepted, while others use it as a year to decide upon a specialty. In addition, five states still require osteopathic physicians to complete a traditional rotating internship before residency.

Residency
Each of the specialties in medicine has established its own curriculum, which defines the length and content of residency training necessary to practice in that specialty. Programs range from three years after medical school for internal medicine to five years for surgery to six or seven for neurosurgery. This does not include research years that may last from one to four years if a PhD degree is pursued. Each specialty training program incorporates an internship year to satisfy the requirements of state licensure.

Fellowship
Many highly specialized fields require formal training beyond residency. Examples of these include cardiology, endocrinology, oncology after internal medicine; cardiothoracic surgery, pediatric surgery, surgical oncology after general surgery; reproductive endocrinology/infertility, maternal-fetal medicine, gynecologic oncology after obstetrics/gynecology. There are many others for each field of study. In some specialties such as Pathology and Radiology, a majority of graduating residents go on to complete a fellowship. The training programs for these fields are known as fellowships and their participants are fellows to denote that they already have completed a residency and are Board Eligible or Board certified in their basic specialty. Fellowships range in length from one to three years and are granted by application to the individual program or sub-specialty organizing board. Fellowships often contain a research component.

Continuing education
The physician or surgeon who has completed his or her residency and possibly fellowship training and is in the practice of their specialty is known as an attending physician or consultant. Each specialty has requirements for practitioners to undertake continuing medical education activities.