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Stages of Medical Education in the United States
Articles
September 15, 2024
If you’re reading this article, you’re obviously interested in becoming a doctor. However, not all premeds understand the complete medical education process. Sometimes that’s due to being the first person in their family to attend college or pursue a health profession. Sometimes it’s because they’re international students from countries where medical education is structured differently.
According to a 2022 article in The Atlantic by Derek Thompson, the United States has “the longest, most expensive medical-education system in the developed world.” For premeds, it’s important to understand the entire roadmap, from starting medical school medical school to completing residency and obtaining a license to practice.
This article looks at what you can expect after you successfully complete your undergraduate degree (and possibly a post-bacc) and get accepted into medical school.
Medical School: The Pre-Clinical and Clinical Years
Medical school generally lasts four years and is divided into two major phases: pre-clinical and clinical.
The first two years of medical school are the pre-clinical years. During this time, you’ll focus on foundational medical sciences such as anatomy, physiology, pharmacology, microbiology, and pathology. You’ll spend most of your time in lectures, laboratories, and small group discussions. Alongside this, you’ll be introduced to clinical skills through simulated patient interactions.
At the end of year two, you will take the first part of your medical licensure exam. The exam taken varies depending on whether you’re pursuing a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
The latter two years of a medical school program are the clinical years, dedicated to clinical rotations (also known as clerkships). During clerkships, students gain hands-on experience in various medical specialties like internal medicine, surgery, pediatrics, psychiatry, obstetrics and gynecology, and family medicine. This phase is essential for helping students decide on their specialty for residency and allows them to apply their classroom knowledge in real-world settings.
During your clinical years, you’ll sit for step two of your licensure exams and prepare to apply for medical residencies.
Licensing Exams
Medical students in the U.S. must pass a series of licensing exams to practice medicine. For MD students, the relevant test is the United States Medical Licensing Exam, or USMLE. For students in osteopathic medical programs (DO programs), the relevant test is the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA). Both exams are split into several sections which are staggered throughout medical school and residency.
The current USMLE timeline looks like this:
- USMLE Step 1: Taken at the end of the second year, this exam assesses your knowledge of basic medical sciences and how these sciences apply to medical practice. It’s considered one of the most challenging and crucial exams, as scores play a significant role in residency placement.
- USMLE Step 2 CK (Clinical Knowledge): Taken during the fourth year, this exam evaluates your clinical knowledge and understanding of patient care.
- USMLE Step 2 CS (Clinical Skills): Also taken during the fourth year, this exam tests your ability to interact with patients, take medical histories, perform physical examinations, and communicate effectively.
- USMLE Step 3: Taken during the first or second year of residency, this final step assesses your ability to manage patients in ambulatory settings. Passing this exam is necessary for obtaining a medical license.
Residency Training
After graduating from medical school and passing the necessary licensing exams, you’ll enter a residency program. Residency is essentially a medical internship that involves completing specialized training in a chosen field of medicine, such as internal medicine, surgery, pediatrics, or dermatology.
Applying to residency programs is a competitive process overseen by the National Resident Matching Program. Residency placements are awarded every March on “Match Day”. Residency programs range from three to seven years, depending on the specialty. Once you’re matched, you will work under the supervision of an attending physician as you provide patient care, conduct procedures, and participate in research.
Residency is known for its long hours, intense workload, and rigorous training. However, it is a crucial period where you’ll gain the experience needed to practice independently. During your residency, you’re likely to undergo regular evaluations and may take in-service exams (in addition to the USMLE or COMLEX step 3) to assess your knowledge and readiness for board certification.
Fellowship (Optional)
For physicians seeking further specialization, a fellowship is the next step after residency. Fellowships provide additional training in sub-specialties such as cardiology, gastroenterology, oncology, or plastic surgery. They can last from one to three years and focus on advanced clinical skills, research, and academic work.
Board Certification
Upon completion of residency (and fellowship, if applicable), doctors take board certification exams in their chosen specialty. Passing these exams grants board certification, signifying a physician’s expertise in their field. While board certification is not mandatory for practice, it is highly regarded and often required by employers.
Licensure and Practice
To practice medicine independently, doctors must obtain a medical license from the state or country where they intend to work. This involves submitting proof of education, residency training, and passing scores for all licensing exams. Continuing medical education (CME) is also required to maintain licensure.
In addition to completing CME, doctors can also further their careers by engaging in research and teaching, or by pursuing leadership positions in hospitals, clinics, or healthcare organizations.
The path to becoming a physician in the United States is long and demanding, typically requiring eight to 10 years of additional study beyond your bachelor’s degree. However, it is a journey filled with growth, learning, and opportunities to make a profound impact on people’s lives. Each stage—from pre-medical education to becoming a fully licensed physician—presents its own challenges and rewards. Understanding this process is the first step in preparing for a fulfilling career in medicine.
If you’re reading this article, you’re obviously interested in becoming a doctor. However, not all premeds understand the complete medical education process. Sometimes that’s due to being the first person in their family to attend college or pursue a health profession. Sometimes it’s because they’re international students from countries where medical education is structured differently.
According to a 2022 article in The Atlantic by Derek Thompson, the United States has “the longest, most expensive medical-education system in the developed world.” For premeds, it’s important to understand the entire roadmap, from starting medical school medical school to completing residency and obtaining a license to practice.
This article looks at what you can expect after you successfully complete your undergraduate degree (and possibly a post-bacc) and get accepted into medical school.
Medical School: The Pre-Clinical and Clinical Years
Medical school generally lasts four years and is divided into two major phases: pre-clinical and clinical.
The first two years of medical school are the pre-clinical years. During this time, you’ll focus on foundational medical sciences such as anatomy, physiology, pharmacology, microbiology, and pathology. You’ll spend most of your time in lectures, laboratories, and small group discussions. Alongside this, you’ll be introduced to clinical skills through simulated patient interactions.
At the end of year two, you will take the first part of your medical licensure exam. The exam taken varies depending on whether you’re pursuing a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
The latter two years of a medical school program are the clinical years, dedicated to clinical rotations (also known as clerkships). During clerkships, students gain hands-on experience in various medical specialties like internal medicine, surgery, pediatrics, psychiatry, obstetrics and gynecology, and family medicine. This phase is essential for helping students decide on their specialty for residency and allows them to apply their classroom knowledge in real-world settings.
During your clinical years, you’ll sit for step two of your licensure exams and prepare to apply for medical residencies.
Licensing Exams
Medical students in the U.S. must pass a series of licensing exams to practice medicine. For MD students, the relevant test is the United States Medical Licensing Exam, or USMLE. For students in osteopathic medical programs (DO programs), the relevant test is the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA). Both exams are split into several sections which are staggered throughout medical school and residency.
The current USMLE timeline looks like this:
- USMLE Step 1: Taken at the end of the second year, this exam assesses your knowledge of basic medical sciences and how these sciences apply to medical practice. It’s considered one of the most challenging and crucial exams, as scores play a significant role in residency placement.
- USMLE Step 2 CK (Clinical Knowledge): Taken during the fourth year, this exam evaluates your clinical knowledge and understanding of patient care.
- USMLE Step 2 CS (Clinical Skills): Also taken during the fourth year, this exam tests your ability to interact with patients, take medical histories, perform physical examinations, and communicate effectively.
- USMLE Step 3: Taken during the first or second year of residency, this final step assesses your ability to manage patients in ambulatory settings. Passing this exam is necessary for obtaining a medical license.
Residency Training
After graduating from medical school and passing the necessary licensing exams, you’ll enter a residency program. Residency is essentially a medical internship that involves completing specialized training in a chosen field of medicine, such as internal medicine, surgery, pediatrics, or dermatology.
Applying to residency programs is a competitive process overseen by the National Resident Matching Program. Residency placements are awarded every March on “Match Day”. Residency programs range from three to seven years, depending on the specialty. Once you’re matched, you will work under the supervision of an attending physician as you provide patient care, conduct procedures, and participate in research.
Residency is known for its long hours, intense workload, and rigorous training. However, it is a crucial period where you’ll gain the experience needed to practice independently. During your residency, you’re likely to undergo regular evaluations and may take in-service exams (in addition to the USMLE or COMLEX step 3) to assess your knowledge and readiness for board certification.
Fellowship (Optional)
For physicians seeking further specialization, a fellowship is the next step after residency. Fellowships provide additional training in sub-specialties such as cardiology, gastroenterology, oncology, or plastic surgery. They can last from one to three years and focus on advanced clinical skills, research, and academic work.
Board Certification
Upon completion of residency (and fellowship, if applicable), doctors take board certification exams in their chosen specialty. Passing these exams grants board certification, signifying a physician’s expertise in their field. While board certification is not mandatory for practice, it is highly regarded and often required by employers.
Licensure and Practice
To practice medicine independently, doctors must obtain a medical license from the state or country where they intend to work. This involves submitting proof of education, residency training, and passing scores for all licensing exams. Continuing medical education (CME) is also required to maintain licensure.
In addition to completing CME, doctors can also further their careers by engaging in research and teaching, or by pursuing leadership positions in hospitals, clinics, or healthcare organizations.
The path to becoming a physician in the United States is long and demanding, typically requiring eight to 10 years of additional study beyond your bachelor’s degree. However, it is a journey filled with growth, learning, and opportunities to make a profound impact on people’s lives. Each stage—from pre-medical education to becoming a fully licensed physician—presents its own challenges and rewards. Understanding this process is the first step in preparing for a fulfilling career in medicine.