The Path to Medical School

dr hegde with students in classroom

How do you go from being a college student to being a doctor? First, you need to be sure about your motivation. Your interest in a career in medicine needs to be well founded based on knowledge and exposure to clinical settings.  That is, being inspired by medical shows on TV or a vague desire to “help people” is not enough. You also need to have a clear idea of what it takes to be competitive for medical school admission. The road to becoming a doctor is long and arduous and, if you are suited for the profession, highly rewarding. You can read the details about the steps below.

I want to be a doctor. How do I get there from here?

Many students who want to be physicians or surgeons have only a vague idea of how to get there; the future looks desirable but the road looks foggy. This table is meant as a general roadmap. There are variations on the theme, but this is the most common route from being a college student to being a doctor.

Step of the JourneyMajor Exams and Rites of Passage

College (Undergraduate)

You’re a “premed”! Major concerns are the courses universally required for medical school admission: biology, general chemistry, organic chemistry, physics, and social sciences. Other important concerns are your overall GPA and getting some form of clinical work or volunteer experience. Take your MCAT and file your AMCAS application at or soon after the end of your junior year, or one year before your intended date of medical school matriculation

MCAT

The most important factor, along with GPA, in your chance at medical school. MCAT-2015 covers biological & biochemical foundations of life; chemical & physical foundations of biology; psychological, social, and biological foundations of behavior; and critical analysis & reasoning skills.

Medical School—Basic Medical Sciences

The first two years of medical school are traditionally centered around lecture and laboratory instruction in the basic medical sciences, although many medical schools now include contact with patients in the first two years or use problem-based learning (learning by independent analysis of case studies). 

M.D./Ph.D. is typically 2 years of preclinical medical school courses, 2+ years of Ph.D. research, then 2 years of M.D. clinical rotations.

USMLE, Part 1

An 8-hour, computer-based exam taken at the end of the second year of medical school. The exam is composed of 336 multiple choice questions on anatomy, physiology, behavioral science, biochemistry, pharmacology, genetics, pathology, nutrition, microbiology, and other subjects. Scores are an important factor in getting the most desirable residencies after med school.

Medical School—Clinical Rotations (Clerkships)

More emphasis on developing clinical skills—taking a medical history, doing physical exams, and arriving at diagnoses and treatment plans. This involves clinical experiences taught in hospitals and clinics by physicians in each of several specialties, such as family medicine, internal medicine, OB/GYN, pediatrics, general surgery, emergency medicine, neurology, psychiatry or behavioral medicine, and four electives (such as dermatology, plastic surgery, cardiology, radiology, anesthesiology, oncology, urology, gerontology, and others). Each rotation or clerkship lasts for 4 to 8 weeks. Clinical rotations are when medical students typically find out what fields of medicine they have a real enthusiasm and aptitude for, and what they would like to practice. This phase ends with the awarding of the M.D. degree—but this doesn’t mean you can go out and practice medicine yet, at least not on your own! There are more hurdles to jump, and at least a few more years, before you can get a license to practice.

USMLE, Part 2

Part 2 of the USMLE is usually taken during the fourth year of medical school and is meant to test whether a candidate can perform proper patient care under the supervision of an experienced physician. The Clinical Knowledge (CK) section is a 9-hour test of such areas as internal medicine, surgery, pediatrics, psychiatry, and obstetrics–gynecology. The Clinical Skills (CS) section is a test of clinical skills in which the candidate interacts with actors who are trained to simulate certain types of standardized patients. The examinee faces 12 “patients,” and for each one, has 15 minutes to take a medical history and perform a clinical examination, then 10 minutes to write up a patient note including findings, differential diagnosis, and what tests should be ordered.

Match Day

A big day when everyone is informed of what residency programs have accepted them.

Internship—1 year

This is the first year of postgraduate medical training. The new M.D. practices medicine in a hospital or clinic under the supervision of a licensed physician. In some cases, the internship is considered to be the first year of residency; in others, one is considered a medical resident only after completing the year of internship.

USMLE, Part 3

Part 3 of the USMLE tests whether a candidate is competent to provide proper patient care without supervision. It is usually taken at the end of a year of internship or residency. This is a 2-day exam beginning with 144 multiple choice questions and then a test of the ability to manage simulated patients in a real-time scenario. The examinee enters orders for tests or medications into a computer and the condition of the patient changes according to what was ordered. Each case must be managed successfully within 25 minutes.

Residency—3 to 10 years

A resident is one who has earned the M.D. and practices medicine under the supervision of licensed physicians in a hospital or clinic. A residency is in a medical specialty such as anesthesiology, dermatology, internal medicine, pediatrics, OB/GYN, sports medicine, radiology, psychiatry, surgery, or others. The length of a residency varies from typically 3 years in pediatrics and family medicine to 10 years for neurosurgeon or cardiac surgeon. Residencies vary greatly in competitiveness (ability to get the residency of choice).

Licensure

Upon completion of all parts of the USMLE and appropriate residency, a physician must apply to his or her state medical board for a license to practice. License renewal requires earning Continuing Medical Education (CME) credits throughout one’s career.

Fellowship

Optional; additional supervised research or training in some medical specialties (e.g., oncology, nephrology); 1 to 3 years.

 

Independent Physician

At last! Now you may open a private medical practice, join an existing group practice, or may practice medicine in government, industry, the military, nonprofit organizations, or university/medical college settings.

Continuing Medical Education (CME)

Credits must be earned throughout one’s career to remain licensed.