Medical education in the United States

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The Jackson Memorial Hospital (MJMH) complex in Miami, Florida, which serves as the primary teaching hospital for the Leonard M. Miller School of Medicine ((UMMSM) within the University of Miami (UM), is pictured in July 2010. Aerial-Picture-of-Jackson-e1445995779731.jpg
The Jackson Memorial Hospital (MJMH) complex in Miami, Florida, which serves as the primary teaching hospital for the Leonard M. Miller School of Medicine ((UMMSM) within the University of Miami (UM), is pictured in July 2010.

Medical education in the United States includes educational activities involved in the education and training of physicians in the country, with the overall process going from entry-level training efforts through to the continuing education of qualified specialists in the context of American colleges and universities.

Contents

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

Issues in higher education in the U.S. have particular resonance in this context, with multiple analysts expressing concern of a physician shortage in the nation. 'Medical deserts' have also been a topic of concern.

Medical school

In the U.S., a medical school is an institution with the purpose of educating medical students in the field of medicine. Admission into medical school may not technically require completion of a previous degree; however, applicants are usually required to complete at least 3 years of "pre-med" courses at the university level because in the US medical degrees are classified as Second entry degrees. Once enrolled in a medical school the four years progressive study is divided into two roughly equal components: pre-clinical (consisting of didactic courses in the basic sciences) and clinical (clerkships consisting of rotations through different wards of a teaching hospital). The degree granted at the conclusion of these four years of study is 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. [1] [2]

Internship

During the last year of graduate medical education, 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.

Not withstanding the trend toward internships integrated into categorical residencies, the one-year "traditional rotating internship" (sometimes called a "transitional year") continues to exist. Some residency training programs, such as in neurology and ophthalmology, do not include an internship year and begin after completion of an internship or transitional year. 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, osteopathic physicians "are required to have completed an American Osteopathic Association (AOA)-approved first year of training in order to be licensed in Florida, Michigan, Oklahoma and Pennsylvania." [3]

Lately there has been an increasing acknowledgment of the significance of education (IPE), in the field of training. IPE entails students from healthcare disciplines studying together to enhance teamwork and enhance patient care results (Zorek & Raehl 2013). This method is especially pertinent as healthcare services are transitioning to a team oriented approach. [4]

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 3 years after medical school for internal medicine and pediatrics, to 5 years for general surgery, to 7 years for neurosurgery. Each specialty training program either incorporates an internship year to satisfy the requirements of state licensure, or stipulates that an internship year be completed before starting the program at the second post-graduate year (PGY-2).

Fellowship

A fellowship is a formal, full-time training program that focuses on a particular area within the specialty, with requirements beyond the related residency. [5] Many highly specialized fields require formal training beyond residency. Examples of these include cardiology, endocrinology, oncology after internal medicine; cardiothoracic anesthesiology after anesthesiology; 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 further their training. 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. [6]

Board certification

The physician or surgeon who has completed their residency and possibly fellowship training and is in the practice of their specialty is known as an attending physician. Physicians then must pass written and oral exams in their specialty in order to become board certified. Each of the 26 medical specialties has different requirements for practitioners to undertake continuing medical education activities.

Moreover there is an increasing focus on integrating technology into the field of education. Virtual reality (VR) simulations and online platforms are being utilized to enrich opportunities in disciplines like anatomy, surgical training and telemedicine. Research has shown that VR simulations are effective in enhancing competencies and minimizing mistakes (Andrzej A., et al., 2019). With the advancements in technology medical schools are exploring methods to incorporate these resources into their programs to adequately equip students for contemporary healthcare settings. [7]

Continuing Medical Education

Continuing medical education (CME) refers to educational activities designed for practicing physicians. Many states require physicians to earn a certain amount of CME credit in order to maintain their licenses.  Physicians can receive CME credit from a variety of activities, including attending live events, publishing peer-reviewed articles, and completing online courses. The Accreditation Council for Continuing Medical Education (ACCME) determines what activities are eligible for CME.

There is a growing emphasis on diversity, equity and inclusion (DEI) in education. Tackling health inequalities and providing care are vital aspects of medical instruction. Medical institutions are placing importance on DEI efforts, including attracting and supporting minority students integrating competence training and advocating for diversity, among faculty and leaders (Dogra et al., 2009). These initiatives strive to establish a healthcare workforce that mirrors the patient communities it serves. [8]

See also

Related Research Articles

<span class="mw-page-title-main">Urology</span> Medical specialty

Urology, also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary system and the reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs.

Obstetrics and gynaecology is the medical specialty that encompasses the two subspecialties of obstetrics and gynaecology. The specialization is an important part of care for women's health.

In the medical profession, a general practitioner (GP) or family physician is a physician who treats acute and chronic illnesses and provides preventive care and health education to patients of all ages. GPs' duties are not confined to specific fields of medicine, and they have particular skills in treating people with multiple health issues. They are trained to treat patients to levels of complexity that vary between countries. The term "primary care physician" is more usually used in the US. In Asian countries like India, this term has been replaced mainly by Medical Officers, Registered Medical Practitioner etc.

Doctor of Medicine is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a professional degree. This generally arose because many in 18th-century medical professions trained in Scotland, which used the M.D. degree nomenclature. In England, however, Bachelor of Medicine, Bachelor of Surgery (M.B.B.S.) was used and eventually in the 19th century became the standard in Scotland too. Thus, in the United Kingdom, Ireland and other countries, the M.D. is a research doctorate, honorary doctorate or applied clinical degree restricted to those who already hold a professional degree (Bachelor's/Master's/Doctoral) in medicine. In those countries, the equivalent professional degree to the North American, and some others' usage of M.D. is still typically titled Bachelor of Medicine, Bachelor of Surgery.

A medical school is a tertiary educational institution, professional school, or forms a part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery, Master of Medicine, Doctor of Medicine (MD), or Doctor of Osteopathic Medicine (DO). Many medical schools offer additional degrees, such as a Doctor of Philosophy (PhD), master's degree (MSc) or other post-secondary education.

<span class="mw-page-title-main">Residency (medicine)</span> Postgraduate medical training

Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, veterinarian, dentist, podiatrist (DPM) or pharmacist (PharmD) who practices medicine, veterinary medicine, dentistry, podiatry, or clinical pharmacy, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant. In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. In the meantime, they practice "on" the license of their supervising physician. An individual engaged in such training may be referred to as a resident, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training. Whereas medical school teaches physicians a broad range of medical knowledge, basic clinical skills, and supervised experience practicing medicine in a variety of fields, medical residency gives in-depth training within a specific branch of medicine.

A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (paediatrics), cancer (oncology), laboratory medicine (pathology), or primary care. After completing medical school or other basic training, physicians or surgeons and other clinicians usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a specialist.

<span class="mw-page-title-main">Medical education in Australia</span> Summary of education and training of medical practitioners (doctors) in Australia.

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A medicalintern is a physician in training who has completed medical school and has a medical degree, but does not yet have a license to practice medicine unsupervised. Medical education generally ends with a period of practical training similar to internship, but the way the overall program of academic and practical medical training is structured differs depending upon the country, as does the terminology used.

The American Board of Medical Specialties (ABMS) is a non-profit organization established in 1933 which represents 24 broad areas of specialty medicine. ABMS is the largest and most widely recognized physician-led specialty certification organization in the United States. The other certification organizations in the United States are the American Board of Physician Specialties and American Osteopathic Association Bureau of Osteopathic Specialists.

Touro University Nevada (TUN) is a private university in Henderson, Nevada. It is part of the Touro College and University System. Touro University Nevada is a branch campus of its sister campus Touro University California.

Modern medical education in Hong Kong started with the founding of the Hong Kong College of Medicine for Chinese in 1887. Currently, six institutes of higher education are engaged in the training of medical practitioners in Hong Kong.

<span class="mw-page-title-main">Oklahoma State University Medical Center</span> Hospital in Oklahoma, US

Oklahoma State University Medical Center is a public teaching hospital with medical clinics located in Tulsa, Oklahoma. OSU medical center operates a large number of osteopathic residency and fellowship programs. The hospital is the largest osteopathic teaching center in the United States, training 135 resident physicians in primary and sub-specialty care each year.

A fellowship is the period of medical training, in the United States and Canada, that a physician, dentist, or veterinarian may undertake after completing a specialty training program (residency). During this time, the physician is known as a fellow. Fellows are capable of acting as an attending physician or a consultant physician in the specialist field in which they were trained, such as internal medicine or pediatrics. After completing a fellowship in the relevant sub-specialty, the physician is permitted to practice without direct supervision by other physicians in that sub-specialty, such as cardiology or oncology.

In Canada, a medical school is a faculty or school of a university that trains future medical doctors and usually offers a three- to five-year Doctor of Medicine (M.D.) or Doctor of Medicine and Master of Surgery degree. There are currently 17 medical schools in Canada with an annual admission success rate normally below 7.5%. As of 2021, approximately 11,500 students were enrolled in Canadian medical schools graduating 2,900 students per year.

Medical education in Philippines is principally offered and developed by accredited and government recognized medical schools in the country.

Most physicians in the United States hold either the Doctor of Medicine degree (MD) or the Doctor of Osteopathic Medicine degree (DO). Institutions awarding the MD are accredited by the Liaison Committee on Medical Education (LCME). Institutions awarding the DO are accredited by the Commission on Osteopathic College Accreditation (COCA). The World Directory of Medical Schools lists both LCME accredited MD programs and COCA accredited DO programs as US medical schools. Foreign-trained osteopaths do not hold DO degrees and are not recognized as physicians in the United States or in other jurisdictions.

Doctor of Osteopathic Medicine is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licensed as a physician or surgeon and thus have full medical and surgical practicing rights in all 50 US states. As of 2021, there were 168,701 osteopathic physicians and medical students in DO programs across the United States. Osteopathic medicine emerged historically from osteopathy, but has become a distinct profession.

<span class="mw-page-title-main">College of Osteopathic Medicine of the Pacific</span> Medical school in Pomona, California, U.S.

The College of Osteopathic Medicine of the Pacific (COMP) is a private, non-profit medical school for osteopathic medicine located in downtown Pomona, in the U.S. state of California. The college opened in 1977 as the only osteopathic medical school west of the Rocky Mountains. COMP was the founding program of Western University of Health Sciences (WesternU), which now has 8 colleges in addition to COMP, each offering professional degrees in various fields of healthcare. COMP has a single 4-year program, conferring the Doctor of Osteopathic Medicine (D.O.) degree. Graduates are eligible to practice medicine in all 50 states and more than 85 countries.

<span class="mw-page-title-main">Reading Hospital</span> Hospital in Pennsylvania, U.S.

Reading Hospital is a 697-bed non-profit teaching hospital located in West Reading, Pennsylvania. The hospital was established in 1867 and is the anchor institution of Tower Health.

References

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  7. "Shibboleth Authentication Request". libwin2k.glendale.edu. Retrieved 2024-04-29.
  8. Dogra, Nisha; Bhatti, Farah; Ertubey, Candan; Kelly, Moira; Rowlands, Angela; Singh, Davinder; Turner, Margot (2016-04-02). "Teaching diversity to medical undergraduates: Curriculum development, delivery and assessment. AMEE GUIDE No. 103". Medical Teacher. 38 (4): 323–337. doi:10.3109/0142159X.2015.1105944. ISSN   0142-159X.