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Medical Education
in USA
Medical Colleges and Universities in the USA
In the US
medicine is taught only at the postgraduate level after an undergraduate
university education. You cannot apply to US medical schools after
completing A levels or Scottish Highers. You must first complete an
undergraduate degree.
Medical education in the US is generally considerably longer than
medical education in the UK. Four years of undergraduate study (pre-medical
education) are followed by four years of medical school, then three to seven
years of residency training. Upon successful completion of the four-year medical
school curriculum and exams, the Doctor of Medicine (MD) degree is conferred.
The entire process can take anywhere from 11 to 15 years. Due to educational,
cultural and language differences, many US medical schools encourage
international applicants to enrol for at least one year of undergraduate
coursework at a regionally-accredited American university prior to starting the
MD programme. Contact medical schools directly to find out what they recommend.
List of
Medical Colleges in USA
Check with the
appropriate professional association in your home country to see if a US degree
meets your home country's requirements to practise medicine. Questions regarding
specific education credentials, visa requirements and examinations required for
licensure should be directed to the individual state medical boards.
Admission to US medical schools is extremely competitive. Many US
medical schools, especially at state-supported institutions, will not consider
international students for admission to MD programmes. The representation of
foreign students in US medical schools stands at less than 1% of all students.
US medical schools have a primary obligation to train US citizens and are strict
about accepting international students into the first year class. This obstacle
can be overcome if you can establish permanent residency status prior to making
an application. If you plan to apply to a state-supported school, be aware that
most are required to give preference to in-state residents. Most international
students accepted by US medical schools had attended a US undergraduate
institution for at least one year.
Expenses
and Financial Aid
Average annual cost of tuition and fees for first year medical students
is approximately $11,000 for state residents and $25,000 for international
students at a state-funded medical school, and $30,000 at a private school. In
addition, the cost of living for one academic year (nine months) ranges from
$8,000-$15,000 depending on location in the US. Few scholarships are announced
for international students to pursue medical education, and loans are generally
not available from US lending institutions without a US citizen as a
co-borrower.
The
Structure of an MD Programme
The
MD degree is usually completed in four years. In general, during the first two
years you will study basic medical sciences: anatomy, biochemistry, physiology,
microbiology, pathology and pharmacology, as well as behavioural sciences,
introductory patient interviewing and examination techniques along with an
introduction to health care. In the third year, you will gain experience with
patients in hospital, clinic and office settings in the fields of internal
medicine, family medicine, paediatrics, obstetrics and gynaecology, surgery and
psychiatry. The fourth year is a mix of required and elective courses where you
will gain additional experience and expertise in caring for patients. Towards
the end of medical school, you will choose a speciality in which you will spend
at least three years in a residency after completing the MD programme. During
that period you may obtain a licence to practise.
Other
Options
Combination
BA or BS/MD Programmes
This type of programme combines undergraduate college study with
postgraduate medical education, and you are admitted provisionally to the
postgraduate medical degree programme based on high school credentials. If your
performance in undergraduate courses is satisfactory you are allowed to progress
to the MD programme. This combination programme shortens the normal length of
formal education for a medical degree to six or seven years instead of eight,
and can also make it easier to gain admission into a medical school.
Applying
for Advanced Standing
If you wish to transfer from a non-US medical school to a US medical
school with advanced standing, you should contact the individual medical schools
directly for information regarding admission and application procedures.
Advanced standing is rarely offered and the chances of success are slim. No list
of medical schools that consider applications for advanced standing was
available at the time of writing.
Combined
and Interdisciplinary Programmes
These programmes allow you to study for a master's or doctoral degree
in basic medical sciences in combination with study for the MD degree. Some
programmes exist that allow combined study in a non-science subject e.g. MD-JD,
which will allow you to secure a Juris Doctor law degree as well as the MD.
Combined programmes considerably extend the time needed to graduate with both
degrees. They usually lead to careers with limited clinical duties, in academia
and research.
Admission
to the MD Programme
How to Apply
There are currently two
ways to apply to US medical schools. If a medical school is a member of the
American Medical College Application Service (AMCAS) then you must apply through
AMCAS. If a school is not a member of AMCAS then you will need to apply directly
to the school.
American Medical
College Admission Service (AMCAS)
AMCAS is a centralised processing service for medical school
applications. Most US medical schools are participants in AMCAS and do not
accept applicants not participating in AMCAS. US medical schools may use AMCAS
for preliminary screening and outstanding applicants would be asked to fill out
a further medical school-specific application. Contact the admissions office of
the medical school by post, fax or email to make initial inquiries on admission
requirements. To reach AMCAS on-line visit www.aamc.org. This site will also
give you access to the Association of American Medical Colleges.
The admissions
committees of US medical schools where you apply will consider the following
factors:
Undergraduate
Coursework and Performance
The nature of the US liberal arts degree allows students to obtain a
strong foundation in the natural sciences, but also take courses in the arts,
social sciences and humanities. The majority of US students who intend to apply
to medical schools take their bachelor's degree in biology, chemistry or another
science-related subject, though this is not mandatory or even encouraged. All US
medical schools emphasise the importance of the liberal arts education.
Although mandatory courses
at the undergraduate level vary from school to school, the basic requirements
for medical schools are:
Biology or
Zoology, 1 year with lab
Inorganic Chemistry, 1 year with lab
Organic Chemistry, 1 year with lab
Physics, 1 year with lab
English, 1 year
A number of
schools also require coursework in mathematics, behavioural science, the
humanities and computers. Note that a "pre-med" degree does not
guarantee admission to medical school and may not even be treated as the best
curriculum for all students. Students should choose a major based on their
interests, not based on concern for admission to a postgraduate programme in
medicine; it is possible to take the above list of subjects at a US university
while majoring in an unrelated subject.
In addition to
successful completion of required undergraduate coursework, a strong cumulative
Grade Point Average (GPA) is also necessary. The GPA for the average matriculant
is about 3.5 on a 4.0 scale (the approximate equivalent of a B+ or 2:1 degree
classification). A high GPA by itself, however, does not guarantee admission to
medical school. As already mentioned, admission to US medical schools is
extremely competitive, so students applying with degrees lower than a 2:1 would
have a very slim chance of admission.
Postbaccalaureate
Programmes
Individuals who have completed a postbaccalaureate pre-medical
education now comprise a small but significant part of the medical school
applicant pool. These programmes are aimed at individuals who wish to change
careers, have been uncommitted as to their career but now have decided to study
medicine, or have been rejected by a medical school and are looking to improve
their chances when re-applying. These programmes vary in length and content.
Your choice of programme will quite often depend on your prior academic history.
They can assist non-science majors with the relevant courses or help prepare
candidates for the Medical Colleges Admissions Test (MCAT - see below).
Medical
College Admission Test (MCAT)
The MCAT is an eight-hour multiple choice standardised exam required by
most US medical schools. This test is very important among the admission
criteria and admissions officers rank it among the top three selection factors.
The MCAT is given twice a year and nearly all medical schools suggest you take
it in the spring of the year before you aim to gain admission. Each of the
multiple choice sections of the test is scored on a scale of 1 to 15 and medical
schools view scores above 10 as superior. The Writing Sample section is scored
on a scale of 1 to 6. The MCAT assesses mastery of basic concepts in biology,
chemistry (general and organic), physics, scientific problem solving, critical
thinking and writing skills. Registration materials can be obtained from EAS by
sending an A4-sized SAE for 150 grams.
Obtaining
a License to Practise Medicine
There
is no national medical licensing authority in the US. The licence to practise
medicine in the US is granted by the individual medical licensing authorities in
each of the 50 states, commonly known as the "state medical boards."
Each board sets its own rules and regulations and individuals wishing to
practise medicine in the US are advised to contact the state in which they plan
to work for complete information. Contact details for state medical boards are
available from EAS and at the Federation of State Medical Boards (FSMB).
Your first step
is to contact the state board of medicine for the state in which you plan to
practise. Most states require ECFMG certification of foreign medical graduates
as a pre-requisite to obtaining a licence to conduct supervised medical practice
in that state. To conduct unsupervised medical practice, you must also complete
Step 3 of the USMLE.
Medical
Residencies/Fellowships for Foreign Medical Graduates
After
completing the MD degree, it is standard for doctors to undertake a period of
residency training, usually in a hospital, specialising in one area of medicine.
The length of residency training varies among the different specialities but is
usually between three and seven years. Foreign medical graduates must hold a
valid standard ECFMG Certificate in order to enter residency programmes
accredited by the Accreditation Council for Graduate Medical Education. If you
do not wish to commit to a speciality at the beginning of your training then you
may want to consider a "transitional year" programme. These programmes
last 12 months and give graduates exposure to multiple clinical disciplines to
assist them with their choice of speciality. Note: it is not a complete graduate
medical education programme in itself and is not significant preparation for the
practice of medicine. ECFMG certification is required for participation in
transitional year programmes.
Fellowship
Training
A fellowship usually provides advanced training in a medical
subspeciality and is generally undertaken after several years of residency
training.
Obtaining
a Residency or Fellowship Position
At least 12 months before you wish to start a residency programme,
consult The Graduate Medical Education Directory (the "Green Book")
published annually by the American Medical Association (AMA) and/or the "FREIDA"
database, on the AMA website to choose an appropriate programme. These guides
list accredited graduate medical education programmes in the US. State licensing
boards, speciality societies and hospitals refer to this guide to verify the
authenticity of programmes presented by doctors who wish to qualify for
licensure, certification or hospital privileges. The Graduate Medical Education
Directory is available for reference in the EAS library. You can obtain this
book through Oxford University Press, Science Medical and Journals Division,
Walton Street, Oxford OX2 6DP. Tel: 01536 741727. The guide costs approximately
$64.95 (ISBN 0-89970-920-6).
The Fellowship
and Electronic Residency Database is another way to find residencies. This is
located at the American Medical Association's website.
You should
contact residency programmes as early as possible to determine eligibility
requirements and institutional employment policies and to request application
materials. Carefully review information to find out deadlines, whether the
programmes require on-site interviews and whether the programmes require
applicants to enrol in the National Residency Match Program (NRMP) (see below
for information on the NRMP). You are responsible for requesting
recommendations, arranging transcripts and forwarding materials directly to each
programme by the established deadline. A transcript is a record provided by the
medical school that lists the courses taken during your medical education and
the grades you achieved. Residency salaries will usually support a single person
so if you have a family you may need additional resources. Before signing a
contract you should consider:
-
Duration of
employment
-
Salary,
holidays and benefits
-
Allowances
for housing and food
-
Insurance -
is the professional liability insurance covered by the hospital?
-
Health
insurance
-
Duties and
responsibilities
-
Programme
content and assignments
National
Residency Match Program (NRMP)
In addition to applying directly to hospital residency programmes, you
may also need to register for the NRMP. About 80% of the hospital residency
programmes participate in the NRMP and will not accept applications from
candidates not in the NRMP. The NRMP is not a centralised application service;
it serves as a mechanism for the matching of applicants to programmes in order
of preference of both parties. However, applicants from foreign medical schools
have to apply as independent applicants. Materials about the NRMP can be
obtained from NRMP, 2450 N Street NW, #201, Washington, DC 20037 USA. Tel: 001
202 828 0566.
Visas
for Residencies or Training
All
details should be confirmed with the relevant US authorities.
J-1
Exchange Visitor Visa
This is the visa most commonly used by foreign medical graduates to
undertake postgraduate medical education. The United States Department of State
regulates the Exchange Visitor Program (EVP) and designates various
organisations and institutions as sponsors. The ECFMG is the only organisation
that is authorised to sponsor foreign national doctors to graduate medical
education. To be eligible for the EVP you must:
-
Pass Step 1
and Step 2 of the USMLE.
-
Hold a
standard ECFMG Certificate or be qualified for the certificate and awaiting
its issue.
-
Have a
contract with a residency programme that is affiliated with an accredited US
medical school or other accredited health professions school.
-
Provide a
written statement from the Ministry of Health in your country of most recent
legal permanent residence that attests to the need for physicians trained in
your speciality and that verifies that you have filed written assurance that
you will return to the country upon completion of training.
If you are
entering the US under the J-1 visa programme you are subject to a two-year home
residency rule. This means that you must return to your home country or country
of legal permanent residence for a period of two years before applying for
another visa to enter the US.
Temporary
Worker H-1B
This visa is for temporary workers in speciality occupations who hold
professional level qualifications appropriate to the employment in which they
will be engaged. H-1B employment is employer-specific and the employer must file
an H-1B petition on behalf of the doctor.
Useful Info:
Association
of American Medical Colleges (AAMC) http://www.aamc.org/
2450 N Street NW, Washington, DC, 20037 USA.
Tel: 001 202 828 0400, fax: 001 202 828 1125
Information on medical schools in the US and on the American Medical College
Application Service (AMCAS)
Educational
Commission for Foreign Medical Graduates (ECFMG) http://www.ecfmg.org/
3624 Market St., Philadelphia, PA, 19104 USA.
Tel: 001 215 386 5900, fax: 001 215 387 9963
Information on the United States Medical Licensing Exam (USMLE) and other
aspects of the certification process for foreign-qualified medical
doctors/students.
(
Source: http://www.fulbright.co.uk/eas/studyus/subjects/medicine.html )
Federation of
State Medical Boards (FSMB) http://www.fsmb.org/
National Board of
Medical Examiners (NBME) http://www.nbme.org/
Accreditation
Council for Graduate Medical Education http://www.acgme.org/
American Board of
Medical Specialities http://www.abms.org/
American Medical
Association http://www.ama-assn.org/
List of
Medical Colleges in USA
Financial AIDS
List of
Universities in America
Student Visa
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