Medical Education FAQ [1/2] (misc.education.medical FAQ) [v2.6]

Discussion in 'Health and medical' started by Eric P. Wilkins, Dec 16, 2003.

  1. Archive-name: medicine/education-faq/part1
    Misc-education-medical-archive-name: faq/part1
    Posting-Frequency: 14 days
    Last-modified: 2002/7/17
    Version: 2.6
    URL: http://www.memfaq.com/
    Maintainer: Eric P. Wilkinson, M.D. <[email protected]>

    Welcome to the misc.education.medical Frequently Asked Questions list (FAQ), also known as the
    Medical Education FAQ. This article answers questions commonly asked on the misc.education.medical
    newsgroup, which discusses medical education (MD and DO training issues). It is crossposted to
    several groups with readers interested in medical education. This document should always be
    available on the World Wide Web at:

    <http://www.memfaq.com/>

    or through the hypertext FAQ archives at:

    <http://www.faqs.org/faqs/>

    The FAQ should also be available via anonymous FTP at:

    <ftp://rtfm.mit.edu/pub/usenet/misc.education.medical/>

    and is posted regularly to the following Usenet newsgroups:

    misc.education.medical soc.college.grad soc.college.admissions sci.med news.answers sci.answers
    soc.answers misc.answers

    Comments about the FAQ itself are invited and can be sent to me at <[email protected]>.
    Suggestions for improvement and corrections of inaccurate information are especially welcome. If
    you have a question that is not answered in this FAQ article, try asking it on
    misc.education.medical.

    IMPORTANT NOTE

    If you are looking for answers to questions about medical conditions or procedures, the proper
    newsgroups to read and post to are the sci.med.* groups. If you are seeking medical advice,
    consult a licensed physician. The newsgroup misc.education.medical is for discussions of medical
    education only.

    ACKNOWLEDGMENTS

    This article is not the work of one; many individuals have contributed to this FAQ. Special thanks
    go to James Bright, who maintained the "version 1" FAQ from the early days of the newsgroup in 1994
    until July 1998, and Sandeep Dave, who created the newsgroup in June 1994 and compiled the first
    FAQ answers.

    Contributors to the current FAQ include: Natalie Belle; Tim Cramm; Scott Goodman; Chris Kahn; Ryan
    Maves; Kris McCoy; Greg Nee; John Nguyen; Dave Russo; Eric Wilkinson; and Timothy Wu.

    DISCLAIMER

    This article is provided as is without any express or implied warranties. While every effort has
    been taken to ensure the accuracy of the information contained in this article, the maintainer and
    contributors assume no responsibility for errors or omissions, or for damages resulting from the
    use of the information contained herein.

    ------------------------------

    Subject: 0. Contents

    1) The Journey to Medical School -- Before Applying

    1.1) What is an MD?
    1.2) What is a DO?
    1.3) What are the prerequisites for medical school?
    1.4) What is the MSAR?
    1.5) State school or Ivy League for undergrad?
    1.6) Which major should I choose?
    1.7) Is admission to medical school competitive?
    1.8) Do I have to do research?
    1.9) Do I have to have clinical experience?
    1.10) How old is too old?
    1.11) How high does my GPA need to be?
    1.12) I completed college without finishing the pre-med requirements, and I want to apply to
    medical school. What do I do now?
    1.13) What are some good sources of information about medical school and medicine?

    2) The MCAT

    2.1) What is the MCAT?
    2.2) How important is the MCAT in the admission process?
    2.3) What material is on the MCAT?
    2.4) When should I start studying for the MCAT?
    2.5) How should I study for the MCAT?
    2.6) Should I take a review course?
    2.7) Can you tell me about Stanley Kaplan vs. Princeton Review?
    2.8) Are there any other options for review courses?
    2.9) When should I take the MCAT?
    2.10) Does it matter whether I take the MCAT in April or August?
    2.11) What is a good MCAT score?
    2.12) Are different sections of the MCAT more or less important than other sections?
    2.13) My MCAT score was not stellar. Is it advisable to take the MCAT twice? Three times?
    2.14) Should I go ahead and apply with my current MCAT score, or should I wait until I take the
    test again?
    2.15) How do medical schools interpret multiple MCAT attempts?
    2.16) I heard that you can take the MCAT as "practice" but not have your score count. I could
    use the practice; is this a good idea?
    2.17) Can I decide not to release my MCAT scores and then later decide to release them after I
    have seen my score?

    3) Applying to Medical School

    3.1) What is the timeline for admissions?
    3.2) Where can I find a list of medical schools?
    3.3) What is AMCAS/AACOMAS?
    3.4) How many schools should I apply to?
    3.5) Which schools should I apply to?
    4.5a) What are good sources to help me choose?
    4.1) How expensive is it to apply?
    5.6a) Is there any way to make the application process cheaper?
    5.1) Should I apply to DO schools?
    5.2) What is a secondary/supplementary?
    5.3) What is an MD/PhD program?
    6.9a) What are the different sources of funding for MD/PhD programs?
    6.1) Should I enroll in a combined BS/MD program?
    6.2) What are combined MD/MPH and DO/MPH programs?
    6.3) Can you tell me about combined MD/MBA programs?
    6.4) Can you tell me about combined MD/JD programs?
    6.5) What are PAs?
    6.6) Should I consider going to a foreign school?

    7) The Interview Process

    7.1) How can I prepare for my interview?
    7.2) What should I wear to the interview?
    7.3) Should I bring anything to the interview?
    7.4) What will I be asked?
    7.5) "Why do you want to be a doctor?"
    7.6) What questions should I ask?
    7.7) Should I do anything after the interview?
    7.8) What does "waitlisted" mean? What does "hold" mean?
    7.9) What if I don't get accepted?
    7.10) How should I choose what school to go to?
    7.11) What should I do during the summer before medical school?

    8) Medical School Curricula

    8.1) How long is medical school?
    8.2) What classes are there in medical school?
    8.3) How are students graded/evaluated in medical school?
    8.4) What are "rotations"?
    8.5) What are the "must have" textbooks?
    8.6) What is PBL?
    8.7) Is there any free time in medical school?
    8.8) What is the USMLE?
    8.9) What is a good USMLE score?
    8.10) What is AOA?

    9) Paying for Medical School

    9.1) How expensive is medical school?
    9.2) How can I pay for medical school?
    9.3) Can you tell me about Armed Forces scholarships?
    9.4) Can you tell me about Public Health Service scholarships?
    9.5) Can I really borrow more than $10K/yr in Unsubsidized Stafford Loans?

    10) Residency and Beyond

    10.1) What are the different medical specialties?
    10.2) What is a residency?
    11.2a) What is an internship?
    12.2b) What is a "preliminary" year? A "categorical" year?
    12.1) What is the Match?
    12.2) What is the NRMP?
    12.3) Are there specialties that don't use the NRMP?
    12.4) What is a fellowship?
    12.5) How many hours do interns/residents work?
    13.7a) Aren't there limits on this?
    13.1) What does "board certified" mean?
    13.2) What does FACP/FACS/FACOG/etc. mean?
    13.3) What is an IMG/FMG?
    13.4) What is the ECFMG? The CSA?
    13.5) What is CME?

    ------------------------------

    Subject: 1. The Journey to Medical School -- Before Applying

    13.6) What is an MD?

    An MD, or Doctor of Medicine, most simply is a person who has graduated from a medical school. An
    MD can have many and varying roles in the community. First, an MD is a caregiver, a person turned
    to by members of the community in times of physical, psychological or emotional weakness. MDs
    treat not only the body but also the mind and the spirit, often delving into the emotional,
    psychological or social reasons behind a physical illness. MDs treat people in inpatient settings,
    in the operating room, outpatient clinics, and in emergency room visits.

    Not all MDs, though, deal with patients in such a direct manner. Pathologists deal with diseased
    tissues taken from the patient as well as clinical laboratory and blood bank settings.
    Radiologists deal with images of the patient produced and enhanced by various imaging
    technologies. Some MDs choose to concentrate their efforts solely on research, developing new
    equipment, vaccines, drugs, or discovering the underlying causes of disease. MDs can devote their
    time to teaching, both in a classroom setting (in a medical school, for example) and in the
    community (teaching preventive methods to community members, teaching CPR or first aid, or
    administering vaccines).

    Becoming an MD opens up to you a vast number of possibilities for using your medical training. MDs
    serve the community in many more ways than just seeing patients, prescribing drugs, or performing
    surgery. If you say to yourself, "I'm not a people person, so I'd make a lousy doctor," keep in
    mind that there are ways to use your interest in medicine to benefit the community without seeing
    patients on a day-to-day basis.

    13.7) What is a DO?

    Doctors of Osteopathic Medicine (DOs) are the legal and professional equivalents of Doctors of
    Medicine (MDs). They are licensed to practice medicine in all 50 states and use all conventionally
    accepted therapeutic modalities such as surgery, radiology, and drugs. They are eligible to enroll
    in all federal programs, managed care and insurance plans, serve as commissioned medical officers
    in all branches of armed services, and serve as public health officers, coroners, insurance
    examiners, and team physicians. In other words, they practice complete medicine and surgery. Only
    DOs and MDs can do this.

    DOs represent about 5% of the country's physicians and provide care for approximately 10% of the
    patients. This is because higher proportions of osteopathic medical graduates enter into primary
    care residencies after graduation compared to their MD counterparts.

    Andrew Taylor Still, MD founded osteopathic medicine in the late 1800's in response to what he
    thought was poor medical practice at that time. He based osteopathic medicine on the following
    principles:

    14) The structure of the body and its functions work together, inter-dependently.

    15) The body systems have built-in repair processes which are self-regulating and self-healing in
    the face of disease.

    16) The circulatory system provides the integrating functions for the rest of the body.

    17) The musculoskeletal system contributes more to a person's health than only providing
    framework and support.

    18) While disease may be manifested in specific parts of the body; other parts may contribute to
    a restoration or a correction of the disease.

    The preparation and training of DOs is nearly identical to the training of MDs. Admission
    prerequisites and curricula are very similar. DOs can sit for the MD boards if they are interested
    in pursuing a MD residency after graduation.

    The primary difference in their education is that DO students complete an additional 200-300 hours
    of training in osteopathic manipulative medicine (OMM). OMM is a modality used primarily to treat
    musculoskeletal problems and overlaps in its scope with physical therapy and manual medicine
    techniques. Also, DO schools place more emphasis on producing primary care physicians than do some
    MD schools. This means that during their clinical years, students at DO schools spend more time
    rotating through primary care specialties such as family medicine, pediatrics, obstetrics and
    gynecology, internal medicine, and psychiatry. Nevertheless, specialty training isn't out of the
    question for DOs. Many DOs seek and obtain residencies in surgical and non-surgical specialties.

    For more information, see the American Association of Colleges of Osteopathic Medicine at
    <http://www.aacom.org>.

    18.1) What are the prerequisites for medical school?

    All medical schools require a baccalaureate (BA, AB, BS, or equivalent) degree, with rare
    exceptions. The usual course prerequisites for both MD and DO schools are:

    1 year of Biology or Zoology (with lab) 1 year of Inorganic Chemistry (with lab) 1 year of
    Organic Chemistry (with lab) 1 year of Physics (with lab)

    Some schools require english, humanities, calculus, or biochemistry as well. Check the book
    "Medical School Admission Requirements" (cf
    18.2) for each school's particular requirements.

    The one year of Physics need not be calculus-based, although many colleges offer only the calculus-
    based class.

    There is disagreement over whether prerequisites may be taken at community or junior colleges. To
    be sure, contact the individual schools to which you plan to apply.

    Many students finish their undergraduate degrees without completing the medical school
    prerequisites. Some of these students choose to take the courses at their local public college or
    university, while others enroll in more formal "post-baccalaureate" programs, where the classes
    are taken full-time over approximately a year.

    18.3) What is the MSAR?

    The book "Medical School Admission Requirements," or "MSAR," is often considered the premedical
    student's "bible." Published by the Association of American Medical Colleges (AAMC), it contains
    information on premedical requirements for each of the MD schools in the US and Canada, as well as
    information and statistics about admissions, financial aid, and minority student issues. Many
    questions not answered in this FAQ will be answered in the MSAR. It is revised each April, so make
    sure you get the most recent edition. You should definitely get this book if you are considering
    medical school. You can buy a copy at your local college bookstore, from an online bookstore, or
    direct from the AAMC at: <http://www.aamc.org/publications/resources.htm>.

    18.4) State school or Ivy League for undergrad?

    In general, whether you attend a well-known school or a relatively invisible school is not
    important. What is important, however, is doing well at whichever school you decide to attend. One
    thing you may want to keep in mind is that doing well at a prominent institution goes a lot
    farther than doing well at a lesser-known state college. Choose what you are most comfortable
    with, not what you think the medical schools want to see.

    18.5) Which major should I choose?

    According to the Association of American Medical Colleges, a premedical student may select any
    major he or she chooses, provided that he or she completes the prerequisites for medical study (cf
    18.6). The most important thing is to select a major you enjoy, as this would allow you to master
    the subject. Medical school admissions committees want to see students who master their major
    fields of concentration in college, and many medical schools enjoy receiving applications
    from students who have studied areas outside of the sciences. Acceptance statistics broken
    down by major are provided in the MSAR (cf. 1.4).

    18.7) Is admission to medical school competitive?

    Medical school admissions has always been competitive, as there are always more applicants than
    there are seats. In recent years, however, admissions has become even more competitive as the AAMC
    has logged a record increase in applications which hit a peak of approximately 45,000 applications
    during the 1995-1996 cycle, which represents a ratio of about 3 applicants for every medical
    school seat. Since then the number of applications filed has slowly declined.

    18.8) Do I have to do research?

    Absolutely not, but doing research does help to demonstrate analytical skills in scientific
    investigation which are helpful for practicing physicians. There are many medical students who
    have never stepped inside a lab outside the prerequisite lab courses, but at the same time, many
    people feel that with increased competition for medical school seats, research experience is a much-
    needed notch on the applicant's belt.

    18.9) Do I have to have clinical experience?

    Gaining clinical experience as a premedical student is rather important as it can show that your
    decision to want to go to medical school is well-rooted, and not coming out of left field. Gaining
    clinical experience, however, means different things to different people. Simply volunteering at
    your local hospital may not be sufficient, as these volunteer opportunities often have you do
    tasks very unrelated to medicine (e.g. filing, faxing, copying). Look for "Health Career
    Opportunity Programs," or other such internships designed for premedical students, so that your
    valuable premedical time is not wasted in a second-rate program. If your school has a "premedical
    internship" program, take advantage of it.

    18.10) How old is too old?

    It may not be too late. Students in their 30s and 40s are admitted to many medical schools.
    Anecdotes about students in their 50s have been posted on misc.education.medical. When making
    your plans, keep in mind that the shortest amount of time from entering medical school until
    exiting the shortest residency (general internal medicine, general pediatrics, or family
    practice) is 7 years.

    18.11) How high does my GPA need to be?

    Perhaps every premedical student has heard tales of the 3.9 GPA Phi Beta Kappa applicant getting
    into every medical school he or she applied to, and of the 2.5 GPA student applying to medical
    school without a prayer, but there is a little more to the GPA issue than just getting above a
    certain mark. GPAs will vary depending on the competitiveness of your school, so if you attend a
    world-renowned institution such as Harvard, your GPA will be calculated based on competition with
    an intense student body.

    If you attend Acme State University, where there is a major in bartending, your GPA will be
    calculated based on competition with a slightly less intense student body. Generally, however, a
    2.3 at Harvard is still pretty bad and probably not as good as a 4.0 at Acme State, and we can
    guess that perhaps the Harvard student is not going to get into medical school. So what are the
    generalities we should look at when determining whether our GPAs are good enough for medical
    school? Some premedical advisors say that if your GPA is
    19.3 at a good school, you have a 20% chance for admission. Others will say having a 3.5 to 3.6 is
    the requisite GPA, but if you keep it as high as you can, you should have no problem (so try to
    keep it above 3.3!).

    19.1) I completed college without finishing the pre-med requirements, and I want to apply to
    medical school. What do I do now?

    There are a couple of options. You can enroll at a local college or university as a non-degree
    student and simply take the prerequisites. Additionally, you might consider enrolling in a formal
    post-baccalaureate pre-medical program offered by many of colleges and universities in response to
    an increasing number of students changing careers into medicine. A comprehensive list of "post-
    bacc" pre-med programs can be found at <http://www.aamc.org/students/considering/postbac.htm>.

    19.2) What are some good sources of information about medical school and medicine?

    RECOMMENDED AUTHORS OF BOOKS ABOUT MEDICINE

    Lewis Thomas, MD Sherwin Nuland, MD David Hilfiker, MD Perri Klass, MD Oliver Sacks, MD Robert
    Marion, MD David Ewing Duncan

    BOOKS ABOUT MEDICAL SCHOOL ADMISSIONS

    There are many books on this subject (too many to list), and quality varies widely. For an
    exhaustive list, try doing a search on "medical school" at an online bookstore.

    DOCUMENTARY

    The PBS television show NOVA aired a documentary about the training of seven medical students at
    Harvard Medical School, following them from anatomy lab through residency. Highly recommended.
    "MD: The Making of a Doctor" may be ordered from WGBH-Boston, item #WG2207, by calling 1-800-255-
    9424. It costs $19.95.

    An update on the "Making of a Doctor" physicians was recently completed, called "Survivor MD." It
    is a 3-hour special and can be ordered from WGBH at the number above for $29.95.

    WEB

    "Official" sites on the World Wide Web (many of these are referenced at other points in the FAQ):

    Association of American Medical Colleges (AAMC) <http://www.aamc.org> Liaison Committee on
    Medical Education (LCME) <http://www.lcme.org> National Board of Medical Examiners
    <http://www.nbme.org> Federation of State Medical Boards <http://www.fsmb.org> United States
    Medical Licensing Examination (USMLE) <http://www.usmle.org> American Association of
    Colleges of Osteopathic Medicine (AACOM) <http://www.aacom.org> American Medical Association
    (AMA) <http://www.ama-assn.org>

    USENET

    The Usenet newsgroup for discussing medical school and medical education is
    misc.education.medical. Medicine is discussed in the sci.med.* hierarchy of newsgroups.

    ------------------------------

    Subject: 2. The MCAT

    19.3) What is the MCAT?

    The Medical College Admissions Test, or MCAT, is the standardized admissions test required by
    nearly all U.S. medical schools (some combined BS/MD programs that accept students directly from
    high school do not require the MCAT). The test consists of four sections: Verbal Reasoning (scored
    1-15), Physicial Sciences (scored 1-15), Biological Sciences (scored 1-15), and an essay section
    (scored J-T, with T being the highest). The test takes one long Saturday to complete and is
    offered twice a year, usually in mid April and in late August. Official information about the
    MCAT, including registration information, may be obtained online from the Association of American
    Medical Colleges (AAMC), at <http://www.aamc.org/students/mcat/start.htm>.

    19.4) How important is the MCAT in the admission process?

    The MCAT is very important. A high MCAT score by itself will not get you into medical school, but
    a low MCAT score may keep you out. Unfortunately, an otherwise qualified applicant may not even be
    granted an interview if his or her MCAT scores are not high enough. Once an interview is granted,
    each applicant is evaluated individually in determining acceptance or rejection. In most cases the
    MCAT still is just as important as other parts of the application in making the final decision.

    19.5) What material is on the MCAT?

    The official MCAT registration materials include a syllabus that spells out the subject matter
    tested in detail. Below is a summary:

    * The verbal reasoning test is virtually identical to similar tests found on other standardized
    exams (such as LSAT, GRE, or even SAT), except it typically contains two or three science-
    oriented passages.

    * The essay section consists of two timed half-hour essays. In each essay you are asked to
    interpret an open-ended ambiguous statement.

    * The physical sciences test covers inorganic chemistry and physics. One full year (two
    semesters) each of inorganic chemistry and physics sufficiently covers all the tested material.

    * The biological sciences test covers a variety of biology topics (about 50% of test) and organic
    chemistry (about 50% of test). One full year of organic chemistry plus lab is sufficient to
    cover the organic chemistry material on the MCAT.

    19.6) When should I start studying for the MCAT?

    Nearly all students require at least two months of regular review to cover all the necessary
    material. Many students require longer. However, preparation really begins as soon as you start
    college--by doing your best in your undergraduate science courses and reading broadly to prepare
    for the verbal reasoning section. You can then spend the final 2 or 3 months reviewing and
    solidifying the information you have already learned. It is unlikely that you will learn and
    understand a lot of new material in the final months leading up to the MCAT.

    19.7) How should I study for the MCAT?

    Basically, whatever study methods have served you well in the past should also help you prepare
    for the MCAT. For example, if you read your textbooks heavily in class, then review your
    textbooks. If you used study sheets or notecards in your classes, then review those. A few
    other tips:

    * It is important to be quite disciplined and to make the time necessary for review. Most pre-
    medical students find they don't have the time for MCAT review unless they make a concerted
    effort to make the time.

    * For more structured review, consider buying a review book (such as the Kaplan MCAT
    Comprehensive Review with CDROM, edited by Rochelle Rothstein) or taking a review course
    (see below)

    * No matter what you do, take lots of timed practice tests. Practice MCAT tests are available
    directly from the AAMC, in any book store, or through review courses.

    19.8) Should I take a review course?

    That depends. If you are overwhelmed by the thought of MCAT review, and if you like structure and
    learn well in a classroom environment, then a review course is not a bad idea. When used properly,
    review courses are an expensive, effective way to prepare for the MCAT. They offer structured,
    comprehensive review, teacher-student interaction, numerous practice tests and test- taking
    strategies, and comprehensive, well-written review materials. However, do not enroll in a review
    course just for the materials. Equally good materials (such as the Kaplan Comprehensive Review,
    cf. 2.5) may be purchased in the bookstore for a whole lot less money.

    19.9) Can you tell me about Stanley Kaplan vs. Princeton Review?

    Stanley Kaplan <http://www.kaplan.com> and Princeton Review <http://www.review.com> are the two
    largest standardized test review companies in the United States. Opinions differ as to which
    company offers a better review course for the MCAT. Traditionally, the Kaplan course focused more
    on detail and offered more review materials, while the Princeton Review course focused more on
    "the big picture" and offered more student-teacher interaction. However, Kaplan has recently
    decreased its class-size, and Princeton Review recently increased the amount and detail-level of
    materials offered. Today the two courses really are more similar than they are different. The
    biggest factor in determining the quality of either course is the quality of its teacher. If you
    want to take a review course, it helps to ask around locally to see which courses have a better
    reputation in the local area.

    19.10) Are there any other options for review courses?

    Yes. Many colleges offer structured review courses for the MCAT. Ask your local pre-med advisor
    for details. Also, if you happen to live in California, MCAT review courses offered by the
    Berkeley Review <http://www.berkeley-review.com> have an excellent reputation.

    19.11) When should I take the MCAT?

    You should take the MCAT at least one year prior to the date you wish to begin medical school.
    However, do not take the test until you have completed the necessary pre-requisite courses: one
    year each of biology, inorganic chemistry, organic chemistry, and physics. Many students take the
    April MCAT while they are concurrently taking prerequisite courses (usually Physics II, Organic
    Chemistry II, and/or an advanced biology course). This is not a bad strategy: virtually all of the
    material tested on the MCAT will already be covered by the time April rolls around -- and the
    material should be fresh in your mind, since you have just learned it.

    19.12) Does it matter whether I take the MCAT in April or August?

    If you are prepared for the exam, it's probably best to take it in April. Taking the test earlier
    allows you to complete your application early in the season--and the earlier you submit your
    application, the better. Also, If you are applying under an early decision program, you *must*
    take the April MCAT of that year (or any time prior) so that test scores are available in time for
    early interviews. Of course, there is also an advantage to taking it in August: it allows you more
    time to study. You can take the exam in August and still apply for the same application season,
    but you'll be running a tight time-schedule. Keep in mind that it takes approximately 8 weeks for
    scores to get back to the schools.

    19.13) What is a good MCAT score?

    Traditionally a good score is "double digits" (10 or better) on each test, and a score of at
    least "N" on the essay. You can get into medical school with lower scores, depending on the rest
    of your application and on the medical school. For your state medical school, a total score of 27
    or higher, with no individual score less than 8, is probably sufficient. It is important to have
    a well balanced MCAT score, with no individual score markedly lower than the rest of the test.
    For example, a score of 8,8,8 (total 24) is generally considered superior to a score of 10,10,5
    (total 25).

    19.14) Are different sections of the MCAT more or less important than other sections?

    Yes. The essay section is less important than the other sections. Your essay score is impressive
    if it is extremely high (S or T) and is detrimental if it is extremely low (J or K). However, any
    score in between has little or no impact on your application. Be sure to demonstrate your writing
    abilities to medical schools by composing a well-written personal statement essay.

    19.15) My MCAT score was not stellar. Is it advisable to take the MCAT twice? three times?

    Yes--as long as you improve your score! Taking the MCAT multiple times is only helpful if a
    significant score improvement is reflected in each attempt. However, it is preferrable to study as
    hard as possible and be prepared so that you do an excellent job on your first attempt. Who wants
    to take this test multiple times, anyway?

    19.16) Should I go ahead and apply with my current MCAT score, or should I wait until I take the
    test again?

    If you received greater than 27 on your first attempt, it is advisable to apply with your current
    score and not take the test again. If you received less than 24, you should probably take the test
    again, prepare harder next time, and try to improve your score. The range of 24-27 is a grey zone:
    whether to take the test again depends on the rest of your application and on where you are
    applying. Note that these are just guidelines. You must consider your own individual situation to
    arrive at a final decision. Also
    note: if you take the MCAT in April and are dissatisfied with your scores, you can go ahead an
    apply anyway and still retake the test in August for the same application year. It's better
    to submit your application early than to submit it in the fall.

    19.17) How do medical schools interpret multiple MCAT attempts?

    Medical schools consider them favorably, as long as you improve your score. Most medical schools
    will consider the highest overall MCAT score in evaluating your final application.

    19.18) I heard that you can take the MCAT as "practice" but not have your score count. I could use
    the practice; is this a good idea?

    No. At the end of the exam, you must decide whether or not to release your scores. It is almost
    always advisable to have your scores released. The only good reason not to release scores is if
    you know you did poorly by some fluke; for example, if you filled in all the bubbles incorrectly.
    Deciding not to release your scores on a whim is not advisable.

    19.19) Can I decide not to release my MCAT scores and then later decide to release them after I have
    seen my score?

    Yes, however, medical schools will be informed that you originally did not release your scores and
    later decided to release them. This allowance is actually a new rule recently instituted by the
    AAMC. Because the rule is new, it is unclear how medical schools will view an MCAT score that was
    originally not released. Common sense says that medical schools will not view this favorably, and
    that it is not a good idea to exercise this option.

    ------------------------------

    Subject: 3. Applying to Medical School

    19.20) What is the timeline for admissions?

    AMCAS (cf 3.3) begins accepting applications on June 1. After receiving your application and
    school transcripts, you will receive a Transmittal Notification from AMCAS, which means that
    schools have been sent your central application. After evaluating your application, schools can
    choose to have you continue the process by completing a supplementary application (cf 3.8) and
    after further evaluation, an interview (cf Section 4). Some schools are on a "rolling admissions"
    system where applicants can hear about an admissions decision fairly soon after interviewing.
    Other schools wait until late in the season to send decision letters. More information can be
    found in the MSAR (cf 1.4), the AMCAS application materials, and school admissions brochures.

    19.21) Where can I find a list of medical schools?

    The MSAR (cf 1.4) has a list of all of the medical schools in the US and Canada accredited by the
    Liaison Committee on Medical Education
    (LCME) <http://www.lcme.org>. On the Internet, you can find this same list at
    <http://www.aamc.org/meded/medschls/start.htm>.

    3.3) What is AMCAS/AACOMAS?

    AMCAS, the American Medical College Application Service, is a centralized program which works much
    like the "Common Application" that you may have seen in high school (for applying to college). Run
    by the Association of American Medical Colleges (AAMC), it consists of a form you fill out like an
    application, which is sent to AMCAS, processed, and then distributed to those medical schools you
    wish to apply. In the past several years a computer-based version, AMCAS-E, has been developed.
    See the AMCAS web page at <http://www.aamc.org/students/amcas/start.htm>. AACOMAS, the American
    Association of Colleges of Osteopathic Medicine Application Service, is a similar service for
    osteopathic medical programs run by the AACOM <http://www.aacom.org>.

    3.4) How many schools should I apply to?

    Depends. If you're 4.0 and 40+ on the MCAT, then probably you could apply to only one or two and
    get away with it. There are stories of people who applied to 50 or 60 schools and didn't get into
    any. Most people apply to around 10, more if they feel their folder is a little weak, less if they
    think they've got a pretty solid record.

    3.5) Which schools should I apply to?

    Your best bet is to think about where you'd like to go to school and apply there. Remember:
    Wherever you go, not only will you be spending the next 4 years there, but also the odds are
    pretty good that you will do your residency there as well. So don't pick someplace you'd never
    want to live. Always apply to your state school, if you have one; most (if not all) state schools
    give preference to people who are state residents, and every little bit of help counts. You should
    have 2-3 schools that are a real stretch--places you don't think you could get in to but places
    you'd love to go. Try to find 1-2 places that you think you have an excellent shot at; your state
    school usually goes here. And in the middle, 6 (or more) places that you think you'd be
    competitive at. Finally, don't discount D.O. schools (cf 3.7).

    4.5a) What are good sources to help me choose?

    Your primary source should be your college's pre-medical advisor. Make an appointment with him/her
    early on--sophomore or junior year would be best. Make sure he/she pulls your transcripts, etc.
    before you show up. The two of you can talk about your strong and weak points, what you could do
    to boost your chances, and which schools you should apply to. Also keep in mind that most pre-
    medical advisors send a letter along with your applications, so getting to know him/her will help
    get a more accurate letter for your file.

    The Internet is a good source. Most medical schools have web sites that give lots of information,
    application requirements, etc. In addition, post any questions, concerns, fears, or despairs to
    the misc.education.medical Usenet group. It's populated by lots of grizzled veterans who have been
    through this process (sometimes more than once) and can help you avoid the pitfalls.

    Another essential source is the MSAR (cf 1.4).

    4.1) How expensive is it to apply?

    The AMCAS fee is about $45 for the first school, and $25 for each additional school. When your
    AMCAS is processed, most schools will request "supplementary" information, and filing this
    will cost an additional $60-$125. The AACOMAS fee is practically the same, and the cost for
    filing supplementary materials at osteopathic medical schools is also anywhere from $60 to
    $125. Add in costs for the MCAT, flying to schools for interviews, hotels, and other expenses,
    and the total application cost can rise into the thousands of dollars depending on how many
    schools you apply to.

    5.6a) Is there any way to make the application process cheaper?

    You can request from AMCAS a fee waiver, which covers the cost of AMCAS filing and supplementary
    filing fees for up to 10 medical schools. Fee waivers are based on financial need, and many
    schools will waive their supplementary application fee (cf 3.6) if you have an AMCAS fee waiver.
    The MCAT also offers a fee waiver program.

    5.1) Should I apply to DO schools?

    Osteopathic medical schools have a reputation for "looking past the numbers" in their admissions
    process. Consequently, the average accepted MCAT scores and GPA are a bit lower at DO schools. If
    you're an academically borderline candidate, but have a competitive application overall, your
    chances for admission might be higher at DO schools. Because most DO schools emphasize primary
    care medicine, they look very closely at an applicant's motivation for pursuing medicine and prior
    life experience. The average age of matriculation tends to be higher at DO schools than MD
    schools. Students who want to practice an osteopathic approach to patient care are especially
    sought after; this means demonstrating an interest in hands-on medicine and a commitment to a
    holistic understanding of patient care issues, especially time spent with a
    DO.

    There are two important points to consider if you're thinking of applying to DO schools. First,
    DOs are minority physicians in the profession of medicine. If you are uncomfortable being
    different, think that you'll always have to prove something because you're not an MD, or are
    likely to become frustrated having to explain what a DO is to new patients, then DO schools might
    not be right for you. Second, you might have a harder time competing for some of the "brand-name"
    MD residencies. Many competitive MD residencies don't regard the additional training DO students
    receive as applicable to their particular area of medicine, and with keen competition for slots
    among MD applicants, they feel obliged to take their own first. There are DO specialty residencies
    in everything ranging from aerospace medicine to otolaryngology, but these residencies tend to be
    concentrated in the eastern and mid-western United States. Some students find the geographic
    limitations of these residencies unattractive.

    In short, some students have compared the kind of medical education DO schools offer to the kind
    of undergraduate education that smaller liberal arts colleges offer. Both stress generalist skills
    and training. Like the smaller undergraduate colleges, the research programs at DO schools tend to
    be smaller. Consequently, the basic science faculty is usually more professionally involved in
    medical education than research. However, it is difficult to make accurate generalizations because
    there is much variety in curricular programs offered by both MD and DO schools. There are primary
    care oriented MD schools and research oriented DO schools. The most prudent advice is to look at
    the curriculum and educational focus of each medical school on a case by case basis.

    3.8) What is a secondary/supplementary?

    Secondary (also called supplementary) applications come in a variety of forms and typically are
    utilized only by schools using the AMCAS application (MD programs), or schools using the AACOMAS
    application (DO programs) rather than their own application. Depending on the school, they may
    request no more than a check and signature to complete processing of your application, or they may
    ask you to provide additional information such as SAT scores and respond to several essay
    questions.

    A number of schools "screen" applicants prior to sending secondary applications. This means that
    based on information (essay, biographical data, MCAT scores and GPA) provided by the applicant's
    AMCAS or AACOMAS application, the school decides whether or not to send a secondary application to
    the applicant. Screening of applications at the secondary stage is not done by all schools; many
    schools have all applicants complete all application materials and then decide who to interview
    based on information contained in the primary and secondary applications.

    Information on application fees and whether a school uses secondary applications may be found in
    the MSAR (cf. 1.4).

    3.9) What is an MD/PhD program?

    Students that are enrolled in combined MD/PhD programs pursue the MD and the PhD degrees
    concurrently. Students can select from a number of fields in which to complete the PhD. Although
    this field is typically a biomedical science (e.g., biochemistry, immunology), students in the
    past have combined their medical studies with research in engineering and the humanities. Combined
    programs typically require 7-9 years to complete. The first two years are typically spent on the
    basic science portion of the M.D. curriculum. The next three to five years are spent on full time
    PhD work. The final two years of the combined program are spent on the clinical portion of the MD
    curriculum. MD/PhD programs are eclectic by nature, however, and the course of study can be very
    individualized.

    Combined MD/PhD programs were initiated to train a cadre of academic medical scientists who could
    make fundamental scientific discoveries and then translate these discoveries into tools and
    knowledge that could be used at the bedside. It is important to note that "doing it all", from the
    lab bench to the patient bedside, is extremely difficult. Both caring for patients and running a
    research program are full time jobs in and of themselves! Most MD/PhDs focus on either lab
    research or patient care to stay abreast of their fields and to remain competitive with their
    peers. With that caveat, however, MD/PhD training has some benefits.

    Some good reasons to pursue an MD/PhD

    - You want to focus on clinical research and practice, but would like rigorous research training
    - You want to focus on research, but want the perspective provided by clinical training

    Bad reasons to pursue an MD/PhD
    - You want extra letters after your name
    - You want to save money (in the long run, you probably won't!)

    Ultimately, the decision to pursue an MD/PhD is a personal one. Think about the career goals you
    envision for yourself and whether they can be achieved with a single degree. Consider talking with
    MD/PhDs who have careers similar to that which you envision for yourself. Information on programs
    may be found at <http://www.aamc.org/research/dbr/mdphd/programs.htm>.

    3.9a) What are the different sources of funding for MD/PhD programs?

    4. Medical Scientist Training Program (at official NIH MSTP schools)
    5. Other NIH funds (e.g., Human Genome Training Grant)
    6. School-Specific Funds (e.g., Franklin's scholars program at UPenn)
    7. Funds from special interest groups (e.g., funds for the study of alcoholism)
    8. Howard Hughes Medical Institute Funds

    8.1) Should I enroll in a combined BS/MD program?

    BS/MD programs, or, more appropriately, college/MD programs, allow a high school student to apply
    to both college and medical school during the college application process. If accepted, the
    student is assured a place in a medical school class, assuming she performs at an acceptable
    level. While many of these programs only allow specific majors, some will allow any major,
    including those which award the BA.

    Thirty-six of these programs currently exist all across the United States, in sixteen states and
    the District of Columbia. Program length generally varies from six to eight years, although the
    University of Wisconsin-Madison does allow extension to nine years. Admissions guidelines vary
    widely. Some schools specifically state entrance requirements (e.g., the University of Medicine
    and Dentistry at New Jersey (Newark) expects that their applicants will be in the top five to ten
    percent of their class with a minimum combined SAT of 1400). Most schools require program students
    to take the MCAT during their junior year of college. Many require particular SAT II/Achievement
    tests, particularly those in chemistry and mathmatics.

    In essence, these programs are appropriate for the student who has already explored the field of
    medicine and is positive that it is appropriate for him. While admissions criteria vary widely,
    they all insist that the student be academically superior. As not all programs allow students to
    leave once they have matriculated into the program, the student must be sure that medicine is the
    right choice; those with any doubts are advised to consult their college or guidance counselor
    and consider applying to medical school "normally" in college if they then decide it is the
    correct choice.

    For more current information about combined college/MD programs, browse the Association of
    American Medical Colleges' web site at
    <http://www.aamc.org/students/applying/programs/collegemd.htm>. Students may also wish to read the
    AAMC's guide for high school students considering medical careers at
    <http://www.aamc.org/students/start.htm>.

    8.2) What are combined MD/MPH and DO/MPH programs?

    MPH stands for Masters in Public Health. Public health is an interdisciplinary science of disease
    prevention. Physicians who work in public health are called preventive medicine specialists. The
    MPH is the professional degree for those interested in a career in public health or preventive
    medicine; MPH degree programs usually require approximately 50 additional semester hours of
    coursework in areas such as biostatistics, epidemiology, health behavior, and health economics.
    Many programs offer opportunities for specialization in areas such as toxicology, environmental
    health, epidemiology, and health administration.

    It is not uncommon for medical schools to offer dual degree programs for medical students seeking
    public health training. This may add an additional year or two onto medical school. Usually
    students in dual degree program complete the first two years of medical school and then proceed to
    their MPH work before finishing the last two years, though some break up school between the third
    and fourth years. Some programs allow students to take MPH classes in addition to their medical
    school classes to shorten the length of the program.

    For more information, see the web sites for the American College of Preventive Medicine
    <http://www.acpm.org> and the American Public Health Association <http://www.apha.org>.

    8.3) Can you tell me about combined MD/MBA programs?

    Ten schools offer the combined MD/MBA program. They are: UCLA,
    U. of Chicago-Pritzker, U. of Illinois at Urbana-Champaign, Dartmouth, Wake Forest, Case Western,
    Allegheny, Jefferson, U of Pennsylvania, and Vanderbilt. This list of schools, with direct
    links to them, can be found at <http://www.aamc.org/students/applying/programs/mdmba.htm>. Many
    programs run as two years of medical school, one year of graduate (MBA) school, then a return
    to medical school for the final two years of medical curriculum and completion of MBA material,
    for a total of five years. However, there are variances in application processes and program
    details. For example, UCLA opens its program only to third-year UCLA medical students, who then
    take a year off for the MBA program and complete the MBA program during the fourth year of
    medical school. Application procedures vary by school, so your best bet is to contact the
    admissions department directly and ask for information on the program.

    8.4) Can you tell me about combined MD/JD programs?

    Seven schools offer the combined MD/JD program. They are: Yale,
    U. of Illinois at Urbana-Champaign, U. of Chicago-Pritzker, Southern Illinois U., Duke, Penn, and
    West Virgina U. This list of schools, with direct links to them, can be found at
    <http://www.aamc.org/students/applying/programs/mdjd.htm>. Program details are highly
    variable. One common method of integrating the two programs is to have the student complete
    two years of medical school, two years of law school, then complete law school during the
    final two years of medical school for a total of six years. Applications are generally
    accepted both from first-time applicants and current students from each individual program;
    however, as always, the best information about a particular school can be obtained by
    contacting the school's admissions office.

    8.5) What are PAs?

    Physician assistants, or PAs, provide medical care under the supervision of licensed physicians.
    For information regarding the PA profession and educational programs, see the web page of the
    American Academy of Physician Assistants (AAPA) at <http://www.aapa.org>. Another resource is the
    Usenet newsgroup alt.med.phys-assts.

    8.6) Should I consider going to a foreign school?

    Attending a foreign medical school is a tricky situation. On the one hand, you have the
    opportunity of attending medical school and graduating with a M.D. degree, but on the other hand,
    your opportunities for practice in the U.S. are severely limited. Because of legislation,
    International Medical Graduates (IMGs)--students who obtain their M.D. outside the U.S.--are being
    scapegoated for the country's oversupply of physicians and their acceptance into U.S. residency
    training programs is being scaled back. This means that the IMG who does enter the US for
    residency training generally must score very high on the USMLE and the new Clinical Skills
    Assessment (CSA) examination, which is only administered to IMGs (cf 7.10, 7.11).

    The education may or may not be inferior, depending on the foreign school you wish to attend, but
    whatever the case, attending a foreign school is going to be expensive. Student aid from the U.S.
    may not be so easy to come by, and you may have to spend more time in school because of the
    difference in curricula. Take, for example, the system of medical education in Australia versus
    the United States. In the US, students go through four years of undergraduate college to earn a
    Bachelors degree and then go on for another four years in medical school for the medical degree.
    In Australia, students go into a medical program as high school graduates and earn a Bachelors in
    Medicine and a Bachelors in Surgery in six years. This means that a US college graduate who wishes
    to attend medical school in Australia will have to spend an additional two years because of the
    medical curriculum in Australia, which translates into higher costs.

    Think about your decision to apply to a foreign medical school carefully. Not all are reputable,
    and boasting a World Health Organization (WHO) listing is not at all impressive. Not all foreign
    medical schools offer a solid medical education, which of course does not preclude those that do.
    Speak to your premedical advisor and, if possible, any students at the schools that you consider.

    ------------------------------
    [end of Part 1]
     
    Tags:


  2. Archive-name: medicine/education-faq/part2
    Misc-education-medical-archive-name: faq/part2
    Posting-Frequency: 14 days
    Last-modified: 2002/7/17
    Version: 2.6
    URL: http://www.memfaq.com/
    Maintainer: Eric P. Wilkinson, M.D. <[email protected]>

    [This is Part 2 of the misc.education.medical FAQ.]

    ------------------------------

    Subject: 4. The Interview Process

    4.1) How can I prepare for my interview?

    You should do research on the school itself. Learn a little about the city it is in, the programs
    offered, grading policies, and instruction method (Problem Based Learning or traditional or
    mixed). Look at the school's information packet and their web site. If you're interested in doing
    research in a particular field during medical school, find out which faculty at the school are
    doing research in that area. The more you read about the school, the more questions you will have
    to ask your interviewer.

    In preparing for the questions you will be asked (cf 4.4), definitely consult the Medical School
    Interview Feedback Page begun by Graham Redgrave: <http://www.interviewfeedback.com>.

    4.2) What should I wear to the interview?

    Dress professionally in your style. This simply means to dress like you would if you were a
    doctor, but do not lose all of your personality (i.e. if you are a guy with long hair, don't cut
    it; if you normally have a mustache, leave it...you are not trying to produce a standard image,
    you want to be yourself).

    4.3) Should I bring anything to the interview?

    Bring a list of any questions you wish to ask (you will probably forget most of them if you try to
    memorize them). Always have a pen and paper on you. Find out what the weather will be like and
    bring a coat if necessary. Bring your application to look over between interviews.

    4.4) What will I be asked?

    This is largely dependent on the school and on the interviewer (in other words, on chance). Be
    prepared to answer questions about "defining" moments in your life--elaborating on what you do
    for fun, what your favorite activity is, what sports you play, and just about anything that
    interests you.

    Some schools still drill you though, so beware (these interviews can truly be draining). Stress
    interviews (empty rooms with phones ringing, being asked to open windows that are nailed shut) are
    very rare. If you've done research, and it's on your application, be prepared to discuss it.

    Many students have recorded their interview experiences at the Medical School Interview Feedback
    Page: <http://www.interviewfeedback.com>.

    Some commonly asked questions:

    The favorite--Tell me about yourself. Where do you see yourself in 10 years? (often asked) What
    does your family think about this? What is the biggest problem facing medicine today? What are
    the disadvantages/downsides of a career in medicine, besides no time? What are you looking for in
    a medical school? What do you think about "insert current hot topic here"? (HMO, PPO, Doctor-
    assisted suicide, ethical/moral issues of cloning, other financial issues in health care
    delivery) What field of medicine are you interested in? What do you like to do that isn't science
    related? What will you do if you do not get accepted somewhere this year? What are your
    strengths/weaknesses? And, perhaps the most popular...

    4.5) "Why do you want to be a doctor?"

    If you want to say "to help people," please just make that an introduction to a much deeper
    soliloquy! You can tie this answer to personal experiences (i.e. things you may have seen while
    working/volunteering in the medical field, or possibly an illness that you or a family member
    went through).

    The key is to come across as someone who has genuinely thought through the decision.

    4.6) What questions should I ask?

    Ask anything you want about the school. Many times faculty or students may not know the answer,
    but will be willing to find out and get back to you. A good source of questions to ask is the
    Association of American Medical Colleges' pamphlet "31 Questions I Wish I Had Asked," available at
    <http://www.aamc.org/students/applying/about/31questions.htm>.

    4.7) Should I do anything after the interview?

    Sending a thank you note is purely optional, and some consider it an outdated practice. Others
    feel that acknowledging time spent on your behalf is just common courtesy. One suggestion is to
    follow up with the admissions office, expressing your interest in the school.

    4.8) What does "waitlisted" mean? What does "hold" mean?

    The terms "wait list," "acceptance range," "hold," and any others synonymous with these all mean
    that the class was full, but you have been placed on a ranked list. If spots open up, people on
    the wait list will be moved up and offered seats in the class. In general a school will accept
    twice as many people as its class size when all is said and done. Also, even though waitlists ARE
    ranked, they do not have to pull from them in order, so if something about you really stands out
    (such as a follow up letter stating how impressed you were with the school and how much you would
    like to become part of their institution), you can increase your chances of getting in off the
    wait list.

    4.9) What if I don't get accepted?

    Try again. Trying 2 times seems to be the norm these days but after 3 times you might want to
    consider doing something else (there have been some people who have finally been accepted after
    applying 4+ times, but they are the exception rather than the norm). The most important thing to
    do is to consult each school as to why you were rejected or not taken off of the waitlist and ask
    what you can do to improve your chances. Follow their advice.

    4.10) How should I choose what school to go to?

    This depends on several factors. Important ones include location and what the school "typically"
    produces. In other words, if you want to specialize, it may not be in your best interest to go to
    a state school where most of the class goes into family practice. Financial issues are also a
    factor, as state-funded schools are often much less expensive than private schools.

    Going to a school with an established reputation may be of benefit, especially when applying for
    residencies, fellowships, and positions in academic medicine. If you feel that you may end up in
    an academic position, or are considering a very competitive specialty, you may consider going to a
    "name" school.

    If you narrow it down to two schools which are virtually identical, go to the one that feels right--
    that might be your best choice. How do the students at the school feel? Are they treated well?

    4.11) What should I do during the summer before medical school?

    Nothing at all. Take a deep breath.

    ------------------------------

    Subject: 5. Medical School Curricula

    4.12) How long is medical school?

    In the United States, medical school is generally four years in length. You spend the first
    two years predominantly in the classroom and lab, and the last two years predominantly in
    the hospital.

    4.13) What classes are there in medical school?

    The classes in medical school vary from place to place. But there are some that everyone takes in
    their first two years, no matter where they are:

    Gross Anatomy Biochemistry Pathology Behavioral Science Pharmacology Physiology
    Microanatomy/Histology Microbiology Physical Diagnosis (or some kind of intro to the patient
    class) Medical Ethics

    The amount of lab work varies from class to class and school to school, although some classes
    (like gross anatomy) feature as much lab work as you have time for.

    4.14) How are students graded/evaluated in medical school?

    Again, depends on the school. Many schools still have the standard
    A/B/C/D/F scale of grading. The rest go on the pass/fail scale or some variation of it. Many
    schools have an "honors" grade which reflects performance in an upper percentile of the
    class for that course.

    The grading scale can change as you advance in your studies. For example, some schools have letter
    grades the first two years and then pass/fail grades the last two (or letter grades the first
    three and pass/fail the last year only).

    The grades themselves are objective the first two years - based almost entirely on written exams,
    oral exams, and practical (or lab) exams. In the third and fourth years, grades depend in large
    part on evaluations by other members of your hospital team - the attending physician(s), the
    resident(s) and/or the intern(s). There are also written/oral exams in the last two years, and the
    relative importance of exams vs. evaluations varies greatly from rotation to rotation.

    5.4) What are "rotations"?

    Rotations are the blocks of time you spend on the different services in the hospital. Most schools
    have a set of required rotations and let you choose from a vast field of elective rotations to
    fill out the rest of your third and/or fourth year. The required rotations everywhere:

    Surgery Internal Medicine Psychiatry Pediatrics Obstetrics and Gynecology (Ob/Gyn)

    Generally you will spend a total of about 10 months doing these five rotations. Some schools make
    you take all required rotations in the third year, and some let you spread them out so that you
    can take electives in the third year, thereby allowing you to take some electives that may help
    you narrow down your possible choice of specialty for residency.

    There are some rotations that are required at all but a few schools:

    Family medicine Neurology Orthopedics

    A typical third year might look something like this:

    Surgery - 2 months Pediatrics - 2 months Neurology - 1 month Family Medicine - 1 month Ob/Gyn - 6
    weeks Psychiatry - 6 weeks Internal Medicine - 3 months

    As far as electives go, generally there are several ways you can go. You can take "away" rotations
    - rotations arranged to spend at other hospitals (ideally the hospitals where you think you might
    like to do your residency). Generally, schools will let you do a month or two away. When
    considering away rotations, keep the following tidbits in mind:

    6) Most residency applications are due by October or November, and most residency committees
    start making decisions on who to interview by the end of November at the very latest.
    Therefore, for an away rotation to really help you sway the people at the hospital you visit,
    it must be done in the first few months of the fourth year (keeping in mind that USMLE Step
    II is usually at the end of August of that year). September and to a lesser extent October
    tend to be the most popular months to schedule away rotations.

    7) At most schools, there are a lot of hoops to jump through to get an away rotation approved.
    You have to determine that the hospital you want to go to actually has an open slot in the
    rotation you want during the month you want to be there. Once you've gotten that info, there
    are lots of forms and signatures needed--deans and chairmen from both schools, grading
    papers, course content papers, etc. The point of all this is: once you decide to take an away
    rotation, get started on planning it because it takes a month or two to get everything
    straightened out.

    The electives you do at your home school tend to fall in these categories:

    8) Electives in what you think will be your residency specialty
    9) Electives in things you think will help you in residency (a lot of people take things like
    cardiology, radiology or emergency medicine because they provide valuable training for the
    intern year)
    10) Electives in things that interest you
    11) Electives your friends are taking
    12) Electives that are easy (generally includes things like ophthalmology, dermatology, and lots
    of odd little electives that will turn up on the list at your school; at my school we could
    do a month sitting in the blood bank drawing blood from people, or do a month learning what
    the different lab tests are and what they mean)

    12.1) What are the "must have" textbooks?

    The only absolutely essential, "must have" textbook is the "Atlas of Human Anatomy," by Frank H.
    Netter, M.D. (now in its 2nd edition). Beyond that, your textbook purchases should reflect:

    a) the recommended texts of your school - not all texts cover the same subjects to the same
    depth, and you might miss out on a professor's pet area that he loves to test heavily because
    it's so insignificant that a different book barely touches on it (thus a gentle reminder to
    try to learn what your professors consider themselves to be experts in, because those things
    will always be on the tests). Also, remember that your required texts will all be on reserve
    in the library (usually in multiple copies) - so if you really feel you need to read one
    chapter, you can always just borrow the library copy and read it.

    b) the course materials given out in each class - some classes feature thick, comprehensive
    syllabi that cover each lecture specifically and that make the purchase of an outside textbook
    pointless. And some schools have note-taking services that "can" lectures - basically giving
    you a typed transcription of the entire lecture, complete with copies of overhead materials.
    As with the syllabi, a good set of cans renders a textbook moot. Not all schools allow the
    canning of lectures, but if they are offered you should absolutely sign up and get them.

    c) your personal study preferences - how do you study best? Some people love to read the texts.
    Some people like lectures and don't read much at all. Determine where you fall in the scheme
    of things and plan your purchases accordingly. Even if a text is great (example - the Robbins
    pathology text), generally the book will be dry reading and very long, and if you are not the
    kind of person who learns well from books like that, then your money is better spent
    elsewhere.

    12.2) What is PBL?

    PBL stands for "Problem Based Learning." Basically, there are two basic types of curricula in
    medical schools today: PBL and so-called "traditional" learning. Traditional learning is the basic
    stuff you had in college--lectures and plenty of 'em, labs, classes taught as discrete entities
    (gross anatomy, pathology, pharmacology, etc.). PBL represents a more integrated way of presenting
    the materials. Lectures are kept to a minimum; instead, the emphasis is on small group learning,
    teamwork and problem solving. Groups meet and are given clinical situations in keeping with the
    current subject material. These situations can involve anatomy, pathology, pharmacology, etc. all
    at the same time. The group then solves the problems using available resources (library,
    computers, etc.) and discusses their solutions. In this way they learn the body as it is--a set of
    interrelated systems--instead of in discrete chunks.

    That said, PBL is not for everyone. Some people prefer the lectures. Some schools offer only PBL,
    some only traditional, and some give you an option of which you would prefer. Contact the schools
    you are interested in and ask them about their curricula.

    12.3) Is there any free time in medical school?

    There is as much free time as you want there to be. In spite of what you might hear, medical
    students don't study ten hours a night AND go to every lecture AND go to every lab AND read
    journals just for interest AND work on a cure for cancer. At the beginning, sure, you'll feel this
    overwhelming fear that everyone is ahead of you and you will make the lowest grade and somehow
    people will find out and point and laugh at you. So you'll study like crazy right up until that
    first gross anatomy test that you'll take on no sleep in some caffeine-induced trance. After that,
    though, you'll learn what your best study methods are and how best for you to use your time. After
    that, you'll discover that there is plenty of free time to have a family life, have friends, go to
    parties, form a bowling team in your second year and win the league championship after defeating
    the five-time defending champions in the playoffs (which a group of students from my school -
    myself included - did).

    In the clinical years, your free time depends on your rotation. Surgery tends to lend itself to
    hospital work and sleep only. Psychiatry tends to give you more free time than you could possibly
    fill. The others fall someplace in the middle.

    12.4) What is the USMLE?

    In spite of its resemblance to the words "U SMILE," it's not a happy thing. USMLE stands for
    United States Medical Licensing Examination, and the website may be found at
    <http://www.usmle.org>. There are three parts to it (the first two parts consisting of a one-day,
    eight-hour exam and the third part consisting of a two-day exam), and in virtually every state you
    must pass the parts in order to get licensed. The examination is now offered on computer at
    testing centers, and may be taken whenever the student wishes. See the USMLE web site for more
    information.

    The parts are:

    Step I, taken after your second year Step II, taken in your fourth year Step III, taken at the
    end of your internship year

    12.5) What is a good USMLE score?

    A good score is one that is (a) passing and (b) passing, a fact that the USMLE apparently realized
    because rumor has it they are going to make the exams pass/fail in the near future. For now, keep
    in mind that the national average (which has been rising, probably through artificial means) has
    been around 215 in 1997-98. The cut-off for a "good" score once was 200 (when 200 was set as the
    statistical mean, or 50th percentile score). Now, though, "good" scores start around 215 and go up
    from there. And yes, it is sad but true that some residency programs use USMLE Step I scores as a
    preliminary cut-off point for sending out secondary applications and/or interview requests.
    Generally the programs that do this tend to be the more competitive ones - surgery, orthopedics,
    ENT, neurosurgery, etc.

    12.6) What is AOA?

    Alpha Omega Alpha, or "AOA," is a national medical honor society that was founded in 1902 to
    promote and recognize excellence in the medical profession. Most, although not all medical schools
    have a chapter of AOA. Each school's chapter selects a small group of students to join the
    society, generally in their junior or senior years. "Junior AOA status," or being selected as a
    junior, is considered superior to "senior AOA status."

    In order to meet the minimum requirements of the national society, students must be in the top 15%
    of their class academically, and possess leadership and community service attributes. Academic
    activities such as research, performance in clerkships and electives and extracurricular program
    participation are generally included in the selection criteria.

    Individual chapters may also elect to induct outstanding alumni, faculty and house staff to AOA.
    Induction ceremonies are generally held just before graduation and are highly specific to the
    individual chapters.

    Having AOA on your curriculum vitae is considered an asset when applying in the very competitive
    post-graduate programs such as dermatology and surgical subspecialties.

    [Maintainer's note: Stanford, the University of Connecticut, and Harvard are the schools that do
    not have AOA. If you are aware of other schools that do not have a chapter, please let me know.]

    ------------------------------

    Subject: 6. Paying for Medical School

    12.7) How expensive is medical school?

    Very. According to the AAMC's Medical School Admissions Requirements, the range of tuition and
    student fees for 1996-1997 first-year students was:

    Range Median Mean Private, Resident: 8,152-31,925 24,925 23,835
    Private, Nonresident: 16,403-31,925 25,224 25,407 Public, Resident: 2,908-
    20,129 9,107 9,921 Public, Nonresident: 10,680-51,669 21,129 22,153

    Keep in mind that these figures represent only tuition and fees. Other expenses include room and
    board, books, equipment, transportation, insurance, and personal expenses. In all, these
    additional expenses can easily be up to $15,000 per year.

    12.8) How can I pay for medical school?

    The first consideration is to reduce your expenses. The less expensive schools tend to be public
    schools within your state. If you don't have a medical school in your state, you may be eligible
    to attend other state schools as an in-state resident through an exchange program such as WICHE,
    the Western Interstate Commission for Higher Education, which allows students from Alaska,
    Montana, and Wyoming to apply to and attend any western medical school as a state resident (with
    the exception of the University of Washington). Another major expense that can be reduced, if you
    qualify, is the cost of application. Be sure to apply for an AMCAS fee waiver (if you qualify),
    which can save you hundreds of dollars.

    Unfortunately, reducing expenses still leaves, in most cases, tens of thousands of dollars to pay.
    The most common way to pay this is via loans, particularly federal Stafford loans and private
    alternative loan programs. While some Stafford loans may be subsidized (the government will pay
    the interest while you are in school), there is a limit to the amount you can borrow. Other loan
    programs are often offered by the various schools.

    Grant aid (aid you don't have to repay) is not common. Most schools offer a minimal amount of
    merit- and/or need-based grant aid. There are also two programs that will cover the entire cost
    of school plus give you a stipend. The first, the Medical Scientist Training Program, is a
    highly competitive government-subsidized program designed to recruit students interested in
    earning both an M.D. and a Ph.D. The second, the Uniformed Services University of the Health
    Sciences, is the military's medical school. In return for years of service to the military, your
    education is paid for in addition to your receiving a commission in the military and the
    concomitant salary and benefits.

    Another possibility for covering your expenses is to obligate yourself to later service. Two
    examples of this type of program are the Armed Forces HPSP and the Public Health Service program,
    both of which provide payment for medical school in return for a commitment to serve in either the
    military or in underserved public health regions, respectively.

    Finally, be sure to search the Web and other sources for private scholarship sources. You may be
    eligible for free money or favorable loans due to your extracurricular activities, ethnicity,
    religion, heritage, or any number of other factors. Your school's financial aid office will be
    happy to suggest sources to you as well as discuss means of payment.

    12.9) Can you tell me about Armed Forces scholarships?

    The Armed Forces Health Professions Scholarship Program (HPSP) is a scholarship between two to
    four years in length offered to students in schools of medicine, osteopathic medicine,
    dentistry, and optometry. HPSP students receive full tuition, school-related expenses, and a
    stipend as benefits. The stipend is currently (as of 8/98) around $912/month, paid in two parts
    on the 1st and 15th days on each month by direct deposit. Expenses are reimbursed by the
    submission on an itemized form with receipts and a signed approval letter from your school
    stating that the expenses you claim are reasonable ones for your curriculum; typically, most
    texts and equipment (i.e., stethoscopes, lab coats) are paid without any fuss. Tuition is paid
    directly to your school.

    Basic requirements for the HPSP are that you are a U.S. citizen and meet the qualifications for
    commissioning as a military officer. There is an application and interview process which takes
    place at about the same time as med school apps. (Of course, you do have to actually get into med
    school in order to receive it.) The HPSP is offered through the Navy, Army, and Air Force (the
    Marine Corps is part of the Department of the Navy and is served by Naval docs, and the Coast
    Guard is staffed by docs from the Public Health Service).

    In return, you owe as many years of service to the military as you received in support. Residency
    does not count towards this payback time. What you actually wind up doing, of course, varies
    according to your specialty; there isn't a huge need for pediatric neurosurgery about the average
    aircraft carrier, for example.

    What are the advantages to this little Faustian bargain? Well, for starters, there are the
    financial benefits. The more frugal students will emerge from med school debt-free, and those who
    live a little higher on the hog will owe relatively small student loans. Salary during residency
    is about $10,000/yr greater in the military (in the neighborhood of $40,000 for interns, $50,000
    for more senior residents). Even post-residency, you won't starve; average attending salaries vary
    by specialty, rank, and years of service, but most wind up in the neighborhood of $100,000/yr as
    junior attendings (typically O-4 in rank: a lieutenant commander in the Navy, a major in the other
    two). You are automatically commissioned as an O-1 while a med student (ensign in the Navy, 2nd
    lieutenant in the other two) and are promoted to O-3 on graduation (lieutenant/captain). There are
    some pretty entertaining places to work in the military that you might not the chance to work near
    in the future: Europe, Asia, and so forth. And of course, medicine is medicine: patients can be
    much the same no matter where you work, and in any case the majority of patients in the military
    system are not actually active duty troops but retirees and dependents. Benefits can be nice as
    well: 30 days paid vacation each year, no overhead, and full medical/dental coverage.

    Military residencies, by the way, are generally quite good. When considering your training site
    come application time, you do want to think about issues like patient volume, didactics, and so
    forth, just as in any residency, but board pass rates for military residency grads have been
    uniformly excellent, and people have gotten into fine fellowships with minimal difficulty.
    (Incidentally, if you do a civilian fellowship as an active duty officer, the military will still
    pay you as an attending. Which is pretty sweet.)

    Now for the downside. You are sacrificing a few years of your life, in a sense. Although a
    flexible mindset and a willingness to compromise will help you get a good posting, not everyone in
    the Navy gets to go to Italy or San Diego. Internship and residency are relatively separate
    entities and require separate applications, not only for fields like anesthesia but even for
    fields with categorical internships like internal medicine or general surgery. Not only that,
    there is a risk that you will have to spend a couple of years away from training between your R-1
    and R-2 years as a general medical officer, or GMO. This risk is greatest in the Navy overall but
    present in the Army and Air Force; it is also greater if you plan on pursuing a more specialized
    field like neurosurgery or anesthesia. Medicine, peds, and family med residents are more likely to
    complete their training uninterrupted. GMO tours vary between one to three years in length.

    (A brief proviso on the whole GMO thing. An anesthesiology attending at the National Naval Medical
    Center in Bethesda spent three years as the medical officer aboard the USS Belknap in the
    Mediterranean, and he loved it. After finishing his tour, he went on to his residency at Mass
    General. So it's not the kiss of death. Also, GMOs are a dying breed. The DoD is currently working
    out a plan to abolish GMOs and staff those positions with residency-trained docs. So stay tuned.)

    The military is a startlingly bureaucratic organization which has little ways of reminding you
    that it is, in fact, a branch of the federal government. For physicians, though, military medicine
    is actually not really different than working for a good HMO. Research in military medicine is
    quite impressive, incidentally, although its work is often very practical in orientation. There
    are good research ties with the NIH and CDC, and most residencies are very supportive of research
    (and may in fact require it of residents).

    There are a certain number of people each year in the HPSP who defer their commitment in order to
    do civilian residencies. The exact number varies depending on the year, the specialty, and the
    needs of the service. If you want to defer, it helps to have a good reason
    (i.e., spouse's job) and to not be rude (e.g., "I want to defer because military residencies are
    inferior").

    If you want to postpone the decision about military service, there is a financial assistance
    program (FAP) available to residents in most specialties, wherein you get about $30,000/yr on top
    of your civilian salary to repay loans (or buy a new car, possibly) in exchange for an equivalent
    number of years of service.

    6.4) Can you tell me about Public Health Service scholarships?

    The Public Health Service offers a scholarship (The National Health Service Corps,
    <http://bphc.hrsa.gov/nhsc/>) paying full tuition, books, and supplies, and a monthly stipend,
    with the following requirements:

    7) You must enter a primary care-type of residency (medicine, family med, peds) or at least
    something that's close (OB/GYN, psych), or a residency combining two of the above fields. A
    main limitation is that the residency not take more than 3 or 4 years. After serving your
    commitment you can undergo further medical training (i.e., fellowships).

    8) You must serve one year in a federally-designated underserved area of your choice for each
    year the NHSC paid your tuition (minimum two years), be it an inner city (30% of sites) or a
    rural cow town (70% of sites).

    9) As of December 1998, the IRS has deemed ALL parts of the NHSC scholarship as taxable,
    including tuition. So, if you go to a school that costs $28,000 per year, taxes will leave
    you with about $350 from your monthly $950 stipend. The NHSC has been trying to get Congress
    to reverse the IRS's reading of the law, but to no avail as of yet.

    There are similar programs available through various state governments and the Indian Health
    Service, some funded by the NHSC.

    Physicians who have completed training in a primary care field are eligible for Public Health
    Service positions, with opportunities for loan repayment. Some feel that this may be a better
    choice, as you are not locked into a primary care field without first going through your medical
    school rotations. See the NHSC web site for more information.

    9.1) Can I really borrow more than $10K/yr in Unsubsidized Stafford Loans?

    With the phaseout of the HEAL program at all schools, the Department of Education has now
    authorized increased unsubsidized Stafford loan limits for Health Professions Students. This limit
    is now $30K/yr.

    The Student Financial Aid Handbook section detailing these limits may be found at:
    <http://ifap.ed.gov/sfahandbooks/attachments/0102Vol8Ch3loanperiodamts.pdf>.

    ------------------------------

    Subject: 7. Residency and Beyond

    9.2) What are the different medical specialties?

    A good source for learning about the different medical specialties is the American Board of
    Medical Specialties <http://www.abms.org>, an organization that coordinates and approves changes
    in board certification policy in the different medical fields. A complete list of the certifying
    boards and the general and subspecialty certificates that they offer can be found on their web
    site. A list of the major medical specialties can be found below. No effort has been made to list
    subspecialties.

    Allergy & Immunology Anesthesiology Colon & Rectal Surgery Dermatolology Emergency Medicine
    Family Practice Internal Medicine Medical Genetics Neurological Surgery Neurology Nuclear
    Medicine Obstetrics & Gynecology Ophthalmology Orthopaedic Surgery Otolaryngology Pathology
    Pediatrics Physical Medicine & Rehabilitation Plastic Surgery Preventive Medicine (including
    Occupational Medicine) Psychiatry Radiation Oncology Radiology Surgery Thoracic Surgery
    (including Cardiothoracic Surgery) Urology

    9.3) What is a residency?

    Upon graduation from medical school, you become a "doctor" having earned the M.D. or D.O. degree.
    However, this isn't the end of formal medical training in this country. Many moons ago, back when
    almost all physicians were general practitioners, very few physicians completed more than a year
    of post-graduate training. That first year of training after medical school was called the
    "internship" and for most physicians it constituted the whole of their formal training after
    medical school; the rest was learned on the job. As medical science advanced and the complexity
    of and demand for medical specialists increased, the time it took to gain even a working
    knowledge of any of the specialties grew to the point where it became necessary to continue
    formal medical training for at least several years after medical school. This training period is
    called a "residency," earning its moniker from the old days when the young physicians actually
    lived in the hospital or on the hospital grounds, thus "residing" in the hospital for the period
    of their training.

    During residency, you and your classmates practice under the supervision of faculty physicians,
    generally in large medical centers. Many primary care specialties, however, are based in smaller
    medical centers. As you grow more experienced, you assume more responsibilities and independence
    until you graduate from the residency, and you are released to practice on your own upon an
    unsuspecting populace.

    The length of residency programs varies considerably between specialties and even a little within
    individual specialties. In general, the surgical specialties require longer residencies, and the
    primary care residencies the least time.

    Lengths of Some Residencies
    ---------------------------
    All surgical specialties 5+ years Obstetrics and Gynecology 4 years Family medicine 3 years
    Pediatrics 3 years Emergency Medicine 3-4 years Psychiatry 3 years

    The AMA maintains a database of almost all of the residency programs in the United States, called
    the Fellowship and Residency Electronic Interactive Database Access (FREIDA) system. It is
    available at <http://www.ama-assn.org/go/freida>.

    Recently a new type of residency has emerged, the so-called "combined residency." These
    residencies train physicians in two medical fields, such as internal medicine-pediatrics, or psychiatry-
    neurology. As these types of residencies are new, they are relatively few in number; they provide
    an opportunity for the physician to become "double-boarded" and receive board certification in
    each of the two specialties. Usually these residencies last one or two years less than the total
    years that would be spent doing both residencies.

    10.2a) What is an internship?

    In the old days, all physician completed a one year "rotating internship" after graduating from
    medical school. Such an internship consisted of all the major subdivisions of medical practice:
    Internal medicine, surgery, obstetrics and gynecology, etc. The idea was to provide a broad
    spectrum of training to allow the new physician to work in the community as a "general
    practitioner."

    Today, the closest thing we have to the rotating internships of old is the "transitional year,"
    also completed after graduating from medical school. For a few specialties, a year of post-gradute
    training is required before beginning a residency in that field. Many who want to go into these
    fields fill that requirement with a transitional year. Fields that require a year before beginning
    residency include radiology, neurology, anesthesiology, and ophthalmology.

    In the current lingo, the first year of post-graduate training is called "internship," and any
    medical school graduate in the first year of post-graduate training is called an "intern"
    regardless of what that first year of training consists. Most specialties do not require a
    transitional year, but instead accept medical school graduates straight out of medical school.

    11.2b) What is a "preliminary" year? A "categorical" year?

    An alternative to the transitional year for some is the "preliminary year." Preliminary years come
    in two flavors, internal medicine and surgery. Each of these preliminary years somewhat resembles
    the rotating internships of old, but with a focus on either internal medicine or surgery. Those
    programs that require a year of post-graduate education before beginning residency may accept
    either a transitional year or a preliminary year. Obviously, surgical residencies will require
    that you do a preliminary surgery year while some other specialties will prefer a preliminary
    medicine year.

    The other reason that a new M.D. would go into a preliminary year or transitional year would be
    because he didn't match into the specialty of his choice. The hopeful applicant then takes a
    preliminary or transitional year in the hopes of improving his chances and qualifications for the
    next year's residency match.

    The term "categorical" is used largely to distinguish between the interns who are doing a
    preiminary year and those who are already accepted into the residency program. For instance, a
    general surgery program may have 6 interns every year, but two of them may doing surgery as a
    preliminary year. Those positions that are already accepted into the whole surgical residency
    program are called "categorical."

    11.1) What is the Match?

    The Match (also cf 7.4) is a way to bring together residency applicants and residency programs in
    an organized fashion. After applying to and interviewing at various residency programs in their
    specialty of choice, students submit a "rank order list" which specifies their preferences for
    programs in numerical order. Residency programs submit similar lists. After all of the lists have
    been received, a computer matches applicants and programs. At noon Eastern time, on a fateful day
    in March of each year, all applicants across the country receive an envelope telling them where
    they will spend the next several years.

    Controversy has surrounded the Match algorithm in recent years, due to a slight preference for
    residency programs in a very small percentage of cases. The algorithm has since been changed to
    favor applicants' preferences.

    There are several books about residency and the Match. "First Aid for the Match" by Tao Le, et
    al., and "Getting into a Residency: A Guide for Medical Students" by Kenneth Iserson, MD, provide
    insights about how to prepare for the Match.

    11.2) What is the NRMP?

    The National Resident Matching Program (NRMP) is the official name of the Match, which is run by
    the Association of American Medical Colleges (AAMC). Its home page may be found at
    <http://www.aamc.org/nrmp/>.

    11.3) Are there specialties that don't use the NRMP?

    Several specialties have their own matching programs. Neurology, Neurosurgery, Ophthalmology,
    Otolaryngology, and Plastic Surgery, along with several subspecialty fellowship programs in these
    fields, have their matches coordinated through the San Francisco Matching Program
    <http://www.sfmatch.org>.

    Urology has its own matching program, coordinated by the American Urological Association at
    <http://www.auanet.org/students_residents/>.

    The "Match Day" for these specialties occurs in January, instead of March as for the NRMP. Consult
    the matching programs' web sites for schedules.

    11.4) What is a fellowship?

    A fellowship is a period of training that you undertake following completion of your residency, as
    a means to subspecialization. For instance, a general surgeon can do a number of different
    fellowships
    (e.g. cardiothoracic surgery, plastic surgery), a pediatrician can complete a fellowship in
    pediatric endocrinology, etc. The list of possible subspecialties is almost endless. A
    fellow is considered somewhere in the hierarchy between residents and faculty. They are paid
    like advanced residents, but nothing close to what a private physician makes. People take
    fellowships for a number of different reasons: The subspecialty may be what they've always
    wanted to do in the first place, they may develop an interest in that field along the way,
    and it's often a path to a faculty position in a residency program and medical school. The
    length of fellowships also varies some, but usually lasts three years or less.

    7.7) How many hours do interns/residents work?

    Intern and resident hours vary very widely depending on specialty, hospital, and within hospitals
    between different departments. Some specialties are well-known for their less demanding hours
    during residency (and often afterwards as well). These "lifestyle" fields include radiology,
    anesthesiology, and physical medicine and rehabilitation (physiatry). Specialties whose
    residencies are reputed for difficulty and lack of sleep are general surgery and obstetrics and
    gynecology. Most of the other specialties fall somewhere in between.

    Surgical interns and often internal medicine interns routinely work 100+ hours a week, with some
    months requiring a brutal every other night call schedule. This means, for instance, that you go
    to work on Monday morning (around 5-6 am) work all day, stay in the hospital all night (with
    varying amounts of sleep but usually 2-3 hours), work the following day as well (hoping that you
    may get out early), then go home for around 6 pm only to repeat the whole cycle again the next
    day. On months such as these, if you have a spouse, children, or pets, you won't see them. You can
    do the math to figure out how many hours per week that amounts to. Most call schedules for intern
    years run either every third or every fourth night on call.

    8.7a) Aren't there limits on this?

    There are a few states that limit the number of hours that a resident can work. Perhaps the most
    prominent state with a such a law is New York.

    New York's law, limiting residents to 80 hours per week, came about largely due to the Libby Zion
    case. Libby Zion was a young woman whose death in a NYC teaching hospital sparked an investigation
    into the large amount of hours that residents work.

    Nevertheless, many hospitals in New York still do not follow this law and the state has
    performed "spot inspections" to attempt to verify compliance. For an excellent discussion of
    this issue, read the book "Residents: The Perils and Promise of Educating Young Doctors" by
    David Ewing Duncan.

    8.1) What does "board certified" mean?

    Generally, to become certified by one of the boards recognized by the American Board of Medical
    Specialties <http://www.abms.org>, a physician must meet several requirements:

    9) Possess an MD or DO degree from a recognized school of medicine
    10) Complete 3 to 7 years of specialty training in an accredited residency
    11) Some boards require assessments of competence from the training director
    12) Most boards require the physician to have an unrestricted license
    13) Some boards require experience in full-time practice, usually 2 years
    14) Pass a written examination, and sometimes an oral examination

    After certification, a physician is given the status of "diplomate" in that specialty. Many boards
    require recertification at regular intervals.

    14.1) What does FACP/FACS/FACOG/etc. mean?

    Before discussing this, it may be useful to delineate the differences between organizations that
    physicians may be associated with. Some definitions:

    Association or Academy - A group for physicians in a particular field, that often sponsors
    meetings and publishes journals. Example: American Academy of Family Physicians.

    Board - Organization that conducts periodic examinations for physicians in a particular field, and
    offers "certification" (cf
    14.2). The overseeing organization for all specialty boards is the American Board of Medical
    Specialties <http://www.abms.org>. Example: American Board of Internal Medicine.

    College - Similar to an association, but membership is often tied to board certification and
    experience. More of an honor than simple association membership, doctors are often elected to
    "fellowship" after recommendation by their colleagues. Example: American College of Surgeons.

    After a physician has received board certification in his/her field, and has gained a set amount
    of experience in that field (usually a specified number of years of practice), that physician can
    be recommended for fellowship status in their specialty college. After approval, the physician can
    then use their fellowship status on stationery and business cards, i.e. Susan M. Avery, M.D.,
    F.A.C.S. signifies that Dr. Avery has received fellowship status in the American College
    of Surgeons.

    7.10) What is an IMG/FMG?

    Those who have graduated from medical schools outside of the United States and Canada are called
    International Medical Graduates (IMGs) or Foreign Medical Graduates (FMGs). Sometimes, US citizens
    who have attended foreign schools are called USFMGs to distinguish them from non-citizens.

    There has been a move of late among some members of Congress, the Accreditation Council for
    Graduate Medical Education (ACGME), and the AAMC, in light of a perceived surplus of physicians in
    the US, to reduce the number of Medicare-funded residency positions to 110% of the number of
    graduating US medical school seniors. As of yet, this has not been implemented.

    7.11) What is the ECFMG? The CSA?

    The Educational Commission for Foreign Medical Graduates (ECFMG) <http://www.ecfmg.org> is an
    organization sponsored by the Federation of State Medical Boards, the AAMC, the AMA, the American
    Board of Medical Specialties, and others, that coordinates certification of graduation, passing
    grades on the United States Medical Licensing Examination (USMLE), and other information about
    FMGs. Prior to applying to residency or fellowship programs in the United States that are
    accredited by the Accreditation Council for Graduate Medical Education (ACGME), an FMG must hold a
    certificate from the ECFMG.

    CSA stands for "Clinical Skills Assessment," a new requirement for foreign-trained physicians
    seeking to obtain ECFMG certification. Applicants face 10 simulated patients and be evaluated on
    their ability to take a history, perform a physical exam and record a written note. More
    information can be found on the ECFMG web site at <http://www.ecfmg.org/csahome.htm>.

    7.12) What is CME?

    A physician's education does not end with medical school and residency. Continuing Medical
    Education, or CME, allows physicians to keep up with new developments in all medical fields.
    Physicians earn "credits" for hours spent in various learning activities.

    The American Medical Association (AMA) offers the Physician Recognition Award (PRA) for doctors
    who complete 50 hours of CME credit per year. The AMA's classification of CME is as follows:

    Category 1: Formally organized and planned educational meetings,
    e.g., conferences, symposia. Also includes residency. Category 2: Less structured
    learning experiences, e.g., consultations, discussions with colleagues, and
    teaching. Other: Reading "authoritative" medical literature, e.g., peer-reviewed
    journals, textbooks.

    Organizations that receive the nod from the Accreditation Council for Continuing Medical Education
    (ACCME) <http://www.accme.org>, as well as state medical societies and other groups recognized by
    the AMA can provide "category 1" CME courses.

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