Medical education in the United States

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Jackson Memorial Hospital in Miami, Florida, which serves as the primary teaching hospital for the Miller School of Medicine at the University of Miami Aerial-Picture-of-Jackson-e1445995779731.jpg
Jackson Memorial Hospital in Miami, Florida, which serves as the primary teaching hospital for the Miller School of Medicine at the University of Miami

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

Contents

A typical outline of the medical education pathway is presented below. Medicine is a diverse profession with many options available. For example, some physicians work in pharmaceutical research, [1] occupational medicine (within a company), [2] public health medicine (working for the general health of a population in an area), or even join the armed forces in America. [3] Others are primary care physicians in private practice and still others are employed by large health systems. [4]

Issues in higher education in the U.S. have particular resonance in this context, with multiple analysts expressing concern about a physician shortage in the nation. [5] Others say maldistribution is a bigger challenge, [6] and medical deserts have been a topic of concern.

Medical school

In the U.S., a medical school is an institution with the purpose of educating medical students in the field of medicine. [7] Most medical schools require students to have already completed an undergraduate degree, although CUNY School of Medicine in New York is one of the few in the U.S. that integrates pre-med with medical school. [8]

Once enrolled in a medical school, the usually four years of progressive study (sometimes three years [9] or five years [10] ) is often divided into two components: pre-clinical (consisting of didactic courses in the basic sciences) and clinical (clerkships consisting of rotations through different wards of a teaching hospital). Historically, these two parts were roughly equal, but the pre-clerkship phase has been getting shorter in recent years with the clinical phase becoming longer. [11] Many schools have also created meaningful clinical roles for students, starting as early as the first year. [12] This provides clinical context for the foundational concepts and is important in professional identity formation. [12]

Interprofessional education (IPE) is becoming an increasingly important part of medical school. [13] IPE entails students from health care disciplines studying together to enhance teamwork and teaming skills and improve patient care results. This method is especially pertinent as health care services are transitioning to a team oriented approach. [14]

The degree granted at the conclusion of medical school is Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) depending on the institution. Both degrees allow the holder to practice medicine after completing an accredited residency program. [15] [16]

Financing a medical school education

Most U.S. medical students fund medical school themselves through a combination of personal and family resources and loans. A total of 73% of medical school graduates have education debt, with $200,000 being the average amount of debt. [17] This cost contributes to the lack of economic diversity among U.S. medical students with nearly a quarter of all medical students coming from families with incomes in the top 5% of the country. [18] Half of all U.S. medical students come from families with incomes in the top quintile. [18]

The various options to defray the costs of medical school include scholarships [19] and service commitments [20] (military [21] or public service [22] ). Some medical schools also no longer charge tuition. [23]

Residency

During the last year of medical school, students apply for residencies, also referred to as graduate medical education (GME), in their chosen field of specialization. [24] These vary in competitiveness depending upon the desirability of the specialty, the prestige of the program, and the number of applicants relative to the number of available positions. [25] All but a few positions are granted via a national computer match algorithm. This algorithm prioritizes the preferences of the applicant and pairs them with programs that also prefer them. [26]

Residents are both trainees and employees of the health system hosting the GME program, [27] and the amount of graduate medical education required for licensure as a physician who can practice independently varies by state. [28] A minimum of one year of graduate medical education is required in some states with many states requiring two years or more. [28] International medical graduates may be subject to additional requirements. [28]

In July 2015, the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, and the American Association of Colleges of Osteopathic Medicine signed a memorandum of understanding to work toward a single accreditation system for residencies that would train MD and DO physicians. [29] This process concluded in June 2020, and MD and DO students participate in a single match. [29] The single match increased the match rates for graduates of osteopathic medical schools. [30]

The Accreditation Council for Graduate Medical Education has established Common Program Requirements and a shared competency framework [31] for all accredited residencies, although each specialty defines its own learning objectives and required experiences. Programs range from 3 years after medical school for internal medicine and pediatrics, to 5 years for general surgery, to 7 years for neurosurgery. [32]

Fellowship

A fellowship is a formal, full-time training program that focuses on a particular area within the specialty, with requirements beyond the related residency. [33] Many highly specialized fields require formal training beyond residency. Examples of these include cardiology, endocrinology, oncology after internal medicine; cardiothoracic anesthesiology after anesthesiology; cardiothoracic surgery, pediatric surgery, surgical oncology after general surgery; reproductive endocrinology/infertility, maternal-fetal medicine, gynecologic oncology after obstetrics/gynecology. There are many others for each field of study. In some specialties such as pathology and radiology, a majority of graduating residents go on to further their training. The training programs for these fields are known as fellowships and their participants are fellows, to denote that they already have completed a residency and are board eligible or board certified in their basic specialty. Fellowships range in length from one to three years and are granted by application to the individual program or sub-specialty organizing board. Fellowships often contain a research component. [34]

Board certification

Physicians must pass exams in their specialty in order to become board certified. [35] Some specialty boards also require logs of early practice experiences. Each of the 24 medical specialties has different requirements for practitioners to undertake continuing medical education activities. [35]

Continuing Medical Education

Continuing medical education (CME) refers to educational activities designed for practicing physicians. Many states require physicians to earn a certain amount of CME credit in order to maintain their licenses. [36]  Physicians can receive CME credit from a variety of activities, including attending live events, publishing peer-reviewed articles, and completing online courses. The Accreditation Council for Continuing Medical Education (ACCME) determines what activities are eligible for CME.

There is a growing emphasis on diversity, equity and inclusion (DEI) in education. Tackling health inequities and providing care are vital aspects of medical instruction. Medical institutions are placing importance on DEI efforts, including attracting and supporting minority students integrating competence training and advocating for diversity, among faculty and leaders. These initiatives strive to establish a health care workforce that mirrors the patient communities it serves. [37]

Diversity, equity, and inclusion

There is a growing emphasis on diversity, equity and inclusion (DEI) in education. Tackling health inequities and providing care are vital aspects of medical instruction. Medical institutions are placing importance on DEI efforts, including attracting and supporting students from historically minoritized communities, integrating competence training, and advocating for diversity among faculty and leaders. [38] These initiatives strive to establish a health care workforce that mirrors the patient communities it serves. [38]

In June 2023, the Supreme Court of the United States struck down the use of affirmative action in college admissions, including medical school. [39]

Master Adaptive Learner Model

In recognition of the exponential growth in medical knowledge, an increasing number of medical schools are incorporating the Master Adaptive Learner Model. [40] This metacognitive approach to learning or “learning to learn” [41] is based on self-regulation that fosters the development and use of adaptive expertise in practice. [40] This concept emphasizes the importance of lifelong learning, self-regulation, and adaptability, enabling health professionals to provide high-quality care in an ever-changing environment. [40]

Health Systems Science

In recognition of the increasing complexity of the health system, health systems science is becoming a more common part of medical education. [42] Health systems science (HSS) is a foundational platform and framework for the study and understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. [43] Some medical schools integrate health systems science throughout all four years. Health systems science has also been integrated into graduate medical education [44] and continuing professional development.

See also

Related Research Articles

Osteopathic medicine is a branch of the medical profession in the United States that promotes the practice of science-based medicine, often referred to in this context as allopathic medicine, with a set of philosophy and principles set by its earlier form, osteopathy. Osteopathic physicians (DOs) are graduates of American osteopathic medical colleges and are licensed to practice the full scope of medicine and surgery in all 50 U.S. states. The field is distinct from osteopathic practices offered in nations outside of the U.S.—in which practitioners are generally considered neither parts of core medical staff nor of medicine itself; rather, they are considered alternative medicine practitioners. The other major branch of medicine in the United States is referred to by practitioners of osteopathic medicine as allopathic medicine.

Internal medicine, also known as general internal medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of internal diseases in adults. Medical practitioners of internal medicine are referred to as internists, or physicians in Commonwealth nations. Internists possess specialized skills in managing patients with undifferentiated or multi-system disease processes. They provide care to both hospitalized (inpatient) and ambulatory (outpatient) patients and often contribute significantly to teaching and research. Internists are qualified physicians who have undergone postgraduate training in internal medicine, and should not be confused with "interns", a term commonly used for a medical doctor who has obtained a medical degree but does not yet have a license to practice medicine unsupervised.

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

Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, veterinarian, dentist, podiatrist (DPM) or pharmacist (PharmD) who practices medicine or surgery, veterinary medicine, dentistry, podiatry, or clinical pharmacy, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant.

<span class="mw-page-title-main">Oklahoma State University Center for Health Sciences</span> Medical school of Oklahoma State University

Oklahoma State University Center for Health Sciences (OSU-CHS) is a public medical school in Tulsa, Oklahoma. It also has a branch campus in Tahlequah, Oklahoma. Founded in 1972, OSU-CHS is part of the Oklahoma State University System. OSU-CHS offers a Doctor of Osteopathic Medicine (D.O.) and over fifteen other different graduate degrees.

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

Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is named a family physician. It is often referred to as general practice and a practitioner as a general practitioner. Historically, their role was once performed by any doctor with qualifications from a medical school and who works in the community. However, since the 1950s, family medicine / general practice has become a specialty in its own right, with specific training requirements tailored to each country. The names of the specialty emphasize its holistic nature and/or its roots in the family. It is based on knowledge of the patient in the context of the family and the community, focusing on disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is "promoting personal, comprehensive and continuing care for the individual in the context of the family and the community". The issues of values underlying this practice are usually known as primary care ethics.

<span class="mw-page-title-main">Medical education</span> Education related to the practice of being a medical practitioner

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<span class="mw-page-title-main">American Osteopathic Association</span> American professional association

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Medical school in the United States is a graduate program with the purpose of educating physicians in the undifferentiated field of medicine. Such schools provide a major part of the medical education in the United States. Most medical schools in the US confer upon graduates a Doctor of Medicine (MD) degree, while some confer a Doctor of Osteopathic Medicine (DO) degree. Most schools follow a similar pattern of education, with two years of classroom and laboratory based education, followed by two years of clinical rotations in a teaching hospital where students see patients in a variety of specialties. After completion, graduates must complete a residency before becoming licensed to practice medicine.

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

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

Doctor of Osteopathic Medicine is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licensed as a physician or surgeon and thus have full medical and surgical practicing rights in all 50 US states. As of 2023, there were 186,871 osteopathic physicians and medical students in DO programs across the United States. Osteopathic medicine emerged historically from the quasi-medical practice of osteopathy, but has become a distinct and proper medical profession.

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

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

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

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

<span class="mw-page-title-main">California Health Sciences University</span> University in Clovis, California, U.S.

California Health Sciences University (CHSU) is a private, for-profit university located in Clovis, California. Founded in 2012, the school currently operates two academic programs, one offering a doctorate degree in medicine and the second offering a masters degree in science. Graduates of the College of Osteopathic Medicine (COM) will receive the Doctor of Osteopathic Medicine (DO) degree, and graduates of the College of Biosciences and Health Professions (CBHP) will receive the Masters of Science in Biomedical Sciences (MSBS) degree. The school had previously also offered a Doctor of Pharmacy (Pharm.D.) degree but no longer offers it.

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