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Medical education in the United States includes educational activities involved in the education and training of physicians in the country, with the overall process going from entry-level training efforts through to the continuing education of qualified specialists in the context of American colleges and universities.
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]
Issues in higher education in the U.S. have particular resonance in this context, with multiple analysts expressing concern of a physician shortage in the nation. [4] Medical deserts' have also been a topic of concern.
In recognition of the exponential growth in medical knowledge, a growing number of medical schools are incorporating the Master Adaptive Learner Model. [5] This metacognitive approach to learning or “learning to learn” [6] is based on self-regulation that fosters the development and use of adaptive expertise in practice. [5] 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. [5]
In the U.S., a medical school is an institution with the purpose of educating medical students in the field of medicine. [7] Once enrolled in a medical school the four years progressive study is often divided into two roughly equal components: pre-clinical (consisting of didactic courses in the basic sciences) and clinical (clerkships consisting of rotations through different wards of a teaching hospital). Health systems science is integrated throughout all four years. [8] The degree granted at the conclusion of these four years of study is Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) depending on the medical school; both degrees allow the holder to practice medicine after completing an accredited residency program. [9] [10]
During the last year of medical school, students apply for residencies, also referred to as graduate medical education, in their chosen field of specialization. [11] These vary in competitiveness depending upon the desirability of the specialty, prestige of the program, and the number of applicants relative to the number of available positions. [12] All but a few positions are granted via a national computer match which pairs an applicant's preference with the programs' preference for applicants. [12]
Historically, graduate medical education began with a free-standing, one-year internship. [13] Completion of this year continues to be the minimum training requirement for obtaining a general license to practice medicine in most states. [14] However, because of the gradual lengthening of graduate medical education and the decline of its use as the terminal stage in training, most new physicians complete the internship requirement as their first year of residency. [15]
Not withstanding the trend toward internships integrated into categorical residencies, the one-year "traditional rotating internship" (sometimes called a "transitional year") continues to exist. Some residency training programs, such as in neurology [16] and ophthalmology, [17] do not include an internship year and begin after completion of an internship or transitional year. Some use it to re-apply to programs into which they were not accepted, while others use it as a year to decide upon a specialty. In addition, osteopathic physicians "are required to have completed an American Osteopathic Association (AOA)-approved first year of training in order to be licensed in Florida, Michigan, Oklahoma and Pennsylvania." [18]
Lately there has been an increasing acknowledgment of the significance of interprofessional education (IPE), in the field of training. IPE entails students from health care disciplines studying together to enhance teamwork and enhance patient care results. [19] This method is especially pertinent as health care services are transitioning to a team oriented approach. [19]
Each of the specialties in medicine has established its own curriculum, which defines the length and content of residency training necessary to practice in that specialty. Programs range from 3 years after medical school for internal medicine and pediatrics, to 5 years for general surgery, to 7 years for neurosurgery. [20] Each specialty training program either incorporates an internship year to satisfy the requirements of state licensure or stipulates that an internship year be completed before starting the program at the second post-graduate year (PGY-2).
A fellowship is a formal, full-time training program that focuses on a particular area within the specialty, with requirements beyond the related residency. [21] 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. [22]
The physician or surgeon who has completed their residency and possibly fellowship training and is in the practice of their specialty is known as an attending physician. Physicians then must pass written and oral exams in their specialty in order to become board certified. [23] Each of the 26 medical specialties has different requirements for practitioners to undertake continuing medical education activities. [23]
Moreover there is an increasing focus on integrating technology into the field of education. Virtual reality (VR) simulations and online platforms are being utilized to enrich opportunities in disciplines like anatomy, surgical training and telemedicine. Research has shown that VR simulations are effective in enhancing competencies and minimizing mistakes. [24] With the advancements in technology medical schools are exploring methods to incorporate these resources into their programs to adequately equip students for contemporary health care settings. [25]
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. [26] 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. [27]
A physician, medical practitioner, medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the study, diagnosis, prognosis and treatment of disease, injury, and other physical and mental impairments. Physicians may focus their practice on certain disease categories, types of patients, and methods of treatment—known as specialities—or they may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities—known as general practice. Medical practice properly requires both a detailed knowledge of the academic disciplines, such as anatomy and physiology, underlying diseases, and their treatment, which is the science of medicine, and a decent competence in its applied practice, which is the art or craft of the profession.
A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians and evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly mental issues. Sometimes a psychiatrist works within a multi-disciplinary team, which may comprise clinical psychologists, social workers, occupational therapists, and nursing staff. Psychiatrists have broad training in a biopsychosocial approach to the assessment and management of mental illness.
A general practitioner (GP) or family physician is a doctor who is a consultant in general practice.
Doctor of Medicine is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a professional degree. This generally arose because many in 18th-century medical professions trained in Scotland, which used the M.D. degree nomenclature. In England, however, Bachelor of Medicine, Bachelor of Surgery (M.B.B.S.) was used: in the 19th century, it became the standard in Scotland too. Thus, in the United Kingdom, Ireland and other countries, the M.D. is a research doctorate, honorary doctorate or applied clinical degree restricted to those who already hold a professional degree (Bachelor's/Master's/Doctoral) in medicine. In those countries, the equivalent professional degree to the North American, and some others' usage of M.D. is still typically titled Bachelor of Medicine, Bachelor of Surgery.
Hospital medicine is a medical specialty that exists in some countries as a branch of family medicine or internal medicine, dealing with the care of acutely ill hospitalized patients. Physicians whose primary professional focus is caring for hospitalized patients only while they are in the hospital are called hospitalists. Originating in the United States, this type of medical practice has extended into Australia and Canada. The vast majority of physicians who refer to themselves as hospitalists focus their practice upon hospitalized patients. Hospitalists are not necessarily required to have separate board certification in hospital medicine.
Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, veterinarian, dentist, podiatrist (DPM) or pharmacist (PharmD) who practices medicine, veterinary medicine, dentistry, podiatry, or clinical pharmacy, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant.
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.
The Medical Corps (MC) of the U.S. Army is a staff corps of the U.S. Army Medical Department (AMEDD) consisting of commissioned medical officers – physicians with either an M.D. or a D.O. degree, at least one year of post-graduate clinical training, and a state medical license.
The American Osteopathic Association (AOA) is the representative member organization for the more than 176,000 osteopathic medical doctors (D.O.s) and osteopathic medical students in the United States. The AOA is headquartered in Chicago, Illinois, and is involved in post-graduate training for osteopathic physicians. Beginning in 2015, it began accrediting post-graduate education as a committee within the Accreditation Council for Graduate Medical Education, creating a unified accreditation system for all DOs and MDs in the United States. The organization promotes public health, encourages academic scientific research, serves as the primary certifying body for D.O.s overseeing 18 certifying boards, and is the accrediting agency for osteopathic medical schools through its Commission on Osteopathic College Accreditation. As of October 2015, the AOA no longer owns the Healthcare Facilities Accreditation Program (HFAP), which accredited hospitals and other health care facilities.
Medical education in Australia includes the educational activities involved in the initial and ongoing training of Medical Practitioners. In Australia, medical education begins in Medical School; upon graduation it is followed by a period of pre-vocational training including Internship and Residency; thereafter, enrolment into a specialist-vocational training program as a Registrar eventually leads to fellowship qualification and recognition as a fully qualified Specialist Medical Practitioner. Medical education in Australia is facilitated by Medical Schools and the Medical Specialty Colleges, and is regulated by the Australian Medical Council (AMC) and Australian Health Practitioner Regulation Agency (AHPRA) of which includes the Medical Board of Australia where medical practitioners are registered nationally.
The Accreditation Council for Graduate Medical Education (ACGME) is the body responsible for accrediting all graduate medical training programs for physicians in the United States. It is a non-profit private council that evaluates and accredits medical residency and internship programs.
A medicalintern is a physician in training who has completed medical school and has a medical degree, but does not yet have a license to practice medicine unsupervised. Medical education generally ends with a period of practical training similar to internship, but the way the overall program of academic and practical medical training is structured differs depending upon the country, as does the terminology used.
The American Board of Medical Specialties (ABMS) is a non-profit organization established in 1933 which represents 24 broad areas of specialty medicine. ABMS is the largest and most widely recognized physician-led specialty certification organization in the United States. The other certification organizations in the United States are the American Board of Physician Specialties and American Osteopathic Association Bureau of Osteopathic Specialists.
Touro University Nevada (TUN) is a private university in Henderson, Nevada. It is part of the Touro College and University System. Touro University Nevada is a branch campus of its sister campus Touro University California.
Modern medical education in Hong Kong started with the founding of the Hong Kong College of Medicine for Chinese in 1887. Currently, six institutes of higher education are engaged in the training of medical practitioners in Hong Kong.
A fellowship is the period of medical training, in the United States and Canada, that a physician, dentist, or veterinarian may undertake after completing a specialty training program (residency). During this time, the physician is known as a fellow. Fellows are capable of acting as an attending physician or a consultant physician in the specialist field in which they were trained, such as internal medicine or pediatrics. After completing a fellowship in the relevant sub-specialty, the physician is permitted to practice without direct supervision by other physicians in that sub-specialty, such as cardiology or oncology.
In Canada, a medical school is a faculty or school of a university that trains future medical doctors and usually offers a three- to five-year Doctor of Medicine (M.D.) or Doctor of Medicine and Master of Surgery degree. There are currently 17 medical schools in Canada with an annual admission success rate normally below 7.5%. As of 2021, approximately 11,500 students were enrolled in Canadian medical schools graduating 2,900 students per year.
Medical education in Philippines is principally offered and developed by accredited and government recognized medical schools in the country.
Most physicians in the United States hold either the Doctor of Medicine degree (MD) or the Doctor of Osteopathic Medicine degree (DO). Institutions awarding the MD are accredited by the Liaison Committee on Medical Education (LCME). Institutions awarding the DO are accredited by the Commission on Osteopathic College Accreditation (COCA). The World Directory of Medical Schools lists both LCME accredited MD programs and COCA accredited DO programs as US medical schools. Foreign-trained osteopaths do not hold DO degrees and are not recognized as physicians in the United States or in other jurisdictions.
Doctor of Osteopathic Medicine is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licensed as a physician or surgeon and thus have full medical and surgical practicing rights in all 50 US states. As of 2021, there were 168,701 osteopathic physicians and medical students in DO programs across the United States. Osteopathic medicine emerged historically from the quasi-medical practice of osteopathy, but has become a distinct and proper medical profession.