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Medical education in the United States

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.

Jackson Memorial Hospital in Miami, Florida, which serves as the primary teaching hospital for the Miller School of Medicine at the University of Miami

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

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Main article: Medical school in the United States

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]

Further information: Comparison of MD and DO in the United States

Financing a medical school education

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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

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Main article: Residency (medicine)

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

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Main article: Fellowship (medicine)

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

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Main article: 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

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Main article: 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]

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Diversity, equity, and inclusion

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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

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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

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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

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References

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  1. ^ Parent, Andrea (2019-07-01). "Outside the Fold: Exploring Nonclinical Work Opportunities for Physicians". NEJM CareerCenter Resources. Retrieved 2024-07-08.
  2. ^ "Discover Occupational Medicine! Midcareer Entry into Occupational and Environmental Medicine". American College of Occupational and Environmental Medicine. Retrieved 8 July 2024.
  3. ^ "Medicine + The Military". Medicine + The Military. Retrieved 2024-07-08.
  4. ^ "Physician employee, partner or owner? 3 paths for young doctors". American Medical Association. 2024-04-30. Retrieved 2024-10-07.
  5. ^ "New AAMC Report Shows Continuing Projected Physician Shortage". AAMC. Retrieved 2024-07-08.
  6. ^ Bennett, Christopher L.; Sullivan, Ashley F.; Ginde, Adit A.; Rogers, John; Espinola, Janice A.; Clay, Carson E.; Camargo, Carlos A. (December 2020). "National Study of the Emergency Physician Workforce, 2020". Annals of Emergency Medicine. 76 (6): 695–708. doi:10.1016/j.annemergmed.2020.06.039. PMID 32747085.
  7. ^ Karle, Hans (August 2010). "How do we Define a Medical School?". Sultan Qaboos University Medical Journal. 10 (2): 160–168. ISSN 2075-051X. PMC 3074706. PMID 21509225.
  8. ^ "Become a Medical Doctor - CUNY School of Medicine". 2022-08-23. Retrieved 2024-10-08.
  9. ^ "Consortium of Accelerated Medical Pathway Programs". Consortium of Accelerated Medical Pathway Programs. Retrieved 2024-10-08.
  10. ^ Rix, Kate (2024-04-04). "Reasons for Completing Medical School in Five Years". U.S. News & World Report. Retrieved 2024-10-08.
  11. ^ Barzansky, Barbara; Etzel, Sylvia I. (2023-09-12). "MD-Granting Medical Schools in the US, 2022-2023". JAMA. 330 (10): 977–987. doi:10.1001/jama.2023.15521. ISSN 0098-7484. PMID 37698578.
  12. ^ a b "Value-Added Roles for Medical Students - 9780323759502". US Elsevier Health. Retrieved 2024-10-08.
  13. ^ Zechariah, Sunitha; Ansa, Benjamin E.; Johnson, Stephanie W.; Gates, Amy M.; Leo, Gianluca De (2019-10-15). "Interprofessional Education and Collaboration in Healthcare: An Exploratory Study of the Perspectives of Medical Students in the United States". Healthcare. 7 (4): 117. doi:10.3390/healthcare7040117. ISSN 2227-9032. PMC 6956332. PMID 31618920.
  14. ^ American College of Physicians; Smith, Cynthia D.; Balatbat, Celynne; National Academy of Medicine; Corbridge, Susan; University of Illinois at Chicago; Dopp, Anna Legried; American Society of Health-System Pharmacists; Fried, Jessica; Hospital of the University of Pennsylvania; Harter, Ron; American Society of Anesthesiologists; Landefeld, Seth; University of Alabama at Birmingham; Martin, Christina Y. (2018-09-17). "Implementing Optimal Team-Based Care to Reduce Clinician Burnout". NAM Perspectives. 8 (9). doi:10.31478/201809c.
  15. ^ Medline Plus (2012). "Doctor of Osteopathic Medicine". U.S. National Library of Medicine of National Institutes of Health. Retrieved 20 December 2012.
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  17. ^ "Physician Education Debt and the Cost to Attend Medical School: 2020 Update". store.aamc.org. Retrieved 2024-10-08.
  18. ^ a b Shahriar, Arman A.; Puram, Vikram V.; Miller, Jonathan M.; Sagi, Varun; Castañón-Gonzalez, Lorenzo Adolfo; Prasad, Shailendra; Crichlow, Renée (2022-03-15). "Socioeconomic Diversity of the Matriculating US Medical Student Body by Race, Ethnicity, and Sex, 2017 - 2019". JAMA Network Open. 5 (3): e222621. doi:10.1001/jamanetworkopen.2022.2621. ISSN 2574-3805. PMC 8924719. PMID 35289863.
  19. ^ "Scholarships for Medical School". www.aafp.org. Retrieved 2024-10-08.
  20. ^ "Paying for Medical School Through Service". Students & Residents. Retrieved 2024-10-08.
  21. ^ "Medical School Programs". Medicine + The Military. Retrieved 2024-10-08.
  22. ^ "National Health Service Corps". nhsc.hrsa.gov. Retrieved 2024-10-08.
  23. ^ Merelli, Annalisa (2024-07-10). "Free medical school tuition unlikely to have a major impact on the U.S. health care system". STAT. Retrieved 2024-10-08.
  24. ^ "2024-2025 Residency Application Timeline and Month-by-Month Schedule". Med School Insiders. 2024-05-07. Retrieved 2024-07-08.
  25. ^ "Intro to The Match". NRMP. Retrieved 2024-07-08.
  26. ^ "How It Works". NRMP. Retrieved 2024-10-08.
  27. ^ Tomei, Krystal L.; Selby, Luke V.; Kirk, Lynne M.; Bello, Jacqueline A.; Nolan, Nathan S.; Varma, Surendra K.; Turner, Patricia L.; Elliott, Victoria Stagg; Brotherton, Sarah E. (November 2022). "Beyond Training the Next Generation of Physicians: The Unmeasured Value Added by Residents to Teaching Hospitals and Communities". Academic Medicine. 97 (11): 1592–1596. doi:10.1097/ACM.0000000000004792. ISSN 1040-2446. PMC 9592142. PMID 35731593.
  28. ^ a b c "State Specific Requirements for Initial Medical Licensure". www.fsmb.org. Retrieved 2024-10-08.
  29. ^ a b "Transition to a Single GME Accreditation System History". www.acgme.org. Retrieved 2024-10-08.
  30. ^ Culbertson, Randall L.; Kadavakollu, Samuel; Boyanovsky, Boris (2020-04-08). "Single Accreditation and The Match: How Does the Change Affect Osteopathic Graduates?". MedEdPublish. 9: 66. doi:10.15694/mep.2020.000066.1. ISSN 2312-7996. PMC 10697474. PMID 38058915.
  31. ^ Batalden, Paul; Leach, David; Swing, Susan; Dreyfus, Hubert; Dreyfus, Stuart (September 2002). "General Competencies And Accreditation In Graduate Medical Education". Health Affairs. 21 (5): 103–111. doi:10.1377/hlthaff.21.5.103. ISSN 0278-2715. PMID 12224871.
  32. ^ "Medical specialty choice: Should residency training length matter?". American Medical Association. 2020-11-19. Retrieved 2024-07-08.
  33. ^ "Osteopathic Postdoctoral Training Structure" (PDF). American Osteopathic Association. Retrieved 10 November 2012.
  34. ^ "About Medical Specialties Matching Program". National Resident Matching Program. 2010. Archived from the original on 9 December 2012. Retrieved 20 December 2012.
  35. ^ a b "Getting Board Certified". American Board of Medical Specialties. Retrieved 2024-07-08.
  36. ^ BoardVitals (2023-01-06). "CME Requirements By State". BoardVitals Blog. Retrieved 2024-07-08.
  37. ^ Dogra, Nisha; Bhatti, Farah; Ertubey, Candan; Kelly, Moira; Rowlands, Angela; Singh, Davinder; Turner, Margot (2016-04-02). "Teaching diversity to medical undergraduates: Curriculum development, delivery and assessment. AMEE Guide No. 103". Medical Teacher. 38 (4): 323–337. doi:10.3109/0142159X.2015.1105944. ISSN 0142-159X. PMID 26642916.
  38. ^ a b Stanford, Fatima Cody (June 2020). "The Importance of Diversity and Inclusion in the Healthcare Workforce". Journal of the National Medical Association. 112 (3): 247–249. doi:10.1016/j.jnma.2020.03.014. ISSN 0027-9684. PMC 7387183. PMID 32336480.
  39. ^ "Supreme Court strikes down affirmative action programs in college admissions". SCOTUSblog. 2023-06-29. Retrieved 2024-10-08.
  40. ^ a b c Cutrer, William B.; Miller, Bonnie; Pusic, Martin V.; Mejicano, George; Mangrulkar, Rajesh S.; Gruppen, Larry D.; Hawkins, Richard E.; Skochelak, Susan E.; Moore, Donald E. (January 2017). "Fostering the Development of Master Adaptive Learners: A Conceptual Model to Guide Skill Acquisition in Medical Education". Academic Medicine: Journal of the Association of American Medical Colleges. 92 (1): 70–75. doi:10.1097/ACM.0000000000001323. ISSN 1938-808X. PMID 27532867.
  41. ^ Regan, Linda; Hopson, Laura R.; Gisondi, Michael A.; Branzetti, Jeremy (November 2019). "Learning to learn: A qualitative study to uncover strategies used by Master Adaptive Learners in the planning of learning". Medical Teacher. 41 (11): 1252–1262. doi:10.1080/0142159X.2019.1630729. ISSN 1466-187X. PMID 31287741.
  42. ^ Gonzalo, Jed D.; Dekhtyar, Michael; Starr, Stephanie R.; Borkan, Jeffrey; Brunett, Patrick; Fancher, Tonya; Green, Jennifer; Grethlein, Sara Jo; Lai, Cindy; Lawson, Luan; Monrad, Seetha; O’Sullivan, Patricia; Schwartz, Mark D.; Skochelak, Susan (January 2017). "Health Systems Science Curricula in Undergraduate Medical Education: Identifying and Defining a Potential Curricular Framework". Academic Medicine. 92 (1): 123–131. doi:10.1097/ACM.0000000000001177. ISSN 1040-2446. PMID 27049541.
  43. ^ "Health Systems Science - 9780323694629". US Elsevier Health. Retrieved 2024-10-08.
  44. ^ Bharel, Sonia; McGillen, Brian; Salas, Rachel; Pandya, Dharmini Shah (July 2024). "Health Systems Science Integration in Graduate Medical Education: A Pathway to Quintuple Aim Success for Independent Practice". The American Journal of Medicine. 137 (7): 677–681. doi:10.1016/j.amjmed.2024.04.008.
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