Medical education is the educational activities involved in the education and training of physicians.
The typical outline of the medical education path in the United States is presented below. However, since medicine is a diverse profession with many options available, there are different paths to take. For example, some physicians decide to work in occupational medicine (e.g. occupational therapy) or join the armed forces.
Medical School[]
Medical school, in the United States, is a four-year graduate institution with the purpose of educating its students in the field of medicine. Graduates receive either a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.) degree, depending on the attended medical school. However, the shown physicians in Grey's Anatomy and Private Practice all are Doctors of Medicine, meaning they have received an M.D. degree.
Typically, medical school consists of four years of training. The first two years consist of basic science classes, such as anatomy, biochemistry, etc. During the second year, the students have to take the first step of the United States Medical Licensing Exam, of which the results affect what residency program the doctor will take. The third and fourth years consist of clinical rotations, sometimes called clerkships, where students attend teaching hospitals and clinics. At the end of the final year, the students have to take the second part of the United States Medical Licensing Exam in order to obtain their medical license. It tests the clinical knowledge and skills in order to practice medicine.
When they pass for the exam, students must apply for a postgraduate residency in their chosen specialty.
Residency[]
After a specialty has been chosen, the education specifically for that specialty is given in a 3 to 6 year residency program. Most doctors on the shows have taken a general surgical residency, though some of them have taken a specialty-specific residency.
Internship[]
| “ | You're interns, grunts, nobodies, bottom of the surgical food chain. You run labs, write orders, work every second night until you drop and don't complain. | ” |
— Miranda Bailey describing the position of interns in the hospital.
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Cristina as an intern.
Once hired by a teaching hospital, the physicians enroll in the hospital's residency program. The first year of the residency is commonly known as the intern year, but depending on the chosen specialty, the intern year may not be included in the specialty's residency. The interns are assigned to a higher year resident, who informs them about the rules and protocols of the hospital. During the intern year, the physicians are under strict supervision of the resident they were assigned to and mostly get stuck with scut work. They get to observe surgeries more rather than operate themselves.
The intern year ends with step 3 of the United States Medical Licensing Exam, this part being more commonly known as the intern exam. When an intern passes this exam, they are certified as general practitioners and can continue in their residency program. Those who do not pass, are either obligated to leave the program or to restart their intern year, depending on the exam results.
Second and Third Year[]
Cristina as a second-year resident.
As of the second year of residency, the physicians are referred to as residents, rather than as interns. They are assigned their own groups of interns to supervise. They continue to be supervised themselves, but now by attendings, whereas interns are primarily supervised by their resident. The residents get to scrub in on surgeries more often and the best residents occasionally get a chance to perform a solo surgery, albeit with an attending watching their every move and ready to step in in case anything goes wrong.
Fourth Year[]
Little changes in the fourth year of residency, but each resident is evaluated throughout this year by the Chief of Surgery and the attendings in order for them to pick a Chief Resident at the end of the year. The residents are now trusted by their attendings to take care of patients in pre- and post-op without their direct supervision.
Fifth Year[]
Cristina in her fifth year.
During the fifth year, the residents rotate in as lead surgeons. Their attendings have to stand back in the OR and allow the fifth years to make the decisions. They only can take over if the patient's life is in imminent danger. Throughout the year, the residents have to prepare for the oral board exams at the end of the year. Each surgical outcome comes on their record and bad outcomes will make the residents hard-pressed to find a fellowship. General surgical residents have to make up their minds about which specialty they are going pick.
At the end of the year, every fifth year resident has to take the oral board exams, where they have to answer questions about the surgeries they performed during their fifth year. If they pass, they are board certified in the specialty of the residency they completed. If they do not pass, they can still be hired as attendings but board certified surgeons are usually preferred.
Fellowship[]
Cristina as a fellow in cardiothoracic surgery.
After completing a general surgery residency, an additional training period referred to as fellowship is meant to further train the fellow in a certain specialty. During a fellowship, a physician acts as an attending albeit still somewhat supervised by an attending, especially for extraordinary cases. The degree to which a fellow is supervised depends on their supervisor. The length of the fellowship depends on what specialty is chosen.