{"id":28,"date":"2005-02-26T15:27:55","date_gmt":"2005-02-26T22:27:55","guid":{"rendered":"http:\/\/jillcook.com\/blog\/?page_id=28"},"modified":"2009-03-23T15:24:32","modified_gmt":"2009-03-23T23:24:32","slug":"dr-jill-the-journey","status":"publish","type":"page","link":"https:\/\/jillcook.com\/blog\/dr-jill-the-journey\/","title":{"rendered":"Dr. Jill – The Journey"},"content":{"rendered":"

(- Or – How does\u00c3\u201a\u00c2\u00a0one become a doctor, anyway?)<\/em><\/p>\n

For me, this journey all started back when I was\u00c3\u201a\u00c2\u00a0just knee high to a duck, as one of my patients likes to say.\u00c3\u201a\u00c2\u00a0 I knew from preschool or so that I wanted to become a doctor, but I (like many of you) really didn’t have any idea of all the hoops one must jump through in order to finally achieve that.\u00c3\u201a\u00c2\u00a0 In fact – I was still rather clueless at the time I entered medical school.\u00c3\u201a\u00c2\u00a0 Now that I have finished my formal medical education, I have the ability to pass on my knowledge on the subject…\u00c3\u201a\u00c2\u00a0 (and if you just want the quick and dirty list of steps, scroll to the end).<\/p>\n

Medical School Prerequisites
\n<\/strong>\u00c3\u201a\u00c2\u00a0\u00c3\u201a\u00c2\u00a0\u00c3\u201a\u00c2\u00a0\u00c3\u201a\u00c2\u00a0\u00c3\u201a\u00c2\u00a0\u00c3\u201a\u00c2\u00a0\u00c3\u201a\u00c2\u00a0\u00c3\u201a\u00c2\u00a0\u00c3\u201a\u00c2\u00a0 First off,\u00c3\u201a\u00c2\u00a0you have to complete the requirements for entering medical school – namely earning a Bachelor’s Degree in the subject of\u00c3\u201a\u00c2\u00a0your choice.\u00c3\u201a\u00c2\u00a0 This is an oft misunderstood point, many people believe you must major in “PreMed” or a science subject, but that is far from the truth.\u00c3\u201a\u00c2\u00a0 Many people come into medicine with degrees in Literature, History, Education, Computer Science, Business\u00c3\u201a\u00c2\u00a0– pretty much anything.\u00c3\u201a\u00c2\u00a0 All medical school applicants must complete certain requirements as an undergraduate (including a certain number of hours of biology, chemistry, physics, mathematics, and english) but beyond that you can do whatever you want.
\nThe other requirement for medical school applicants is to take the MCAT (Medical College Admissions Test) which has 4 sections: Verbal Reasoning, Physical Sciences (physics and chemistry), Biological Sciences (biology and organic chemistry), and a writing sample.\u00c3\u201a\u00c2\u00a0 There is no “passing” score for this exam, but each of the multiple choice sections has a high score of 15 – so the highest possible score is a 45.\u00c3\u201a\u00c2\u00a0 Generally, scores of 30 or higher are considered pretty good (above 35 is excellent), and you are still an “acceptable” applicant if you score is above 24 – usually these people also have some other outstanding qualities (community service, research, extenuating circumstances, great personality) that make them look good to schools.\u00c3\u201a\u00c2\u00a0 As a note, many medical schools have a “cut-off” for MCATs and GPAs where they won’t even look at you if you are below their set numbers… just an FYI.
\nSo, you get your degree, take the MCAT, and apply to the schools – next step is the interview (all medical schools require them and they are a BIG part of deciding if you get accepted).\u00c3\u201a\u00c2\u00a0 Then you wait…\u00c3\u201a\u00c2\u00a0 If you get in, then you are heading off to complete your next step to becoming a doctor.<\/p>\n

Medical School<\/strong>
\nCongratulations, you’re\u00c3\u201a\u00c2\u00a0now in medical school.\u00c3\u201a\u00c2\u00a0 You will spend four years here and take 3 critical exams before graduating.\u00c3\u201a\u00c2\u00a0 In many medical schools you spend your first two years in the classroom\/laboratory – lots of lectures on anatomy, physiology, biochemistry, pathology, and pharmacology that cover all the organ systems of the body.\u00c3\u201a\u00c2\u00a0 There’s also a smattering of ethics, biostatistics, taking a patient history, and performing a physical exam.\u00c3\u201a\u00c2\u00a0 Then you finish your MSII\u00c3\u201a\u00c2\u00a0year (MS=medical student, followed by your year in Roman numerals) and you take the USMLE Step 1 (United States Medical Licensing Examination).\u00c3\u201a\u00c2\u00a0 This is a multiple choice exam given at a testing center on a computer.\u00c3\u201a\u00c2\u00a0 You have to pass this to become an\u00c3\u201a\u00c2\u00a0MSIII, so it is a source of huge stress to medical students, though few people actually end up failing.\u00c3\u201a\u00c2\u00a0 It is also a big deal because this score shows up on your residency applications (more about residency later) so people really want to shine here.\u00c3\u201a\u00c2\u00a0 Scoring for this\u00c3\u201a\u00c2\u00a0exam is really weird, there is really no absolute high or low that is possible… but the breakdown is basically that you need a 182 to pass, the\u00c3\u201a\u00c2\u00a0national average is about 214,\u00c3\u201a\u00c2\u00a0and scores above 230 are pretty impressive.
\nAfter passing the USMLE Step\u00c3\u201a\u00c2\u00a01, you\u00c3\u201a\u00c2\u00a0become an MSIII and the entire year is spent in the hospital working as a member of the health care team.\u00c3\u201a\u00c2\u00a0 You have certain required rotations, and some medical schools differ, but usually they include Surgery, Pediatrics, Neurology, Family Medicine, OB\/GYN, Psychiatry, and Internal Medicine.\u00c3\u201a\u00c2\u00a0 You will work with the Attendings (fully licensed physicians), Residents (not-quite fully licensed physicians – more later), and other students.\u00c3\u201a\u00c2\u00a0 Your responsibilities can vary, but usually you are assigned certain patients that the team is taking care of and you are to see them each morning to see how they are doing,\u00c3\u201a\u00c2\u00a0write a note in their medical chart to document that you’ve seen them, and then present your findings to the residents and attendings at rounds.\u00c3\u201a\u00c2\u00a0 Rounds are where the whole team gets together and talks about all the patients they are caring for and makes decisions about what the plan will be for each of them.\u00c3\u201a\u00c2\u00a0 Often the team will walk to each patient’s room, stop outside to talk about how the patient is doing, and then go in and see the patient.\u00c3\u201a\u00c2\u00a0 Alternatively, the team may sit in a conference room and do all the talking, and then go around and see all the patients.
\nAt many medical schools, the end of each rotation is marked by taking an exam – the standardized ones are called “Shelf” exams (don’t ask why it is called that, no one seems to know).\u00c3\u201a\u00c2\u00a0 After passing all the rotations, you finish third year and head into fourth year.\u00c3\u201a\u00c2\u00a0 This year is also spent entirely in the hospital, but it is so much better because there are very few required rotations and mainly you get to choose electives.\u00c3\u201a\u00c2\u00a0 However, at some point in your fourth year you must take and pass the USMLE Step 2CK and Step 2CS.\u00c3\u201a\u00c2\u00a0 The Step 2CK (Clinical Knowledge) is\u00c3\u201a\u00c2\u00a0just like Step 1 (entirely multiple choice, given on computer) except with a different emphasis – more clinical rather than basic science.\u00c3\u201a\u00c2\u00a0 The scoring for this is much like for Step 1, and the minimum passing score is 182.\u00c3\u201a\u00c2\u00a0 The Step 2CS (Clinical Skills) is an in-person examination using standardized patients (read: actors) who act out certain sets of symptoms, and you must get their history, perform a\u00c3\u201a\u00c2\u00a0physical exam, and write the note that would go in their chart, including a list of up to five diagnoses the patient may have as well as the immediate plan for their care.\u00c3\u201a\u00c2\u00a0 Over the course of the\u00c3\u201a\u00c2\u00a04-5 hour exam, you will see about 10 patients.\u00c3\u201a\u00c2\u00a0 Not only are you evaluated on how well you can\u00c3\u201a\u00c2\u00a0do the\u00c3\u201a\u00c2\u00a0history\/physical and come up with a diagnosis\/treatment plan, you are also evaluated on your communication skills, making the patient feel comfortable, and how you handle challenging situations (angry patient, patient asking “Do I have cancer”, etc).\u00c3\u201a\u00c2\u00a0 The scoring for this exam is not entirely clear to me (it is a very new exam), but it is basically Pass\/Fail when all of the clinical encounters are looked at together.
\nSo, medical school is a four-year process, and at the end you receive your MD.\u00c3\u201a\u00c2\u00a0 Therefore you can now be called Doctor – but you can’t practice on your own yet because you are not fully licensed yet.\u00c3\u201a\u00c2\u00a0 To get that, you must do a residency.<\/p>\n

Residency<\/strong>
\nTowards the end of your MSIV year, you will apply to get a spot in a residency program.\u00c3\u201a\u00c2\u00a0 This is where you finally get to choose what kind of doctor you want to be.\u00c3\u201a\u00c2\u00a0 While medical school was all about exposing you to all that the field of medicine has to offer, residency is all about training you in depth to be a wonderful pediatrician, or hand surgeon, or OB\/GYN (whatever you choose).\u00c3\u201a\u00c2\u00a0 The application process\u00c3\u201a\u00c2\u00a0entails\u00c3\u201a\u00c2\u00a0forms and interviews, and at the end you rank all your top choices in order, all the programs rank their top applicants in order and through the magic of computers applicants are matched with programs on what is appropriately called “Match Day”.\u00c3\u201a\u00c2\u00a0 So on that fateful day you are handed a slip of paper that says where you will be heading off to for the next 3-7 years depending\u00c3\u201a\u00c2\u00a0on what specialty you chose.\u00c3\u201a\u00c2\u00a0 This is way different from applying to jobs out in “the real world” because that slip of paper you get on Match Day is a binding contract – so you submit your top 5 or 10 or 40 choices of where you would like to go for residency, and wherever the computer puts you, you go, whether it’s #1 or #37, you go.\u00c3\u201a\u00c2\u00a0 Technically, the process is supposed to favor the applicants, but you’d better be sure you don’t include any places you wouldn’t like to end up!
\nAfter graduation, you head off to your residency and you start your first year, also referred to as your intern year.\u00c3\u201a\u00c2\u00a0 So, anytime you hear “Intern” in medicine, it refers to the newest kids on the block, but they are actually MDs.\u00c3\u201a\u00c2\u00a0 This is not to be confused with “Internist” which means an MD who specializes in Internal Medicine… but I digress.\u00c3\u201a\u00c2\u00a0\u00c3\u201a\u00c2\u00a0 So your intern year is your first year of residency, and how many years of residency you have to complete depends on what specialty you choose.\u00c3\u201a\u00c2\u00a0 Pediatrics is 3 years (that’s what I did), surgeons have 5-7, OB\/GYNs do 4-5… it all varies.\u00c3\u201a\u00c2\u00a0 During your residency you learn how to be a doctor of whatever your specialty is and you move up in rank each year, from Intern, to R2, to R3 (“R” for “resident” followed by your year number), etc. until, sometimes, you might be a Chief Resident – one of the senior-most residents in charge of all the others (they make the schedules, handle disputes, etc).\u00c3\u201a\u00c2\u00a0 The Chief year is usually an extra year added onto the end of residency, though.\u00c3\u201a\u00c2\u00a0 Sometime during residency you also have to take the USMLE Step 3 – another (mainly) multiple choice exam given on computer (there are also a couple case-simulations on the computer requiring short answers).\u00c3\u201a\u00c2\u00a0 This is best done during your intern year, because it covers all areas of medicine, not just the area of your residency, so the closer to medical school you are, the more the knowledge of those other specialities will still be floating around in your head.\u00c3\u201a\u00c2\u00a0 The minimum passing score for that is 184.\u00c3\u201a\u00c2\u00a0 After you pass all the USMLE Steps and finish residency, you can get your unrestricted medical license.
\nIt is important to note that while you are a resident you\u00c3\u201a\u00c2\u00a0 are called “Doctor” (because you have your degree) and you act as the doctor for your patients.\u00c3\u201a\u00c2\u00a0 You are under the supervision of your more senior residents and, ultimately, the attendings, but you basically are a doctor and you see patients, orders tests, and write prescriptions just like any other doctor.\u00c3\u201a\u00c2\u00a0 You also get a paycheck, though it is quite small compared to what you will make after you finish your residency.<\/p>\n

Licensing and Board Certification<\/strong>
\nThe final step(s) in becoming an autonomous doctor are receiving your unrestricted medical license and becoming board certified.\u00c3\u201a\u00c2\u00a0 You can apply for your license after passing all 3 Steps of the USMLE, but you will not be granted a full medical license until you have finished residency, so most people wait till about halfway through their last year to start this application process.\u00c3\u201a\u00c2\u00a0 Once you finish your residency, you can apply to take the board certification exam for your specialty.\u00c3\u201a\u00c2\u00a0 This is NOT required to practice, but most physicians become board certified because it carries more weight with patients, and often hospitals require it if you want a contract with them.\u00c3\u201a\u00c2\u00a0 This certification must be renewed every so many years (varies by specialty) by taking CME (Continuing Medical Education) credits and passing a\u00c3\u201a\u00c2\u00a0renewal certification exam.\n<\/p>\n

So there you have it – now you’re a real live doctor.\u00c3\u201a\u00c2\u00a0 Hopefully you were able to understand everything.\u00c3\u201a\u00c2\u00a0 And for those of you wanting the quick and dirty overview, here it is:<\/p>\n

\n

1. Undergraduate –<\/em> get your Bachelor’s degree
\n2. Medical Student – <\/em>4 years, includes classroom and in-hospital work, at the end you get your MD and can be called “Doctor” but you’re not fully licensed yet
\n3. Resident –<\/em> length varies by specialty (3-7 years), first year you are called an “Intern”, at the end you get your unrestricted medical license and board certification
\n4. Fully licensed, practicing on your own Doctor!<\/p>\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"

(- Or – How does\u00c3\u201a\u00c2\u00a0one become a doctor, anyway?) For me, this journey all started back when I was\u00c3\u201a\u00c2\u00a0just knee high to a duck, as one of my patients likes to say.\u00c3\u201a\u00c2\u00a0 I knew from preschool or so that I … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-28","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/pages\/28","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/comments?post=28"}],"version-history":[{"count":0,"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/pages\/28\/revisions"}],"wp:attachment":[{"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/media?parent=28"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}