medical school in the United States

EDUCATION OFFERING

Caribbean offshore medical schools often specified in the Medical Doctor degree, while US and Canadian Medical Schools are often departments of universities who offer several degrees. The curriculum of offshore Medical Schools in the Caribbean follows the one in US, as they usually only offer two years of basic science study and use teaching hospitals or clinics in US or Canada, sometimes in UK for clinical training. The teachings often focus on the United States Medical Licensing Examination (USMLE) and the Educational Commission for Foreign Medical Graduates (ECFMG) certification process, and the measurement of performance is the passing rate of students in the exams. In most schools, passing of the USMLE Step 2 exam is required to graduate and get a M.D. degree.

In most schools, the academic calendar is divided into trimesters, with semesters starting in January, May and September. The lack of a summer break offers students a potentially faster route than US medical schools to a degree with a compressed curriculum.

STUDENT BODY

Caribbean offshore medical schools have less than 5% local students and the rest are mainly from North America. They are also relatively older than their North America counterparts. As of 2004, the average ages in schools are 27–30 years old, and half of them are nurse, paramedic, physician assistant etc. on their second career. Whether a school has state board accreditation or is recognized by loan programs appear to have great influence on the number of applicants, and the effect is seem in the size of student body. Between 1993 and 2007, the mean age of first time ECFMG certification exam applicants from Caribbean offshore medical schools was 29.5 years, and 38% of the applicants were female. The passing rate were 57.4% for the USMLE Step 1 but results varies wildly by country.

FACULTY

Most educational faculty in Caribbean offshore schools are physicians or medical teachers from US or Canada, with at least a MD degree, some with PhDs. Lacking research faculties, the student-to-teacher ratio ranges between 9 and 13.

ACCREDITATION

Like United States and Canada, there is no central authority for accreditation as rules and regulations in many Caribbean countries differ greatly. CAAM-HP is a local accreditation body, while ACCM is invited by some countries to accredit on their behalf. Although a US state board accreditation is not necessary for students to participate in residency matching, some school seek such accreditation as it is required for attractive residency destinations such as California or New York.

According to the World Bank, establishing a medical school in Caribbean is significantly easier than in the states. Schools are not required to do research and perform clinical training as LCME accreditation demands. Typically it only requires a business license to open a medical school in the Caribbean and get listed in the International Medical Education Directory (IMED), which qualifies their students to undergo the ECFMG certification process. As of 2010, there were 61 IMED-listed medical schools in Caribbean, up from 29 10 years ago, of which 22 began instruction and 5 ceased operation between 2000 and 2010. There were 5 additional schools applied for IMED listing between 2007 and 2010 but did not meet IMED's listing requirement as of 2010.

The increasing number of schools has both positive and negative effects. On one hand, low initial cost in establishment increased competition, that in turn increases the quality of service. On the other hand, this created a big demand in clinical rotations that even the large states have problem accommodating, let alone their home country, and draw attention from US and Canada auditors who are concerned over public loan use.

The Medical College Admission Test (MCAT) is a computer-based standardized examination for prospective medical students in the United States, Australia, Canada, and Caribbean Islands. It is designed to assess problem solving, critical thinking, written analysis and knowledge of scientific concepts and principles. Prior to August 19, 2006, the exam was a paper-and-pencil test. Since January 27, 2007, however, all administrations of the exam have been computer-based.

Offshore medical school

An offshore medical school is a medical school that caters "primarily to foreign (North American) students, wishing to practice medicine in the US and Canada" according to the World Bank, compared to local public schools that focus on their home nation.Nonetheless, the local economies often benefit from the academic and economic influence from those schools. Such schools are chiefly located in the Caribbean.

INTERNATIONAL MEDICAL STUDENTS IN USA

An international medical graduate (IMG), earlier known as a foreign medical graduate (FMG), is a physician who has graduated from a medical school outside of the country where he or she intends to practice. Generally, the medical school of graduation is one listed in the International Medical Education Directory (IMED) as accredited by the Foundation for Advancement of International Medical Education and Research or the World Health Organization.

Medical schools around the world vary in education standards, curricula, and evaluation methods. Reason why many countries have their own certification program, equivalent to the ECFMG in the United States. The purpose of ECFMG Certification is to assess the readiness of international medical graduates to enter clinical specialty training programs as resident physicians and fellowship programs in the United States.

Graduates of Canadian M.D. programs are not considered IMGs in the United States.

Indian physician with an MBBS are qualified to take the USMLE. However, since the 2010s, the process of obtaining a license was becoming increasingly complicated^. India has exported more physicians to the United States than any other foreign nation

Pathway

The main pathway for IMGs who wish to be licensed as physicians in the United States is to complete a U.S. residency hospital program. The general method to apply for residency programs is through the National Resident Matching Program (abbreviated NRMP, also called "the Match"). To participate in the NRMP, an IMG is required to have an ECFMG certification by the "rank order list certification deadline" time (usually in February of the year of the match). To acquire an ECFMG certification, the main requirements are:

• Completion of USMLE Step 1, USMLE Step 2 Clinical Knowledge and USMLE Step 2 Clinical Skills
• A medical diploma of medical education taken at an institution registered in the International Medical Education Directory (IMED)

In comparison, regular graduates from medical schools in the United States and Canada need to complete USMLE Steps 1 and 2 as well, but can participate in the NRMP while still doing their final year of medical school before acquiring their medical diplomas. In effect, taking regular administrative delays into account, and with residency programs starting around July, there is a gap of at least half a year for IMGs between graduation from medical school and beginning of a residency program.

Those IMGs who have passed the necessary USMLE exams and obtained the ECFMG certification can then apply to U.S. residency positions via the NRMP and ERAS.

One study came to the result that almost half of IMGs were unsuccessful in their first attempts in the pursuit of a U.S. residency position, and three-quarters began a residency after five years. It also indicated that IMGs were considerably older when they first applied for a residency position than are most U.S. medical graduates, with mean age of IMGs when the ECFMG certificate was issued being 31.3 years, with a standard deviation of 5.6 years.

All applicants to residency programs in California need a Postgraduate Training Authorization Letter (PTAL), colloquially called a "California Letter". Obtainment of a PTAL requires graduation from a medical school listed by the Medical Board of California, which is more stringent than the International Medical Education Directory. It also requires having a Social Security number.

The Doctor of Medicine (Latin: Medicinae Doctor, meaning "teacher of medicine," abbreviated M.D.) is a terminal medical degree for practitioners of medicine. The meaning of the degree varies between different countries. In countries that follow the United States system, the M.D. denotes a first professional graduate degree awarded upon initial graduation from medical school. In countries that follow the tradition of the United Kingdom, the M.D. denotes a research doctorate, higher doctorate, honorary doctorate or advanced clinical coursework degree restricted to medical graduates. In those countries, the title of the equivalent first professional degree is Bachelor of Medicine, Bachelor of Surgery.

United States and Canada

In the United States, MDs are awarded by medical schools as "Professional Doctorate" and is accredited by the Liaison Committee on Medical Education (LCME), an independent body sponsored by the Association of American Medical Colleges and the American Medical Association (AMA).

Admission to medical schools in the United States and Canada is highly competitive, and in the United States about 17,800 out of approximately 47,000 applicants received at least one acceptance to any medical school in recent application years. Before entering medical school, many schools require that students complete a four-year undergraduate degree and take the Medical College Admission Test (MCAT); however, some medical schools require only a certain amount of undergraduate coursework (but not degree completion) before the start of the medical curriculum.Before graduating from a medical school and achieving the Doctor of Medicine degree, most schools require their students to take the United States Medical Licensing Examination (USMLE) Step 1 and both the clinical knowledge and clinical skills parts of Step 2. The MD degree is typically earned in four years. Following the awarding of the MD, physicians who wish to practice in the United States are required to complete at least one internship year (PGY-1) and pass the USMLE Step 3. In order to receive board eligible or board accredited status in a specialty of medicine such as general surgery or internal medicine, they undergo additional specialized training in the form of a residency. Those who wish to further specialize in areas such as cardiology or interventional radiology then complete a fellowship. Depending upon the physician's chosen field, residencies and fellowships involve an additional three to eight years of training after obtaining the MD. This can be lengthened with additional research years, which can last one, two, or more years.

The Doctor of Osteopathic Medicine or DO degree is the only other legal and professional equivalent to the MD degree in the United States and Canada for physicians . The sole difference between the MD and the DO degrees is the additional musculoskeletal training in osteopathic manipulative treatment (OMT).

In Canada, the MD is the basic medical degree required to practice medicine. McGill University Faculty of Medicine is the only medical school in Canada that continues to award the MD, CM degrees (abbreviated MDCM). MDCM is from the Latin "Medicinae Doctorem et Chirurgiae Magistrum" meaning "doctor of medicine and master of surgery". Upon graduation, students enter into a residency phase of training. Prior to obtaining independent practicing license from a provincial regulatory body, students must complete the Medical Council of Canada Qualifying Examination to obtain the Licentiate of the Medical Council of Canada (LMCC) qualifications.

India

The MBBS (Bachelor of Medicine/Bachelor of Surgery) degree represents the first (undergraduate) level of training required to be licensed as a physician, and the MS or MD degree is a postgraduate degree, representative of specialty training. The equivalent training in the US or Canada would be the completion of a medical (post-graduate) degree. Eligibility for the MS or MD course is restricted to medical graduates holding the MBBS degree.

The MBBS course is for five and a half years, and training imparted is as follows:

1. Pre-clinical (Anatomy, Physiology, and Biochemistry)
2. Para-clinical (Pathology, Microbiology, Pharmacology, Forensic Medicine and Community Medicine)
3. Clinical (Ophthalmology, Otorhinolaryngology, General Medicine, General Surgery, Pediatrics and Obstetrics/Gynecology; with specialty rotations such as Orthopaedics, Radiology, etc.).

After three years of study and the successful completion of an examination, which includes both theoretical and practical elements, in a pre-clinical or clinical subject of a non-surgical nature (e.g. Physiology, Pharmacology, Internal Medicine, Pediatrics) the candidate receives MD degree, whereas in a pre-clinical or clinical subject of a surgical nature (e.g. Anatomy, General Surgery, Orthopaedics, Obstetrics/Gynaecology), the candidate receives the equivalent degree Master of Surgery (MS).

A second alternate qualification termed DNB [Diplomate of National Board], is considered equivalent to the MD and MS degrees. This can be obtained by passing the exam conducted by the National Board of Examinations after completing 3 years of post-MBBS residency training in teaching hospitals recognised by the board. The College of Physicians & Surgeons of Bombay, India (Established 1912) also awards higher postgraduate degrees in clinical and pre-clinical specialties, called FCPS; it involves three years of study and the successful completion of an examination, which includes both theoretical and practical elements, and a research thesis and a viva. The FCPS is representative of specialty clinical training, and equivalent to MD/MS/DNB in India, or Ph.D. or Professional Doctorates in other parts of the world. Until 2007, the Government of India and the Medical Council of India recognised the FCPS qualification - since then, this is being done by State Medical Councils.

After obtaining the first postgraduate degree, that is MD/MS/FCPS/DNB, one can go for further specialisation in medical or surgical fields. This involves a highly competitive entrance examination. Course has three years of additional training and study and then after passing an examination, both theory and practical, the degree awarded is DM (Doctor of Medicine), like DM in Cardiology, Neurology, Nephrology, Gastroenterology, Neuroradiology, Critical Care, Pulmonology, Hematology, Medical Oncology, Cardio-anaesthesia, Clinical Pharmacology and Neuroanaesthesia. For surgical superspecialities the degree awarded is MCh (Magister Chirurgiae), like MCh in Cardio-thoracic and Vascular Surgery, Endocrine Surgery, Neurosurgery, Surgical Gastroenterology, Urology, Plastic Surgery, Pediatric Surgery etc. DM and MCh are Doctorate degrees. A third alternate qualification is DNB (superspecialties), offered by National Board of Examinations, like DNB in Cardiology, Neurology, Cardiac Surgery, Neurosurgery.

Following DM or MCh, one can further go for a third postdoctorate degree that is, postdoctoral fellowship programs of one-year duration in specific subspecialties like Cardiac Electrophysiology, Invasive cardiology, Pediatric cardiology, Epilepsy, stroke, electroencephalography, movement disorders, neuromuscular disorders, cerebrovascular surgery, skull base surgery, pediatric cardiac surgery etc. offered by prestigious government institutes.

A medical school in the United States is a four-year graduate institution with the purpose of educating physicians in the field of medicine. Such schools provide a major part of the medical education in the United States. Graduates receive either a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.) degree.

Admissions to medical school in the United States is generally considered competitive. Admissions criteria include grade point averages, Medical College Admission Test scores, letters of recommendation, and interviews. Most students have at least a bachelor's degree, usually in a biologic science, and some students have advanced degrees, such as a master's degree. Most students that apply to medical school do not matriculate at a medical school. Medical School in the United States does not require a degree in biological sciences. People with degrees in different fields can be admitted to medical school as long as the criteria for admission is followed.

Medical school typically consists of four years of training, although a few programs (at least two) offer three-year tracks. The first two years consist of basic science courses, such as anatomy, biochemistry, histology, microbiology, pharmacology, physiology, cardiology, pulmonology, gastroenterology, endocrinology, psychiatry, neurology, etc. The third and fourth years consist of clinical rotations, sometimes called clerkships, where students attend hospitals and clinics. These rotations are usually at teaching hospitals but are sometimes at community hospitals or with private physicians. The typical "core" (i.e. mandatory) rotations taken in third year are Obstetrics and Gynecology, Pediatrics, Psychiatry, Family Medicine, Internal Medicine, and Surgery. Fourth year for the most part will consist of electives and some mandatory rotations like Emergency Medicine and Neurology - but again, some schools are different and some have been able to allow students to take an elective or two during third year, while many schools have also been trying to do the same. Some schools have been trying to incorporate Neurology and/or Emergency Medicine into third year, since by the time students are applying for residency programs, many haven't been exposed to either. However, again, it varies by school, and it varies by the mission of each medical school.

The Flexner Report, published in 1910, had a significant impact on reforming medical education in the United States. The report led to the implementation of more structured standards and regulations in medical education. Currently, all medical schools in the United States must be accredited by a certain body, depending on whether it is a D.O. granting medical school or an M.D. granting medical school. The Liaison Committee on Medical Education (LCME) is an accrediting body for educational programs at schools of medicine in the United States and Canada. The LCME accredits only the schools that grant a Doctor of Medicine (M.D.) degree; osteopathic medical schools that grant the Doctor of Osteopathic Medicine (D.O.) degree are accredited by the Commission on Osteopathic College Accreditation of the American Osteopathic Association. The LCME is sponsored by the Association of American Medical Colleges and the American Medical Association.

PRE MEDICAL

Pre-medical (often referred to as pre-med) is an educational track that undergraduate students in the United States and Canada pursue prior to becoming medical students. It involves activities that prepare a student for medical school, such as pre-med coursework, volunteer activities, clinical experience, research, and the application process. Some pre-med programs providing broad preparation are referred to as “pre-professional” and may simultaneously prepare students for entry into a variety of first professional degree or graduate school programs that require similar prerequisites (such as medical, veterinary, or pharmacy schools).At most colleges and universities, students do not have the option of pre-medical major or minor. A student on a pre-med track is permitted to choose any undergraduate major in any field of study, so long as certain required courses are completed. Such courses are generally focused in the scientific fields of biology, chemistry, organic chemistry, neuroscience, and physics, which are necessary for an individual to be prepared for the Medical College Admission Test (MCAT) and satisfy most medical school prerequisites.It is for this reason students on a pre-med track generally undertake a major associated with one of those fields; however, an increasing number of students with a background in humanities have been applying in recent years, a situation applauded by medical schools. For example, Mount Sinai School of Medicine has created a program specifically for non-science majors. The Humanities and Medicine Program grants admission to undergraduates majoring in the humanities or social sciences without requiring the Medical College Admission Test (MCAT) or science coursework.

PRE-MED TIMELINE

Typical pre-med students will structure their coursework in their first year in university to accommodate the required courses. After a semester, many pursue extracurricular activities that demonstrate a commitment to medicine. Once junior year arrives, students register for and take the MCAT, the required standardized exam that medical schools use to identify qualified candidates. Once the test is taken, students apply to various schools using the automated AMCAS system, AACOMAS system, or in some cases, the school's own application system. AMCAS primary applications are verified by AMCAS staff, a process that often takes four to six weeks. The application process consists of a review of academic records, MCAT scores, activities, work experience, and a personal statement. Applicants can expect to hear from schools within a few months, at which point they may receive "secondary applications". Different schools have different policies on sending secondary applications to students; many send secondary applications to all students, others screen applications prior to inviting an applicant to submit a secondary application. These applications are generated by each individual school. They generally contain essay questions that the applicant must answer to demonstrate that the applicant possesses qualities that the schools deem necessary to be a good medical student and physician. Qualified applicants can next expect to receive invitations to interview at schools. Upon completion of an interview and receipt of any additional application materials, the application is considered to be complete, and the student then waits for the school's decision to either accept or reject the student.

Some applicants receive admittance to medical school through a "post-baccalaureate" pre-medical program. These programs may be formal, such as the programs offered through Columbia, Johns Hopkins, Mayo Clinic with Barrett, The Honors College, Bryn Mawr, Goucher and Scripps, or semi-formal, such as the program offered at Harvard, but often consist of a student informally enrolling in a college to complete science coursework required for admission to medical school prior to sitting for the MCAT. The AAMC maintains a list of all formal and semi-formal post-baccalaureate pre-medical programs in the United States.

COURSEWORK

The Association of American Medical Colleges has created a list of required courses that every pre-med student must take. Each school is allowed to place its own further requirements.

The pre-medical coursework is offered at many American colleges and universities; however, it is considered to be a "track" that follows a certain curriculum. Most pre-medical students major in the natural and applied sciences, such as agricultural science, biology, chemistry, or physics, though this is not a requirement. Some pre-professional degree programs in agriculture prepare students for direct entry into the workforce in fields in high demand, while also meeting requirements for medical or veterinary schools. The latter curriculum model is meant to enhance employability of graduates awaiting admission or choosing not to attend professional or graduate school.

The courses that must be taken to meet the pre-medical requirements as set forth by the AAMC are two years of chemistry, with one being in organic chemistry, one year of biology, and one year of physics. These course requirements are expected to change since the MR5 Committee, charged with revising the Medical College Admissions Test has created a new set of core competencies for success in medical education and practice. Those core competencies will include a greater emphasis on molecular genetics within the biology curriculum and will include biochemistry. In addition, the 2015 MCAT will test in areas related to multicultural sensitivity and in critical analysis of ethics and philosophy. Many colleges of medicine and undergraduate pre-medical advising offices have yet to formalize pre-medical curricular recommendations. Though it did not address changes in the mathematics, physics, psychosocial or humanities portion of pre-medical education, the American Society for Biochemistry and Molecular Biology (ASBMB) developed a set of pre-medical curricular recommendations. ASBMB advocated that the year of biology includes genetics; that general and organic chemistry be taught with an orientation toward the chemistry of molecules encountered in living things; that one semester of biochemistry be required and two semesters of biochemistry be recommended; and that the laboratory course requirement can be taught in biology, chemistry or biochemistry, so long as research methods and data analysis are emphasized.

Pre-medical students may be advised or required to take upper level biology and chemistry electives, such as cellular biology, physical chemistry, biochemistry, molecular biology and genetics. Specific requirements for these courses vary by institution. Schools may also have requirements for non-science classes. Some require a certain number of general humanities credits, while others have specific requirements for courses in English, psychology, or other disciplines