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Medical education in the United States

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Jackson Memorial HospitalinMiami,Florida, which serves as the primary teachinghospitalfor theMiller School of Medicineat theUniversity of Miami
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Education in the
United States
Summary
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Education policy issues
Levels of education
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Medical education in the United Statesincludes educational activities involved in the education and training ofphysiciansinthe 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 themedical educationpathway is presented below.Medicineis a diverseprofessionwith many options available. For example, some physicians work inpharmaceuticalresearch,[1]occupational medicine(within a company),[2]public healthmedicine (working for the general health of a population in an area), or even join thearmed forcesin America.[3]

Issues in higher education in the U.S.have particular resonance in this context, with multiple analysts expressing concern of aphysician shortage in the nation.[4]Medical deserts'have also been a topic of concern.

Master Adaptive Learner Model

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In recognition of the exponential growth in medical knowledge, a growing number of medical schools are incorporating theMaster Adaptive LearnerModel.[5]Thismetacognitiveapproach 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, enablinghealth professionalsto provide high-quality care in an ever-changing environment.[5]

Medical school

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Main article:Medical school in the United States

In the U.S., amedical schoolis 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 (clerkshipsconsisting of rotations through different wards of ateaching hospital).Health systems scienceis integrated throughout all four years.[8]The degree granted at the conclusion of these four years of study isDoctor of Medicine(M.D.) orDoctor 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]

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

Internship

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Main article:Internship (medicine)

During the last year of medical school, students apply forresidencies,also referred to as graduate medical education, in their chosen field ofspecialization.[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 inneurology[16]andophthalmology,[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 anAmerican 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]

Residency

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Main article:Residency (medicine)

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 completedbeforestarting the program at the second post-graduate year (PGY-2).

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.[21]Many highly specialized fields require formal training beyond residency. Examples of these includecardiology,endocrinology,oncologyafterinternal medicine;cardiothoracic anesthesiologyafteranesthesiology;cardiothoracic surgery,pediatric surgery,surgical oncologyaftergeneral surgery;reproductive endocrinology/infertility,maternal-fetal medicine,gynecologic oncologyafter 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 asfellowshipsand their participants arefellows,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 orsub-specialtyorganizing board. Fellowships often contain a research component.[22]

Board certification

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Main article:Board certification

The physician or surgeon who has completed their residency and possibly fellowship training and is in the practice of their specialty is known as anattending 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 undertakecontinuing medical educationactivities.[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

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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.[26]Physicians can receive CME credit from a variety of activities, including attending live events, publishing peer-reviewed articles, and completing online courses. TheAccreditation 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]

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.Retrieved2024-07-08.
  2. ^"Discover Occupational Medicine! Midcareer Entry into Occupational and Environmental Medicine".American College of Occupational and Environmental Medicine.Retrieved8 July2024.
  3. ^"Medicine + The Military".Medicine + The Military.Retrieved2024-07-08.
  4. ^"New AAMC Report Shows Continuing Projected Physician Shortage".AAMC.Retrieved2024-07-08.
  5. ^abcCutrer, 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.ISSN1938-808X.PMID27532867.
  6. ^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.ISSN1466-187X.PMID31287741.
  7. ^Karle, Hans (August 2010)."How do we Define a Medical School?".Sultan Qaboos University Medical Journal.10(2): 160–168.ISSN2075-051X.PMC3074706.PMID21509225.
  8. ^Fred, Herbert L.; Gonzalo, Jed D. (2018-06-01)."Reframing Medical Education".Texas Heart Institute Journal.45(3): 123–125.doi:10.14503/THIJ-18-6729.ISSN0730-2347.PMC6059511.PMID30072846.
  9. ^Medline Plus (2012)."Doctor of Osteopathic Medicine".U.S. National Library of Medicine of National Institutes of Health.Retrieved20 December2012.
  10. ^Medline Plus (2012)."Doctor of Medicine profession (MD)".U.S. National Library of Medicine of National Institutes of Health.Retrieved20 December2012.
  11. ^"2024-2025 Residency Application Timeline and Month-by-Month Schedule".Med School Insiders.2024-05-07.Retrieved2024-07-08.
  12. ^ab"Intro to The Match".NRMP.Retrieved2024-07-08.
  13. ^Wentz, Dennis K. (1984)."A Brief History of the Internship".JAMA: The Journal of the American Medical Association.252(24): 3390–3394.doi:10.1001/jama.1984.03350240036035.PMID6389916.Retrieved2024-07-08.
  14. ^Schierhorn, Carolyn (2014-02-05)."Practicing after one year of residency: Is it feasible? Should it be?".The DO.Retrieved2024-07-08.
  15. ^Altus, Ashley (2019-02-27)."First Year of Residency: What to expect as an intern".The DO.Retrieved2024-07-08.
  16. ^"How to Apply for Residency".www.aan.com.Retrieved2024-07-08.
  17. ^"Residency Match - American Academy of Ophthalmology".www.aao.org.Retrieved2024-07-08.
  18. ^DO-Online.org | Postdoctoral Training | FAQS,[1]
  19. ^abZorek, Joseph; Raehl, Cynthia (March 2013)."Interprofessional education accreditation standards in the USA: a comparative analysis".Journal of Interprofessional Care.27(2): 123–130.doi:10.3109/13561820.2012.718295.ISSN1469-9567.PMID22950791.
  20. ^"Medical specialty choice: Should residency training length matter?".American Medical Association.2020-11-19.Retrieved2024-07-08.
  21. ^"Osteopathic Postdoctoral Training Structure"(PDF).American Osteopathic Association.Retrieved10 November2012.
  22. ^"About Medical Specialties Matching Program".National Resident Matching Program. 2010. Archived fromthe originalon 9 December 2012.Retrieved20 December2012.
  23. ^ab"Getting Board Certified".American Board of Medical Specialties.Retrieved2024-07-08.
  24. ^Kononowicz, Andrzej A.; Woodham, Luke A.; Edelbring, Samuel; Stathakarou, Natalia; Davies, David; Saxena, Nakul; Tudor Car, Lorainne; Carlstedt-Duke, Jan; Car, Josip; Zary, Nabil (2019-07-02)."Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration".Journal of Medical Internet Research.21(7): e14676.doi:10.2196/14676.ISSN1438-8871.PMC6632099.PMID31267981.
  25. ^"ProQuest | Better research, better learning, better insights".ProQuest.
  26. ^BoardVitals (2023-01-06)."CME Requirements By State".BoardVitals Blog.Retrieved2024-07-08.
  27. ^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.ISSN0142-159X.PMID26642916.
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  • List Of Cardiology continuing medical educations events[2]
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