MEDICAL EDUCATION IN THE US

In this document you will find an overview of medical education in the US, as well as information about choosing a medical school, applying to medical school, financing a medical degree, US professional qualification exams and poststudy career options. Information on additional resources related to medical education is also available in this document. For general information on pursuing postgraduate study in the US, please refer to the Postgraduate Study in the US section of the Fulbright website at: www.fulbright.co.uk

OVERVIEW: In the US, the formal study of medicine is only available at the postgraduate level. To attend a US medical school, a student must already hold at least an undergraduate degree. Thus, students with A-levels or Scottish Highers cannot expect to attend a medical school in the US without first earning an undergraduate degree. Universities may offer first degrees in medicine-related fields (e.g. a Bachelor of Arts degree in Biological Sciences) or a pre-medicine track, but such degrees are not sufficient to practise medicine in the US or UK. Degrees on Offer: The most common degrees offered by US medical schools are the professional Doctor of Medicine (MD) degree and Doctor of Osteopathic Medicine (DO). These professional degrees are meant for those who wish to practice medicine in the US. Please note that to practice medicine in the US, you must first pass a medical licensure exam and have the legal right to work in the US. (For information about eligibility criteria for US permanent residency and citizenship, as well as sponsorship for work visas, please visit the US Embassy website: http://london.usembassy.gov/) Many medical schools also offer the option of joint degrees in various disciplines. The most common degrees are a MD/PhD in areas related to medical research or a MD/JD (law) or MD/MBA (business). Joint degrees will likely take more time to complete than the MD degree alone due to the added degree requirements, but are generally shorter than completing the two degrees separately. Structure of the MD Degrees: MD degrees usually consist of a four-year programme of postgraduate study. The first two years of study are relatively structured with compulsory modules in the basic sciences on which clinical medicine are based. In the first year, modules focus on topics relating to the human body such as anatomy, physiology, histology, biochemistry, embryology and neuroanatomy. The second year of study consists of modules on disease and treatment including pathology, pharmacology, microbiology and immunology. Students are also exposed to other topics such as nutrition, substance abuse, human sexuality, medical ethics and laboratory medicine during the first half of their degree. By the second year, students are trained in interacting with patients through taking medical histories and conducting physical examinations. During the third and fourth year of study, students undertake four to twelve week clinical rotations or clerkships in which they experience different medical specialities. During these rotations, students work with patients and their families in both hospital and surgery settings under the supervision of faculty physicians and related practitioners (e.g. nurses, psychologists, social workers and pharmacists). Additionally, fourth year students are typically given the opportunity to take electives (i.e. modules of their choice). Also during their final year of medical school, students choose a medical speciality and apply for appropriate residency programmes which they undertake after completing their MD. A residency is a three to seven-year period of practical education and training (depending on the speciality) during which graduates learn to treat patients under the supervision of fully qualified physicians. Residents learn to how to apply the basic science knowledge and clinical skills gained during their MD course to diagnosing and treating actual patients illnesses and injuries. During residency, MD graduates also cultivate clinical decision-making and patient management skills and are expected to actively contribute to specialty team discussions and patient visits, as well as in case-based lectures and more formal group discussions. Structure of the DO Programme: Generally speaking, the structure of DO programmes mirrors that of an MD, with four years of osteopathic medical school followed by specialty training and board certification. In fact, with the exception of teaching Osteopathic manipulative medicine, US medical schools that offer the DO have curricula that are very similar to those of MDUS-UK Fulbright Commission Advisory Service 62 Doughty Street London WC1N 2JZ www.fulbright.co.uk

granting schools. Typically, the first two years are classroom-based, while the third and fourth years consist of clinical rotations through the major specialties of medicine. After graduation, osteopathic medical physicians may choose to pursue residency training programs accredited by either the American Osteopathic Association (AOA) or the Accreditation Council for Graduate Medical Education (ACGME). Alternatively, depending on state licensing laws, graduates of DO programmes may complete a year-long internship at an American -approved hospital. Please note that most of information to follow is specific to prospective MD students as MD programmes are more popular. For more information about Doctor of Osteopathic Medicine programmes, including choosing a DO degree programme, how to apply and financing your studies, you may wish to visit the American Association of Colleges of Osteopathic Medicine website at: http://www.aacom.org/Pages/default.aspx

CHOOSING A MEDICAL SCHOOL: In order to practise medicine in the US, many states require a candidate to have a MD/DO degree from a medical school that has is accredited by the Accreditation Council for Graduate Medical Education (ACGME). The ACGMEs Liaison Committee on Medical Education is recognised by the US Department of Education as the accrediting agency for professional MD programmes. Graduates of non-LCME accredited schools, as well as residency programmes, often have difficulty becoming board certified (i.e. licensed to practise medicine). For a list of LCME approved schools, visit: http://www.lcme.org/directry.htm If you plan to practise medicine in the US, attending a well-known school with a strong academic reputation and high level of prestige can set your CV apart when applying for jobs. Further, being part of a network of alumni from a wellrespected school can provide networking opportunities as your career progresses. Therefore, when choosing a medical school and in particular, a MD programme, students may wish to carefully research the schools academic reputation and to refer to rankings such as US News and World Reports. Prospective MD students should also consider academic specialties and opportunities for practical experience and research. Additionally, it is important to choose a school in the state in which you wish to be licensed to practise medicine. When choosing a medical school, it is also advisable to weigh factors such as class size, atmosphere, location and funding, which are described on the Postgraduate Study - Choosing a Postgraduate Degree Programme page of www.fulbright.co.uk Note for Non-US Citizens: As discussed above, it is widely-recognised that admission to US medical schools is especially competitive for international students. To research which medical schools may be most likely to admit an international student, you may wish to consider purchasing the Association of American Medical Colleges Medical School Admission Requirements in which schools, listed alphabetically, indicate whether international applications are considered and how may international students, if any, enrolled in the most recent academic year.

APPLYING TO US MEDICAL SCHOOLS: Admission to US medical schools is extremely competitive, especially for international applicants. Admissions criteria include: Undergraduate and postgraduate (if applicable) coursework Medical College Admission Test (MCAT) scores Exposure to the field of medicine (through coursework or volunteering/work experience) Extracurricular involvement and community service Letters of recommendation Personal statement Interview Financial arrangements (applicants may be asked to provide information on how they intend to fund their medical education) Previous Coursework:

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MD programmes do not require that applicants take an undergraduate degree in a particular subject or to have completed specific courses. Instead, they emphasize the importance of a demanding and well-rounded education with experience in a variety of disciplines. Students should choose an undergraduate major based on their interests; it is possible to acquire the knowledge and skills necessary for admission into a medical programme while majoring in an unrelated subject. However, requisite courses for admission to an MD programme include mathematics, biology, chemistry, physics and English. With this in mind, UK university graduates may need to undertake a year-long post-baccalaureate premedical programme at a US institution, or complete online coursework, to complete the required prerequisite courses. For the most accurate information about admissions requirements for a particular medical school, you should the medical school websites. It is important to note that a Pre-Medical Bachelors degree does not guarantee admission to a medical school. Medical College Admission Test Scores: For MD applicants, it is also important to keep in mind that admissions officers rank the MCAT among the most top selection factors. The MCAT is an eight-hour multiple choice standardised exam, with sections that test verbal reasoning, writing ability and knowledge of physical biological sciences. Students should take the MCAT in the spring of their penultimate year of undergraduate study. For more information about the MCAT, please see the checklist at the end of this handout or refer to the Association of American Medical Colleges website at: http://www.aamc.org/students/mcat/ Application Process: There are currently two ways to apply to US medical schools: via the American Medical College Application Service (AMCAS) or directly to the institution. AMCAS is a centralised processing service for medical school applications. Most US medical schools are participants in AMCAS and only accept applications made via this online system. Generally speaking, US medical schools use AMCAS for preliminary screening only. After this initial round, candidates that they wish to learn more about will be invited to fill out a medical school-specific application, sometimes referred to as secondary or supplementary applications. Each of these candidates will likely be required to attend an interview in the US. For more information about AMCAS, please visit: http://www.aamc.org/audienceamcas.htm Those applying to non-AMCAS member schools will need to submit their application directly to the school. For information about application procedures, contact the admission office of the medical schools to which you intend to apply. For an admissions checklist for MD programmes, please see the end of this handout. You may also wish to consult the AAMCs website for prospective students, www.aspiringdocs.org, for a more detailed application timeline. For more general information about applying for postgraduate degree programmes in the US, please refer to the Postgraduate Study - Completing an Application section of www.fulbright.co.uk

FINANCING A MEDICAL DEGREE: Expenses: As the cost of higher education increases in both the US and UK, it is important for students to know what costs to expect and to develop a plan to cover these. Keep in mind you will need to demonstrate access to funding for the first year of study in order to apply for a visa. In addition to the cost of attendance, students need to budget for application expenses. Prospective MD (and DO) students need to factor in the cost of sitting the MCAT exam ($290 includes international testing centre fee). If applying to one of the 117 medical schools that use the American Medical College Application Service (AMCAS) centralised application system, prospective MD students can also expect to pay $160 for the first application and $30 for each additional application. Many of these institutions may also require a secondary, or supplemental, application, which incur a fee from $25 to $100 per application. Finally prospective MD students applying to one of the nine medical schools that administer their own online application process can expect fees to range from $50 to $120 per application. Tuition and fees rates can vary significantly from university to university, as there are no standard government set fees as in the UK. Rather, each university sets its own tuition and fees rates. International student tuition for a professional medical degree programmes is, on average, approximately $40,000 per academic year; however, to find the most accurate information you will want to consult each medical schools websites for their specific fee rates.
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When considering funding for your degree, you should also consider living and travel expenses, books and personal costs, which should be estimated on the medical schools website. Prospective MD students should also note that they will incur additional fees during their fourth year when applying for residency programmes. Funding: There is very limited university funding available for medical degrees, particularly for non-US citizens. You will want to investigate funding from external funding bodies as according to the Association of American Medical Colleges (AAMC), about 81% of medical students borrow money to cover expenses and, in most instances, financial aid comes from sources outside of medical school. That being said, you should explore all options for university scholarships and fellowships and make sure you are considered for applicable awards. Whilst the US-UK Fulbright Commission offers a number of competitive, highly-prestigious awards for UK citizens to undertake postgraduate study in the US, they cannot be applied to an MD or DO programme. However, those students considering a PhD or postdoctoral research in a field related to medicine are eligible. For more information, please refer to the Fulbright Awards section of www.fulbright.co.uk For more information on university funding, external funding bodies and loans, please see the Postgraduate Study Finances section of www.fulbright.co.uk

NB: NON-US CITIZENS CONSIDERING MEDICAL EDUCATION IN THE US Although our remit is to promote US-UK educational exchange and support students interested in US study, we would be remiss to not say a word of caution to non-US citizens considering medical education in the US. International students without permanent US resident status will likely find it is much more difficult to enter a US medical school (to undertake an MD or DO) and to fund their studies than to enter and fund a PhD or MS in the US in a related field, such as biochemistry, biomedical engineering, etc. This is due to a few widely-recognised factors: Many US medical schools are public institutions that receive government funding. State governments mandate the schools produce graduates that can meet the health care needs of that particular state. Public medical schools, therefore, are obligated to give priority to legal residents of the state in which the school is located, which means that, without possessing the legal right to work in the US, even the most academically well-qualified international student is at a significant disadvantage over legal US residents. Although private medical schools that do not receive government funding are more likely to be able to admit international students, issues surrounding eligibility to work in the US after graduation still greatly impacts admission decisions at these institutions. It is not in your best interest, nor theirs, to allow you to train/qualify to practise medicine in a country in which you cannot work. (For information about eligibility criteria for US permanent residency and citizenship, as well as sponsorship for work visas, please visit the US Embassy website: http://london.usembassy.gov/). Very limited financial aid for medical study requires most students to take out education loans in order to pursue their degree. However, eligibility for many US Federal Government-sponsored and private financial loans is usually restricted to US citizens or US permanent residents. Therefore, the vast majority of international students are ineligible for the US-based loans typically available for medical study. In some instances, students with significant personal savings may write to US medical schools to declare the ability to pay as a means of diminishing the impact finances has in the admission process. However, it is likely that these students will be asked place one to four years tuition (up to $200,000) into a savings account as proof of funds.

Whilst completing a full medical degree may not be the best fit for many international students, you may wish to consider options such as: 1. completing a postgraduate degree in a related field 2. undertaking an elective course or volunteer project during and/or following a UK medical degree to gain medical experience in the US. For information about US medical work experience opportunities during UK medical degree programmes, you should contact individual medical departments at UK institutions. You may also wish to conduct a search on the AAMCs On-Line Extramural Electives Compendium (https://services.aamc.org/eec/students/index.cfm) to search for US institutions that accept international medical students on elective opportunities. For information about volunteer medical projects in the US, you may wish to investigate volunteer programmes like Remote Area Medical Volunteer Corps (http://www.ramusa.org/contact/volunteerwithram.htm) that offer qualified physicians the opportunity to gain US clinical experience. 3. completing the US Medical Licensing Exam (USMLE) and applying for a US-based residency programme (see following sections for more information).
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QUALIFYING TO PRACTISE MEDICINE IN THE US: In order to practise medicine in the US, in addition to having the legal right to work in the US, one must first be licensed to practice in an individual state. For graduates of both US and overseas medical programmes, this entails passing the United States Medical Licensure Examination (USMLE) and any other exams required by the state licensure examiners. The USMLE is the method of evaluation for medical licensure established by the Federation of State Medical Boards (FSMB) and the Board of Medical Examiners (NBME). The USMLE is a single exam comprised of three Steps that assess a doctors ability to apply the medical knowledge that constitutes the basis of safe and effective patient care. Steps 1 and 2 are medical science written exams and can be taken worldwide. Step 3 is a clinical exam that must be done in the US. For MD students at US medical schools, the first two steps of the USMLE are built into their programme of study and Step 3 is completed during the first year of residency. For more information about the USMLE, see: http://www.usmle.org/ It is important to note that there is not a national medical licensing authority in the US. Instead, the criteria for eligibility for medical licensure (in addition to passing the USMLE) are set by each states medical licensing authority. Therefore, for information about licensure requirements, contact the medical licensure board of the state in which you intend to practice medicine. A list of state medical boards can be found on the AMA website at: http://www.amaassn.org/ama/pub/education-careers/becoming-physician/medical-licensure/state-medical-boards.shtml Licensure for Foreign Medical Graduates: Most states require Educational Commission for Foreign Medical Graduates (ECFMG) certification of foreign medical graduates as a pre-requisite for obtaining a license to conduct supervised medical practice in that state (i.e. to begin a residency programme). ECFMG certification can be obtained by passing Steps 1 and 2 of the USMLE, as well as undergoing a clinical skills assessment and proving adequate English language proficiency. For more information about requirements for foreign medical graduates, visit the ECFMG website at: http://www.ecfmg.org

MEDICAL RESIDENCIES/FELLOWSHIPS FOR FOREIGN MEDICAL GRADUATES: Foreign medical graduates must hold a valid standard ECFMG certificate (see above) in order to enter residency programmes accredited by the Accreditation Council for Graduate Medical Education (ACGME). A fellowship usually provides advanced training in a medical subspecialty and is generally undertaken after several years of residency training. Please note that residency programmes do not offer degrees. Check with officials in your home country for information about which credentials will be recognised when you return. Obtaining a Residency or Fellowship Position: You should begin to research residency or fellowship programmes at least 12 months before you wish to start. Contact programmes as early as possible to determine eligibility criteria and institutional employment policies and to request application materials. Carefully review information to find out other admissions requirements and application deadlines, and whether the programmes require applicants to enrol in the National Residency Match Program (NRMP). Many hospital residency programmes participate in the NRMP and will not accept applications from candidates not in the NRMP. For more information, visit the NRMP website at: http://www.nrmp.org With regard to fellowships, it is possible to arrange a position directly, without enrolling with NRMP. Some organisations, such as the Centers for Disease Control and Prevention (CDC), offer direct employment opportunities for doctors interested in fellowships or associateships. To search for fellowships, you may wish to utilise the AMA Fellowship and Residency Electronic Interactive Database (FREIDA): http://www.ama-assn.org/ama/pub/educationcareers/graduate-medical-education/freida-online.shtml. Alternatively, you may wish to contact individual organisations with which you would like to work directly for information about vacancies. It is important to keep in mind that you will have to request recommendations, arrange transcripts and forward materials directly to each programme by the published deadline. Before signing a contract you should consider factors such as duration of employment, salary and benefits, health insurance and programme content and responsibilities.

CAREER OPTIONS IN THE UK: Whereas it can be possible to gain the right to work in the US as a medical professional after completing an MD, it is advisable to research careers options for US medical graduates in your home country. For example, MD students (and, ideally, applicants) should check with the appropriate professional association in their home country to see if a US degree meets their home countrys requirements to practise medicine. In the UK, organisations such as the Royal
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Society of Medicine (RSM) can provide information for international medical graduates pursuing a career in medicine in the UK. For a list of medical associations and societies in the UK, refer to the RSN website at: http://www.rsm.ac.uk/welcom/linksocs.php Whilst the NHS states that competition is high, as posts are often filled by UK or EEA-trained doctors, returning US medical graduates with UK citizenship will likely have an advantage over other overseas applicants. However, in order to be eligible to practice medicine in the UK, you must be registered with the General Medical Council (GMC). Before you may do so, you must first verify that you possess an acceptable primary medical qualification to apply for registration by visiting the GMC website at: http://www.gmcuk.org/doctors/registration_applications/join_the_register/acceptable_primary_medical_qualification.asp. Once you have confirmation that you hold the required medical qualifications, you may register with the GMC, for which the requirements will depend on a few of factors: your nationality the country in which you gained your primary medical qualification the type of work you want to do whether or not you have completed a period of post-graduate training or an internship Additionally, international medical graduates (IMGs) will be required to demonstrate their medical knowledge and skills, competence of English language and fitness to practise before they may register with the GMC. It is important to note that registration with the GMC does not guarantee that you will find employment within the UK. Additionally, if you are not a UK/EEA national, you will need to meet the requirements of the UK Border Agency regulations to gain the right to enter and work in UK.

FOR MORE INFORMATION: Please note that the Fulbright Advisory Service offers a number of resources on postgraduate study in the US, through our advising website www.fulbright.co.uk, annual USA Grad School Day event and commercial partners. For more information, you may wish to consult the following websites:

EducationUSA: www.educationusa.state.gov Test Tutors & Educational Consultants: www.fulbright.co.uk/study-in-the-us/postgraduate-study/resources American Medical Association (AMA): www.ama-assn.org Association of American Medical Colleges : www.aamc.org AAMCs AspiringDocs.org: www.aspiringdocs.org American Medical College Application Service (AMCAS): http://www.aamc.org/students/amcas/start.htm Medical College Admission Test (MCAT): http://www.aamc.org/students/mcat ACGMEs Liaison Committee on Medical Education Directory of Accredited US Medical Schools: http://www.lcme.org/directry.htm United States Medical Licensing Examination (USMLE): www.usmle.org National Residency Match Program (NRMP): www.nrmp.org AMA Fellowship and Residency Electronic Interactive Database (FREIDA): http://www.amaassn.org/ama/pub/education-careers/graduate-medical-education/freida-online.shtml General Medical Council: http://www.gmc-uk.org/register Postgraduate Medical Education and Training Board: www.pmetb.org.uk Royal Society of Medicine: www.rsm.ac.uk NHS Careers: http://www.nhscareers.nhs.uk/explore_oversea.shtml

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MD ADMISSIONS CHECKLIST: 1-1 Years Prior to Enrolment: Begin by reading the Postgraduate Study in the US section of the Fulbright website, this handout and several medical schools admissions webpages to gain an overview of the MD admissions process.

Attend USA Grad School Day Spring 2010: Have the unique opportunity to attend information sessions on a
variety of topics related to postgraduate study in the US, including the Fulbright Awards.

Narrow your medical school choices to the schools to which you will apply. Take into account your MCAT
score and undergraduate degree results to judge the relative competitiveness of your application and ensure you apply to a range of schools, including schools at which you feel confident you will be accepted. If you do not have an MCAT score, sit 1-2 mock exams to determine an estimated score.

June MCAT testing date: MD programmes require that applicants sit the MCAT. It is strongly advisable to take
the MCAT by June at the latest. This will allow the opportunity to re-sit the exam in July, August or September if necessary. The MCAT is offered in London at the Thomson Prometric Centre up to 22 times per year. Registration deadlines are fourteen calendar days before the exam; however, the testing board recommends registering 60 days or more in advance of the exam day in order to ensure a place on your preferred testing date. The registration fee is approximately $290. To register, visit: http://www.aamc.org/students/mcat To prepare for the MCAT, you may wish to take advantage of the free resources the AAMC publishes, which include study aids and a previously administered test at no charge. For more information about preparation materials from the AAMC, visit: http://www.aamc.org/students/mcat/preparing/start.htm. Alternatively, you may wish to purchase a book from the Buy Books page on www.fulbright.co.uk, take advantage of the MCAT courses provided by one of our partners listed on the Postgraduate Study Additional Resources page of www.fulbright.co.uk or access one of the MCAT preparation books in our Resource Library.

July/August - Complete your AMCAS application: The early application deadline for all medical schools
participating in AMCAS is 1 August. Although medical schools will have regular decision deadlines later in the autumn (typically between October and December), applying early in the cycle will give you an advantage because many medical schools follow a rolling admissions policy under which applications are reviewed as and when they arrive. Please see the Postgraduate Study in the US Completing an Application section of www.fulbright.co.uk for more information about application requirements such as personal statements, transcripts and reference letters. 10-12 Months Prior to Enrolment:

Early Autumn Complete supplementary applications: If invited by the schools to which you applied, you will
be required to submit an additional, school-specific application. Again, submission by the early supplementary application deadline is highly recommended.

Late Autumn/Early Winter Attend an interview: Most medical schools require an interview, which are typically
held between November and January and can take place on or off-campus (typically in the US). Interviews may be conducted by an admissions committee member, by a panel of admissions committee members or by offcampus interviewers, such as practicing physicians. The evaluations completed by interviewers are then considered alongside the other application materials you submit.

As time permits, apply for funding from US universities and external funding bodies as you complete your
admissions applications. Lead up to Enrolment: Spring: Receive admissions decisions by post or e-mail. Summer: Notify the schools of your decision, pay a non-refundable deposit and apply for your visa. Summer: Read the pre-departure information on www.fulbright.co.uk to prepare for your arrival in the US. August/early September: Begin study in the US!

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