It’s no secret that the path from medical school application to practicing physician is a long one. But what actually happens during those 8+ years of school, residency, and fellowship that actually makes someone an attending physician?
Pre-contemplation, contemplation, and decision. Prospective applicants come from all different backgrounds. “Traditional” applicants are the kids about to graduate college, often on a pre-medical track but not necessarily. Some have taken a year or two off to work in a medically-related field or to do research. They’re the ones who have already completed their pre-reqs and have taken the MCAT and will make up the majority of any given medical school class. “Non-traditional” applicants (like you!) are everyone else…people of all ages and professions who have done literally anything else for some time and have decided that they’d like to be a doctor. Some are also kids about to graduate college but who haven’t done any medical school pre-requisites (these are often your liberal arts folks). Non-traditional applicants make up the minority of most medical school classes, though in recent years more and more medical schools have recognized the value of non-traditional students in the medical field and have attempted to recruit more.
Application. Traditional students roll right into application since they’ve got their pre-reqs and test scores done. Non-traditional students may satisfy these requirements in a post-baccalaureate pre-medical program or on their own. Either way, once applications are signed, sealed, and delivered, programs send out requests for secondary essays and interviews. Acceptance notices are sent in the spring before enrollment in the fall.
The first 1 1/2 to 2 years of medical school are referred to as the “preclinical years.” This is when we spend a horrendous amount of time in lectures and studying…every school’s curriculum varies somewhat but most will be heavy on biochemistry, anatomy, professional development, and the major systems of the human body. Some schools split the curriculum up by organ (like the heart), while others break it up by organ system (like cardio-pulmonary system). While some institutions still rely on traditional lectures, others teach with the case method, active learning, or practical examinations…most seem to be combinations of various teaching methods. Regardless, the preclinical years are a time of high-stress, long days, and lots of written tests.
USMLE Step 1. Easily the hardest exam you will ever take. Ever. Medical students take Step 1 at the end of their preclinical curriculum,** as it is a comprehensive examination of everything they have learned so far. Schools usually give their students 5-8 weeks off simply to study for this nine hour test. The scores come back in three or four weeks and are weighted heavily in applications for residency. You only get one chance to take Step 1, so no pressure!
**Some schools have shifted the timing of Step 1 from the end of preclinicals to some time during the third year of medical school. This is still the minority but certainly worth mentioning…there’s a lot of debate as to which is better.
Clinical rotations. The vast majority of the third year of medical school is dedicated to required clinical rotations in assorted specialties. Most schools require eight to twelve weeks each in surgery, internal medicine, pediatrics, psychiatry, primary care, neurology, anesthesia, and emergency medicine. There may also be some time for electives during the third year. This is when medical school gets really fun (and maybe a little intimidating!). At the end of each rotation, students take “shelf exams,” which are standardized exams in a specific subject. While they certainly require preparation and studying, the content of shelf exams is significantly more practical and based on clinical scenarios, and most people find them much less stressful than preclinical exams!
USMLE Step 2. Similar to Step 1, but not quite as anxiety-provoking. This exam can be taken at any point during the fourth year of medical school and is required for graduation but not for residency applications, though strong scores on Step 2 can be helpful if the student chooses to take the exam prior to application submission. Like the shelf exams, Step 2 is based on practical and clinical knowledge; many equate it to a compilation of all the shelf exams. There are two parts, however…the “Clinical Knowledge” part (also called Step 2 CK) is another nine hour multiple choice exam, very similar in format to Step 1. The “Clinical Skills” part (called Step 2 CS) is a practical exam involving several scenarios with standardized patients to assess your clinical skills in person.
Fourth year, residency application, and the Match. The fourth year of medical school is mostly electives. While academic demands are often much less than in previous years, the majority of the time is dedicated to application and interviews for residency. Students choose their intended specialty at the beginning of fourth year and work on their applications for submissions in the early fall. Programs extend interview invitations shortly thereafter and peak interview season is November-December. Students will rank order the programs they interviewed with and submit their preferences in February. In mid-March, everyone finds out if and where they matched. Every year, on Match Day, medical students take part in a special ceremony during which they are handed sealed envelopes that contain both their matched specialty and location…at 12pm eastern time, everyone is allowed to open them and tears of either joy or mirth are shed in copious amounts as students find out where they will be going for residency. Between Match Day and graduation, most will take a well-deserved vacation.
Graduation. This is when you’re officially a “doctor” and can start signing off with an “MD” after your name. But we’re far from over…
Residency. This is time for training in one’s individual specialty. Residencies range from three years to seven-plus years depending on specialty. Some may opt to take gap years for research or other projects mid-residency or do a year as a chief resident (which may or may not be a whole extra year, again depending on specialty).
During the first year of residency, also known as the “intern year,” we take the USMLE Step 3. This is generally less of a big deal than either Step 1 or Step 2, but it is a two-day exam that one must pass to continue in their residency program.
Fellowship. A fellowship is completely optional and may be completed at any time in a physician’s career after residency. This is when doctors of any specialty can specialize further and narrow their scope of practice. For example, an internist may do a fellowship in cardiology or endocrinology, while a general surgeon may do a fellowship in vascular or colorectal surgery.
The attending physician. An attending is a real, “all grown up,” doctor who is licensed and able to practice on their own. Some go into private practice while others work in large hospitals. Some are inpatient, others outpatient. The opportunities are truly endless!