Medical Education in the United States

Tina Koral, MPH
Senior Research Associate
AMA PRA Standards & Policy Liaison Activities
American Medical Association

Medical Education in the United States

The education of physicians in the United States is lengthy and involves undergraduate education, medical school, and graduate medical education (the term graduate medical education [GME] includes residency and fellowship training; the American Medical Association does not use the term "postgraduate education"):

Undergraduate Education--4 years at a college or university to earn a BS or BA degree, usually with a strong emphasis on basic sciences, such as biology, chemistry, and physics (some students may enter medical school with other areas of emphasis).
Medical School (undergraduate medical education) -- 4 years at one of the LCME-accredited US medical schools, consisting of preclinical and clinical parts. After completing medical school, students earn their doctor of medicine degrees (MDs), although they must complete additional training before practicing on their own as a physician. (Note: Some physicians receive a doctor of osteopathic medicine [DO] degree from a college of osteopathic medicine.)
Residency Program (graduate medical education) -- Through a national matching program, newly graduated MDs enter into a residency program that is 3 to 7 years or more of professional training under the supervision of senior physician educators. The length of residency training varies depending on the specialty chosen: family practice, internal medicine, and pediatrics, for example, require 3 years of training; general surgery requires 5 years. (Some refer to the first year of residency as an "internship"; the AMA no longer uses this term.)
Fellowship -- 1 to 3 years of additional training in a subspecialty is an option for some doctors who want to become highly specialized in a particular field, such as gastroenterology, a subspecialty of internal medicine and of pediatrics, or child and adolescent psychiatry, a subspecialty of psychiatry.

After completing his or her undergraduate, medical school, and graduate medical education, a physician still must obtain a license to practice medicine from a state or jurisdiction of the United States in which they are planning to practice. They apply for the permanent license after completing a series of exams and completing a minimum number of years of graduate medical education.

The majority of physicians also choose to become board certified, which is an optional, voluntary process. Certification ensures that the doctor has been tested to assess his or her knowledge, skills, and experience in a specialty and is deemed qualified to provide quality patient care in that specialty. There are 2 levels of certification through 24 specialty medical boards -- doctors can be certified in 36 general medical specialties and in an additional 88 subspecialty fields. Most certifications must be renewed after 6 to 10 years, depending on the specialty.

Learning does not end when physicians complete their residency or fellowship training. Doctors continue to receive credits for continuing medical education, and some states require a certain number of CME credits per year to ensure the doctor's knowledge and skills remain current. CME requirements vary by state, by professional organizations, and by hospital medical staff organizations.

For Further Reading

American Medical Association. Becoming an MD.
Describes the process of medical education in the United States.
URL: http://www.ama-assn.org/ama/pub/category/2320.html [Last accessed 14 October 2008].