Medical School- Explained!

As a service to all of my future faithful readers, I’d like to take this opportunity to fill you in on some of the lingo of medical school. Otherwise, someday I'll spout off something like “I think I’ll wait til after my Sub-I to take Step 2, but I definitely want to take it before I submit my rank list”, and you won't know what the heck I'm talking about.  But after my tutorial, you'll be able to give me some really super comment like, “O totally- otherwise you won’t be licensed in time for internship.” And we will all look so brilliant! So I’ve made a this special, once-in-a-lifetime med school tutorial just for you! 

The Basics: Med school is 4 years long, it’s preceded by a 4 year undergraduate degree in any field you want, and it’s followed by a residency that lasts anywhere from 3 years (for ER, family med, etc) up to 7 years (cardiothoracic surgery).  Medical school is people who are going to become doctors. Not nurses. Nursing school is for nurses. I was asked, just yesterday, if I was going to medical school to become a nurse, or to be a doctor. Yes, even blonde haired, female ‘medical students’ will eventually be doctors; not nurses. And big, burly men in nursing school will become nurses, not doctors. Crazy!

Medical School Itself:   Medical school year 1 and 2 are called 'preclinical years', and are basically the same structure as undergraduate- lectures 5-6 hours a day and then tests every few months.  Between year 2 and year 3, students take the 'Board Exam' also called ‘the boards’, ‘the USMLE’ or 'Step 1'. In order to be a licensed doctor in the US, you have to pass all three ‘steps’ of the US Medical Licensing Exam (USMLE aka board exam). Step 1 is after two years of med school, Step 2 is taken during your 4th year of medical school, and Step 3 is taken during residency and is specific to your chosen field (ie pediatrics, surgery or ObGyn all take different ‘Step 3' exams).

Medical school year 3 and 4: often called 'clinical years', 'rotations', 'clerkships' or 'being on the wards'. Third year is full of required clerkships- medicine, surgery, pediatrics, ObGyn, etc. Every med student has to do all of them and has to pass a test at the end of each required rotation, proving they learned everything that they were supposed to. The exam at the end of each required rotation is call a 'shelf exam'- maybe because they found the tests on a shelf somewhere? A shelf labeled 'Ridiculously Impossible Tests'? The other big issue about required rotations is that most of your grade comes from the evaluations that the doctors that you work with fill out about you. And they don't take bribes. Or I'm maybe not offering enough.  I thought my offer for a free cup of coffee from the coffee machine in the lounge was a good bribe. No?

Fourth year is full of elective rotations, and has been called by some- “The $40,000 Vacation”. There are TONS of electives you can pick from. Electives are notoriously ‘easy’, in that there isn’t a test at the end of the rotation, so a lot of the pressure is off. There are a lot of gotta-do’s during 4th year, though
(1) You have to take Step 2 of the boards at some point, otherwise you won’t be a licensed a doctor when you graduate.
(2) You have to do a sub-internship in the area that you are applying- for example, if I’m applying to surgery residency programs, I have to do a 4 week rotation on a surgery team where I am treated like an intern rather than a medical student (hang in there- we are getting to the point where I explain what an intern is)
(3) You have to apply to residency programs- which involves your personal statement, letters of recommendations, resume, picking ~30 programs to apply to, and interviewing at ~15 of the programs
(4) You have to submit you ‘rank list’ in February of 4th year, which is when you rank all the residency programs that you interviewed at
(5) You have to match to a residency program. All the residency programs rank the medical students they interviewed, and the med students rank the programs, then a big computer decides all of our fates by smushing the lists together and spitting out which residency program you will be going to.

Residency:   Interns =1st year residents, meaning they just finished medical school and are just beginning residency. After your first year of residency, you are called a resident. So technically you can call an intern a resident (they are in their 1st year of residency), but no one really does. But don’t call a resident an intern. That’s a really good way to land yourself on the wrong side of a ‘medical error’. For those of you who want to be a little extra confused- there are some residency programs that want you to do a separate internship first. Example- radiology residency is 4 years long, but before you can start it, you have to do an ‘intern year’ in either medicine or surgery. So medical student interested in becoming a radiologist have to apply, during their 4th year of medical school, to both programs for their intern year, as well as programs for the 4 years after that.

And perhaps the most misunderstood part of residency- you make about $40,000/year. That’s right. I didn’t leave off a zero. $40,000. Considering I’m PAYING that much right now, it’s actually an $80,000 raise for me, so I’m not complaining. The salary slowly creeps up to a measly $55,000 at the end of 5 years; but it’s not til after residency that doctors get paid to be doctors.  After residency, you are called an "attending"- I think because you get to attend the meeting where they hand out the real paychecks.

If you made it through all that, I’m proud of you. I took about 6 breaks and watched 2 episodes of How I Met Your Mother before I finished writing it- so I applaud your attention span.  Here's a silly picture of my nephew to reward your perserverence: