Med School Timeline

AUC Main Building

Before coming to medical school, I feel it is important for all prospective students to understand the overall step-by-step process that one must go through to become a doctor. It bothers me that some students come to medical school not knowing the difference between clinical rotation and residency, and not knowing that there are licensing exams to take that are much longer than the MCAT. Because of this, I’d like to give an overview in chronological order the timeline that a student has to go through to become a doctor. This page is also for my friends and family back home to understand more about the schedule of my medical education.

Disclaimer: Here, I am only talking about the education schedule in getting an MD for the majority of med schools in the US, which also applies to most off-shore Caribbean medical schools. Some med schools in the US and in other countries may have 7 year programs that combine undergraduate education with medical education, which I do not cover here.

1. Pre-Med
In order to get into med school, we must first earn a Bachelor’s degree through four years of undergraduate college, and take pre-med classes. Pre-med is not a major. It is simply a set of classes we must complete in order to go to med school. We don’t have to have a major in one of the sciences in order to go to med school. There are plenty of people who majored in something else in undergrad, like art or music, and still go to med school, as long as they complete the pre-med classes either as an undergraduate student or a post-bacc student (which is what I did).

2. MCAT
In addition to pre-med classes, one must take the Medical College Admission Test (MCAT). There is no “passing grade” or “failing grade” on the MCAT. There is simply a score. Different med schools may require different MCAT scores in order to consider an applicant. In 2013, the average MCAT score of matriculants to US medical schools is 31. At the top Caribbean medical schools, it is 25.

3. Medical School
Once we get accepted into med school, it is another four years. The four years of med school are divided into two parts: two years of Basic Sciences (called Medical Sciences at some schools), and two years of Clinical Sciences.

Years 1 & 2 – Basic Sciences (aka Medical Sciences, MS1 & MS2)
The first two years of med school is called “Basic Sciences.” Basic Sciences consists of two years of studying in the classroom setting. We start off learning what is “normal” in the human body (i.e. anatomy, physiology, cell bio) and then learn how the “normal” human body can become abnormal via diseases (i.e. pathology). We also learn what drugs are out there and how they work (pharmacology).

USMLE Step 1
There are 3 parts (or “steps”) to the US Medical Licensing Exam (USMLE) – Step 1, Step 2 CS, Step 2 CK, and Step 3. After Basic sciences, and before moving onto Clinical Sciences, we take the first part of the USMLE, called the USMLE Step 1 Exam. The exam is 8 hours total. Unlike the MCAT, there is a definite passing and failing score on each of the USMLE board exams. As of 2014, the passing score for Step 1 is 192.

Years 3 & 4 – Clinical Sciences (aka Clerkships, Clinical Rotations, MS3 & MS4)
Once we pass the USMLE Step 1 exam, we move onto two years of Clinical Sciences, in which we study in the hospital/clinic setting. We do not get paid during this portion. We follow doctors and residents in the hospital, working, shadowing, and learning the art of medicine on real patients. During year 3 of medical school (sometimes called MS3), we rotate in all major fields of medicine: Psych, Internal Medicine, OB/Gyn, Surgery, Pediatrics, etc. During year 4 of medical school, we rotate in fields that are more specialized, such as cardiology, neurology, endocrinology, emergency medicine, etc. We do not need to choose which field of medicine we want to pursue until we apply to residency programs towards the end of Clinical Sciences.

USMLE Step 2 CS and CK
During Clinical Sciences, usually between third and fourth year of med school, we take the USMLE Step 2 CS and Step 2 CK. Step 2 CS gauges our clinical skills (abbreviated CS). It is an 8 hour exam in which we see 12 different patients who are actors and come up with diagnoses. It is scored as pass/fail. The Step 2 CK tests for our clinical knowledge (abbreviated CK), and it is a 9 hour exam on the computer. While the Step 1 exam focuses on how diseases work and how treatments work, in contrast, the Step 2 CK exam focuses on how to diagnose and manage diseases. As of 2014, the passing score is 203.

Applying for Residency
Although a medical school diploma can give you an MD behind your name, it does not give you a specialty, nor does it allow you to practice independently as a physician. In order to practice medicine independently in a certain specialty in the US, all medical school graduates must go through an ACGME-accredited residency program at a US teaching hospital after graduating from medical school. During our 4th year of med school, we apply to numerous residency programs across the country in our chosen specialty. For all the hospitals we interview at, we rank the hospitals to our preference on the National Resident Matching Program (NRMP) website. The hospital does the same and ranks the students that they interviewed to their preference. Then on Match Day in March, the “Match” happens, and you are matched into a residency program at a hospital. The Match ensures that the hospitals get the graduates they want the most and that the graduates get the hospitals they want the most. However, the Match does not guarantee a spot for every student, and while most graduates do match somewhere, there are certainly some who also do not. At the end of year four, we graduate from medical school and earn an MD degree. Then, the next step is residency.

4. Residency
Residency is both a job and a training program, and all graduates must go through residency in order to pursue the medical career they want and eventually be state-licensed and board-certified to practice medicine. You must choose a specialty for your residency, like family medicine, internal medicine, psychiatry, pediatrics, obstetrics/gynecology, PM&R, dermatology, surgery, neurology, radiology, pathology, ophthalmology, etc. Some residency programs offer dual specialties, like IM/Peds or Peds/Psych, but there aren’t that many of these. Residencies may last between 3-5 years depending on the specialty, and residents are often paid around $47,000-$53,000 per year or so.  The first year of residency is called Internship, and first-year residents are called “interns.”

5. Licensing and Board Certification
So what’s the difference? Licensing is state-specific whereas Board Certification is specialty-specific. State licensing is an absolute requirement for you to legally practice medicine in the US. While Board Certification is technically not required by law, it is required by many, if not most hospitals and clinics for employment, and therefore, practically-speaking, it is a requirement. The USMLE Step 3, the last part of the US medical licensing exam, is typically taken by the end of your intern year of residency. Step 3 is a 2-day computer-based exam focusing on medical management. Once you pass USMLE Step 3 as well as satisfy your state’s other licensing requirements, you become licensed as a physician in that particular state. Every state has slightly different licensing requirements. In addition, towards the end of your residency, you take your specialty’s board examination, which upon passing, you become board-certified in that specialty.

 6. Practice or Fellowship
After you finish residency, get licensed to practice in a certain state, and become board certified in your chosen specialty, you can choose to directly begin working at a hospital or go into private practice. After residency, you can also decide to specialize even further (“subspecialize”), such as becoming an endocrinologist, cardiologist, pulmonologist, sports medicine doctor, child psychiatrist, etc. In order to do this, you must complete an ACGME-accredited fellowship in that subspecialty, and this takes another few years, depending on the subspecialty. Then, you pass an exam and satisfy requirements to become board certified in that subspecialty.

7. Continuing Medical Education
State Licensing and Board Certification are not one-time occurrences, and must be renewed every so often in order for you to continue practicing medicine in the US. To keep your state license, you must complete a certain number of Continuing Medical Education (CME) credits per year, depending on the state. To keep your board certificate, you must pass an exam every 6-10 years, depending on the specialty or subspecialty. If you want to become a doctor, expect a life of studying and taking exams for the rest of your career.

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