<p>General overview:</p>
<p>College: 4 -5 years
You'll enter as a freshman pre-med, which it should be noted is just an advising category NOT a major. You can major in anything you want, preferably something you are passionate about or at least enjoy. I was a sociology major, I have friends who were everything from applied math to guitar performance to business to political science. As a pre-med you'll take one year of general chemistry, organic chemistry, intro biology, and physics, all with lab. Most medical schools also require at least a semester of "college math" which typically means calculus. A semester of stats is a good idea. Extra science courses which may be beneficial (even required by some medical schools) include: Anatomy, physiology, genetics and biochemistry. After you have completed (or nearly completed) the big 4 requirements (bio, chem, organic, physics) you will prepare for the Medical College Admissions Test (the MCAT). This will typically be in the spring or early summer of your junior year (though if you end up taking 5 years to graduate, you could schedule it later). It's a test about 5.5 hours long, now given on computer (which is new for 2007 - but won't be new for you). There are 3 sections, each scored 1-15: Physical Sciences (50% Physics, 50% gen chem), Verbal Reasoning, and Biological Sciences (25% Organic, 75% Biology). National average for all test takers is about a 24, national average for everyone who applies to medical school is about a 27, and the national average for everyone who matriculates to a medical school is essentially a 30. Typically only about 60-70 people, out of some 70,000+ administrations of the test, ever score a 42. 90%ile is usually at a 34.</p>
<p>During your pre-med years, you need to be shadowing physicians, volunteering (hospitals are great), being involved on campus, taking part in research with a professor, and doing well academically. The national average for overall GPA of matriculants is 3.6, and a science/math GPA of 3.3 (or a touch higher). You don't have to get all A's, and an occasional C is not the end of the world, but you should be getting mostly A's.</p>
<p>In the summer before your senior year, you will begin filling out the "primary" application online through a service called the American Medical College Application Service (AMCAS). This includes a personal statement, list of post-secondary experiences, your transcripts, and lots of demographic information. You will select which medical schools you wish to have this primary application sent to, pay a boatload of money for the service and send them off. Most students will send out between 10-15 applications. Schools will judge your application, ask you for more money, and then send you a "secondary" application. This would include extra essays, more information about yourself, your experiences and your goals. Some secondaries are easy requiring no work, and others have 8 or more essays. The secondaries will be assessed and then you'll be invited for an interview at the school. Once all these steps have been completed your complete file will be reviewed and you'll either accepted, waitlisted or rejected. Currently only about 45% of all applicants receive an acceptance into one of the 125 allopathic medical schools in the US (those that grant an MD).</p>
<p>Medical School: 4 years
First two years are the basic science years. There are a wide variety of curriculum designs which I won't get into here, just know that not all schools do the same thing. In very general terms, most schools use the first year to teach you the way things are supposed to work in the body, and the second year is how they get messed up and how they are treated. Every school also includes a sort of "how to be a doctor course" in addition to the basic sciences which teaches you how to properly take a history, perform a physical exam, write in charts, begin to understand insurance, deal with ethics, handle special patient populations, understand the medical literature, and so on. You take out massive amounts of loans (I'll have a debt of ~$155k when I'm done in 2009 and I pay in-state tuition at a state school...it'll be approx. 80-100k more at a private school), study your ass off, get really drunk after tests and basically give up the first part of your 20's.</p>
<p>After 2nd year, all medical schools require you to take the United States Medical Licensure Exam (USMLE) Step 1, a 6 hour, 300 question multiple choice exam that must be passed to move on to the next year. It tests on all aspects of the first two years, typically in clinical vignettes, with questions that are usually "3rd Order" or higher in nature (an example of a third order question: image of a cell with an arrow pointing to a unidentified granule in the cell with the question "What is the function of the product released by this granule?" you have to know 1) what cell and tissue, 2) what enzyme is released by that cell in that tissue, and 3) what the function of the enzyme is.) USMLE is also notorious for "Type A" questions in which all the answers are technically correct, but you must find the "most correct" answer choice.</p>
<p>The third year is a series of required clerkships, in which you become an integral part of the health care team. Most schools have about 6 required clerkships with the most popular being: Internal Medicine, Pediatrics, Surgery, OB/GYN, Psychology (I don't think I've a curriculum that didn't include those 5, ever, they're pretty standard). The 6th or 7th options include Family Practice, Neurology, Emergency, Pathology, and Radiology. You as an M3 are essentially the first contact with the patient when they are admitted, and you begin the formulation of the treatment plan. You'll have maybe 3 or 4 patients you'll be "responsible" for, who you'll interview and examine, and then present to your Intern (MD who just graduated), they'll help you with the Assessment and Plan, ask you questions, teach, and then you'll present the case to a resident, repeat, maybe present to a chief resident, and then to the Attending (actual full on MD, done with all their training and legally liable for the patient you are using to learn). </p>
<p>Fourth year, is comprised of a variety of different electives in which you get the opportunity to figure out what field you want to end up in for residency early on in the year (july, august, september, october) and then explore the other types of medicine you want to experience before you no longer have a chance (november-april). August through October is the time to prepare residency applications, November through February is interview season, and in the middle of february (for most specialties) you send in a list of your top choices (ranked in order), while the residency programs rank the applicants they saw. The lists are fed into a computer and in 6 minutes some 24000 residency positions are filled trying to get everyone their top choices.</p>
<p>You also have to take USMLE Step 2 during your 4th year. It has two parts Clinical Knowledge which is just like step 1 and Clinical Skills which is done with standardized patients where you are given 15 minutes in a room to interview and examine a patient, then 10 minutes to write the chart note, and you're graded on how you handle yourself, your exam skills and chart writing. (If you watch Grey's Anatomy, this is the boards exam that Alex failed last season).</p>
<p>Residency and fellowship: 3-7 years.</p>
<p>This is where you finish your training and become a specialist. Pediatrics is three years, but if you want to enter something like pediatric cardiology or pediatric oncology, you would have to enter a 3 year fellowship after your 3 year residency. There are a variety of different paths so I won't get into it here just to say that Peds, Internal Med, and Family Practice are 3 years. General Surgery is 5, OB/GYN is 4. Few residencies are more than 5, but when you tack on a fellowship training could be as long as 7. </p>
<p>As a resident or fellow you are gaining the requisite (as determined by each specialty oversight organization) knowledge base to be a practicing physician. You work long hours (No more than 80/wk) for little pay (first year house officers average about $44k/yr before taxes - each year has a raise attached but it's usually about 2,000 - 3,000 dollars)...and you have outrageous loans to pay off.</p>
<p>I'll post more about your other questions later.</p>