Medical School FAQ

Medical School Curricula

5.1 How long is medical school?

In the United States, medical school is generally four years in length. You spend the first two years predominantly in the classroom and lab, and the last two years predominantly in the hospital.

The classes in medical school vary from place to place. But there are some that everyone takes in their first two years, no matter where they are:

The amount of lab work varies from class to class and school to school, although some classes (like gross anatomy) feature as much lab work as you have time for.

Again, depends on the school. Many schools still have the standard A/B/C/D/F scale of grading. The rest go on the pass/fail scale or some variation of it. Many schools have an "honors" grade which reflects performance in an upper percentile of the class for that course.

The grading scale can change as you advance in your studies. For example, some schools have letter grades the first two years and then pass/fail grades the last two (or letter grades the first three and pass/fail the last year only).

The grades themselves are objective the first two years - based almost entirely on written exams, oral exams, and practical (or lab) exams. In the third and fourth years, grades depend in large part on evaluations by other members of your hospital team - the attending physician(s), the resident(s) and/or the intern(s). There are also written/oral exams in the last two years, and the relative importance of exams vs. evaluations varies greatly from rotation to rotation.

Rotations are the blocks of time you spend on the different services in the hospital. Most schools have a set of required rotations and let you choose from a vast field of elective rotations to fill out the rest of your third and/or fourth year. The required rotations everywhere:

Generally you will spend a total of about 10 months doing these five rotations. Some schools make you take all required rotations in the third year, and some let you spread them out so that you can take electives in the third year, thereby allowing you to take some electives that may help you narrow down your possible choice of specialty for residency.

As far as electives go, generally there are several ways you can go. You can take "away" rotations - rotations arranged to spend at other hospitals (ideally the hospitals where you think you might like to do your residency). Generally, schools will let you do a month or two away. When considering away rotations, keep the following tidbits in mind:

1. Most residency applications are due by October or November, and most residency committees start making decisions on who to interview by the end of November at the very latest. Therefore, for an away rotation to really help you sway the people at the hospital you visit, it must be done in the first few months of the fourth year (keeping in mind that USMLE Step II is usually at the end of August of that year). September and to a lesser extent October tend to be the most popular months to schedule away rotations.

2. At most schools, there are a lot of hoops to jump through to get an away rotation approved. You have to determine that the hospital you want to go to actually has an open slot in the rotation you want during the month you want to be there. Once you've gotten that info, there are lots of forms and signatures needed--deans and chairmen from both schools, grading papers, course content papers, etc. The point of all this is: once you decide to take an away rotation, get started on planning it because it takes a month or two to get everything straightened out.

The electives you do at your home school tend to fall in these categories:

1. Electives in what you think will be your residency specialty
2. Electives in things you think will help you in residency (a lot of people take things like cardiology, radiology or emergency medicine because they provide valuable training for the intern year)
3. Electives in things that interest you
4. Electives your friends are taking
5. Electives that are easy (generally includes things like ophthalmology, dermatology, and lots of odd little electives that will turn up on the list at your school; at my school we could do a month sitting in the blood bank drawing blood from people, or do a month learning what the different lab tests are and what they mean)

The only absolutely essential, "must have" textbook is the "Atlas of Human Anatomy," by Frank H. Netter, M.D. (now in its 2nd edition). Beyond that, your textbook purchases should reflect:

a) the recommended texts of your school - not all texts cover the same subjects to the same depth, and you might miss out on a professor's pet area that he loves to test heavily because it's so insignificant that a different book barely touches on it (thus a gentle reminder to try to learn what your professors consider themselves to be experts in, because those things will always be on the tests). Also, remember that your required texts will all be on reserve in the library (usually in multiple copies) - so if you really feel you need to read one chapter, you can always just borrow the library copy and read it.

b) the course materials given out in each class - some classes feature thick, comprehensive syllabi that cover each lecture specifically and that make the purchase of an outside textbook pointless. And some schools have note-taking services that "can" lectures - basically giving you a typed transcription of the entire lecture, complete with copies of overhead materials. As with the syllabi, a good set of cans renders a textbook moot. Not all schools allow the canning of lectures, but if they are offered you should absolutely sign up and get them.

c) your personal study preferences - how do you study best? Some people love to read the texts. Some people like lectures and don't read much at all. Determine where you fall in the scheme of things and plan your purchases accordingly. Even if a text is great (example - the Robbins pathology text), generally the book will be dry reading and very long, and if you are not the kind of person who learns well from books like that, then your money is better spent elsewhere.

PBL stands for "Problem Based Learning." Basically, there are two basic types of curricula in medical schools today: PBL and so-called "traditional" learning. Traditional learning is the basic stuff you had in college--lectures and plenty of 'em, labs, classes taught as discrete entities (gross anatomy, pathology, pharmacology, etc.). PBL represents a more integrated way of presenting the materials. Lectures are kept to a minimum; instead, the emphasis is on small group learning, teamwork and problem solving. Groups meet and are given clinical situations in keeping with the current subject material. These situations can involve anatomy, pathology, pharmacology, etc. all at the same time. The group then solves the problems using available resources (library, computers, etc.) and discusses their solutions. In this way they learn the body as it is--a set of interrelated systems--instead of in discrete chunks.

That said, PBL is not for everyone. Some people prefer the lectures. Some schools offer only PBL, some only traditional, and some give you an option of which you would prefer. Contact the schools you are interested in and ask them about their curricula.

There is as much free time as you want there to be. In spite of what you might hear, medical students don't study ten hours a night AND go to every lecture AND go to every lab AND read journals just for interest AND work on a cure for cancer. At the beginning, sure, you'll feel this overwhelming fear that everyone is ahead of you and you will make the lowest grade and somehow people will find out and point and laugh at you. So you'll study like crazy right up until that first gross anatomy test that you'll take on no sleep in some caffeine-induced trance. After that, though, you'll learn what your best study methods are and how best for you to use your time. After that, you'll discover that there is plenty of free time to have a family life, have friends, go to parties.

In the clinical years, your free time depends on your rotation. Surgery tends to lend itself to hospital work and sleep only. Psychiatry tends to give you more free time than you could possibly fill. The others fall someplace in the middle.

In spite of its resemblance to the words "U SMILE," it's not a happy thing. USMLE stands for United States Medical Licensing Examination, and the website may be found at <http://www.usmle.org>. There are three parts to it - each part consists of a two-day, twelve-hour exam, and in virtually every state you must pass the parts in order to get licensed. The examination is being converted to computer format; Step I will now only be one day long and may be taken whenever the student wishes. See the USMLE web site for more information.

A good score is one that is (a) passing and (b) passing, a fact that the USMLE apparently realized because rumor has it they are going to make the exams pass/fail in the near future. For now, keep in mind that the national average (which has been rising, probably through artificial means) has been around 215 in 1997-98. The cut-off for a "good" score once was 200 (when 200 was set as the statistical mean, or 50th percentile score). Now, though, "good" scores start around 215 and go up from there. And yes, it is sad but true that some residency programs use USMLE Step I scores as a preliminary cut-off point for sending out secondary applications and/or interview requests. Generally the programs that do this tend to be the more competitive ones - surgery, orthopedics, ENT, neurosurgery, etc.

Alpha Omega Alpha, or "AOA," <http://www.alphaomegaalpha.org> is a national medical honor society that was founded in 1902 to promote and recognize excellence in the medical profession. Most, although not all medical schools have a chapter of AOA. Each school's chapter selects a small group of students to join the society, generally in their junior or senior years. "Junior AOA status," or being selected as a junior, is considered superior to "senior AOA status."

In order to meet the minimum requirements of the national society, students must be in the top 15% of their class academically, and possess leadership and community service attributes. Academic activities such as research, performance in clerkships and electives and extracurricular program participation are generally included in the selection criteria.

Individual chapters may also elect to induct outstanding alumni, faculty and house staff to AOA. Induction ceremonies are generally held just before graduation and are highly specific to the individual chapters.

Having AOA on your curriculum vitae is considered an asset when applying in the very competitive post-graduate programs such as dermatology and surgical subspecialties.

[Maintainer's note: Stanford is one of the few schools that does not have AOA. If you are aware of other schools that do not have a chapter, please let me know.]