Sanford School of Medicine M.D. Program

A Primer on Medical Education

Extensive training is required before you become a practicing physician. We've created this guide to help you understand the path to becoming a doctor. Use it to familiarize yourself with the training and process of medical education.

Medical School (Allopathic Schools)

With rare exceptions, entry to medical school requires a college degree. Students who are in college may apply for entry to medical school, but must finish their degree successfully before starting their medical training. Although no specific college major is required, most medical schools require courses in the sciences and more recently in social-behavioral studies.

Application Process
People who wish to apply to medical school do so through the American Medical College Application Service (AMCAS). It's a a national system that collects information in a central repository. Applicants then designate which medical schools should receive their application.

The Medical College Admissions Test (MCAT) is required for application to medical school.

Medical Education
Medical school is four years long.It includes classroom study, laboratory work, and clinical work with patients. Courses include basic science and clinical skills. Usually, at least half of the four years is spent in a clinical setting so that the student can learn how to take care of patients and apply the skills they have acquired.

Testing during Medical School
Students take three national examinations during medical school. These are the USMLE Step I, USMLE Step II clinical skills and the USMLE Step II clinical knowledge. Students must pass all of these examinations to eventually obtain licensure and many schools requires students to pass all of them in order to graduate.

After four years, graduates are awarded the M.D. degree. However, they are not permitted to practice medicine without further training in a residency program.


What is a residency?
A residency is a period of on-the-job training that allows medical school graduates to become specialists in a field.For example, a graduate who wants to become a pediatrician would do a residency in pediatrics.

What types of residencies are available?
Residencies are available in many fields including family medicine, pediatrics, internal medicine, surgery, obstetrics/gynecology, radiology, dermatology, anesthesiology, pathology, ophthalmology, urology, neurosurgery, neurology, orthopedics, emergency medicine, psychiatry and others.

Is residency training required?
A residency is required of medical school graduates before they are allowed to practice medicine. Some states will grant provisional licensure during residency, whereas others require full completion of a residency to become an independent practitioner.

What does a resident do?
A resident works with a senior, licensed physician (sometimes called an attending physician). The resident sees patients, decides on a plan and reviews it with the senior attending physician. Residents can write prescriptions, give medical orders and document in the medical record. They also attend required lectures and take examinations to ensure that they gain the knowledge required to become a specialist in their field.

Is there a standard approach to resident education?
Yes, there are national requirements for what must be taught to residents, how they must be supervised and even how many hours per week they are allowed to work.These standards are set by the Accrediting Commission on Graduate Medical Education (ACGME). Every specialty has a committee within the ACGME that oversees specialty-specific requirements. This Residency Review Committee (RRC) visits programs regularly to ensure they are following requirements.

How long is a residency?
The length of training varies with the specialty. Some are three years long and some are four or five years long.

What is the difference between an intern and a resident?
The term intern usually just refers to a first-year resident.

Are residents paid?
Yes, residents are paid a salary. The salary varies somewhat according to the institution.

How are residencies funded?
Residencies are funded through hospitals. Through Centers for Medicine and Medicaid Services (CMS), the federal government pays hospitals for each resident (known as direct medical education funding, or DME). Hospitals with residents also receive slightly more reimbursement from Medicare for their patients (indirect medical education funding or IME). In most cases, CMS will only pay for a limited number of residents per hospital. States may also contribute to residency education, often through Medicaid programs that are partially funded by CMS.

Why would a hospital want to have a residency program?
Residents are young, energetic physicians who have recently graduated with state-of-the-art knowledge. Hospitals with residency programs are often able to hire new physicians from this pool. Residents also provide direct patient care (under supervision), which helps hospitals manage their patient population. Finally, having a residency is a sign that the hospital staff physicians are highly skilled and capable of serving as role models for the new generation of physicians.

How do medical schools relate to residencies?
Medical schools may take responsibility for the academic and educational programs in a residency. This is called sponsoring the residency. Medical schools may also have a slightly more distant relationship called an affiliation with a residency.

What national tests do residents take?
All specialties have national board examinations which are given after completion of residency. Physicians who pass these boards are board-certified in their field, which is a mark of distinction that is universally desired.

What happens after residency?
After residency, many physicians start practice. Some, however, go on to do more training through a fellowship.

What is a fellowship?
A fellowship is training that a specialist takes to become a sub-specialist. For example, an internal medicine specialist might do a cardiology fellowship to become a cardiologist. Fellowships are usually two to three years long. Subspecialty fields include cardiology, nephrology, infectious diseases, rheumatology, endocrinology, hematology-oncology, pulmonology, critical care, geriatrics, gastroenterology, maternal-fetal medicine and many more.