How does your non-U.S. medical education system work?

[Stephen Ewen]

Hi all.

Recently, "Dutch Doc" posted a thread called (CLICK ON LINK "On request: the Dutch system of med school", which you may reference as a backdrop to this thread.

I think that such knowledge is valubale for readers--to have an "insiders view" of how "different" medical contexts and edu systems work, is simply valuable.

Hence, if you are in a medical system other than the U.S.'s, and are in the process of learning or have quite well "learned the ropes" of it...inform us all, please!

Because as mentioned above, there is simply a whole lot of value in such for both regular readers of SDN and those who "happen to come along"; there is a whole lot to learn, both personally, professionaly, and particularly in terms of pluralism, from the the knowledge of what I suppose we could call "comparative medical education systems."

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[neilc]

just a quick reply for the 6 year program at my school...

year 1 is anatomy, histology, med chem, biophysics, genetics...some low level med courses and some refresher info or pre med type courses as well.
year 2 is biochem, anatomy continued, physiology, micro, immuno and some others. this is the toughest year in terms of exams/failure rate
those are the major basic science years.
year 3 is the preclinical year with all the pathology (path, pathophys, pathobiochem) the rest of micro, pharmacology, psychology. also, we get to the clinic a few times a week, and begin to integrate our classroom knowledge with patient care and diagnostics.
years 4 and 5 consist of 2-4 week rotations thru all the specialties of medicine...well, at least a lot of specialties.
year 6 is like a pre internship year with state exams. you do what is basically a sub-internship in med, peds, ob/gyn, surgery and public health. after each course is a comprehensive oral exam by a panel of specialists. basically passing these exams gives you a license to practice general medicine in the czech republic. failing any requires that you start over from year 1.

the school is very different, with all grades determined solely by a comprehensive oral exam. any tests, quizzes, lab work, papers or whatever only serve to qualify you to sit for the exam. it is pretty tough, and was not easy to adapt to after being reared on multiple choice tests and curves.

this turned out a bit longer than i thought, but i hope it answers some questions, and that it was what stephen was looking for. did i leave anything out? ask me if you have any further questions and i will be happy to share.

 

[giselle]

There are 6 years before residency called "internat" in France.

PCEM 1 = P1 = first year = fundamental sciences (biology, physics, chemistry, biophysics, biochemistry, human sciences, micro anatomy, gross anatomy, embryology). There is a hard competition durin this year, only 15 or 20 % of the students are allowed to go on studying medicine. Usually, french students make it in 2 years.

PCEM 2 = P2 = second year = fundamental sciences (anatomy, physiology, biochemistry, biophysics, embryology, statistics, psychology, public health) and semiology (the study of the signs of the diseases). And of course medical english . The first month, we work the whole day at the hospital as a nurse, and the folowwing moths, we spend 4h a week with patients.

DCEM 1 = D1 = third year = medical sciences (neurology, pathology, pharmacology, clinical biochemistry, genetics, immunology, infectious diseases, emergency medicine, ethics).
In the second part of this year, we work at the hospital as "externe".

DCEM 2, 3, 4 = 4, 5 and 6th years of medicine = "externat". Clinical rotations : we spend every morning for 3 months in a ward and then we change. We have "astreintes " (to be on call) during the week-end , and we are frequently on duty.
in the afternoons we have lectures.

Then there is a competition at the end of the sixth year. It's called "internat" and it allows you to become a resident...

giselle

 

[Dutch Doc]

Hello,

Thanks for the info on the other systems.

You know, ours isn't so bad after all.

(especially regarding the fact that I'm typing this from a hospital floor because I've got nothing better to do)

Dutch Doc

 

[El Duderino]

In Sweden, the curriculum varies between different schools, but where I'm at there's 1,5 years of molecular biology, anatomy and physiology, 1 year of pathology, 1,5 years of internal medicine, and surgery (ortho/gyn/anaest/urol etc) then another 1,5 years of the rest (ENT, derm, neuro/psych etc). That's the part (5,5 years) that's spent at the university hospital. Then, you do an additional 1,5-2 years of internship at just about any hospital (country hospitals as well as university hospitals, it's your choice). This internship is comprised of several months each of IM and surg, psych and family practice.

After that (7-7,5 years), if you pass your licencing exam, you get to be an MD, and you're qualified to apply for residency spots.

 

[Long Hair and a Beard]

Okay, I'll fill in for the Indian system:

The Indian Medical degree is called MBBS: Bachelor of Medicine and Bachelor of Surgery, for which the eligibility is 12 years of schooling (I think equivalent to high school in US). There are medical colleges all over India, which take medical students from their respective states on the basis of State-Level Pre-medical Exams. There is also the All India Pre-Medical Test for which students of all states are eligible, and through which 15% of all seats in all medical colleges are filled. There are also national institutes which conduct their own Entrance Tests which is open for all students. These Tests are basically Multiple Choice Questions on Physics, Chemistry and Biology.

The MBBS:

The whole thing takes 5 1/2 years divided as follows:

!st Professional (1 year): Anatomy, Physiology and Biochemistry.

2nd Professional (1 1/2 year) : Pathology, Microbiology, Pharmacology and Forensic Medicine. The clinical training starts in the second year in our college. But varies according to college.

3rd Professional (2 years): The clinical subjects; alongwith clinical training.

Internship (1 year): Rotation in different departments.


After MBBS, one has to sit in another competitive examination to get Residency.

 

[Resident Alien]

The Pakistani system is similar, but im fuzzy on the details. Will post as soon as i found out, unless StormReaver beats me to it

 

[Skip Intro]

Good thread, I'm learning a lot!

Thanks!

-Skip

 

[Lille My]

Hi everyone!I will tell you a little about medical education in Norway
You can start right out of high scool if you you have completed specific requirements in physics, chemistry and maths. entrance is based entirely on Gpa.
All programmes are 6 years long, i.e. 12 semesters.
Here in Oslo we have a Pbl based curriculum with integrated preclinical and clinical subjects. This means, for instance, that you don't learn reproductive anatomy and physiology until the 5th year when you have ob/gyn & peds. Here's an outline of the Oslo curriculum:
1 st sem: an intro course in the history of philosophy & logics, statistics, communication and behaviour, epidemiology and a brief intro to human biology.
2 sem: cell bio ( histology & biochem included) early patient contact through FPs.
3 sem: anatomy & physiology of the cv & resp systems and kidney (acid/ base), immunology, microbiology, hematology, basic pathology and intro to clinical exam.
4 sem: first 8 weeks of the digestive tract (ana& phys, micro & pathology + clin exam then, 12 weeks of the locomotor system (+ ana& phys + how to examine it + some chirurgia minor )suturing and such)
5 sem: diseases of the cv system, resp system and kidney i.e. All clinical subjects concerning these systems are integrated for instance micro, int. med, radiology, surgery etc. Clinical rotations and clinics
6 sem diseases of the blood, skin and the gi system are the main foucus.
7 sem Study of basic neurobiology as well as ophtalmology, ENT and neurology
8 sem Neurology cont. as well as psychiatry
9 sem Reproduction, ob/gyn and peds.
After the 9 semester you get a "temporary physician's licensce" and can take jobs as a physician on holidays/weekends but have to work under close supervision of a fully licensced doctor.
10 sem 6 weeks rotation in a hospital "out of town" in surgery and int med and 6 weeks working with a Family practitioner. 8 weeks community medicine & epidemiology
11 & 12 sem 4 weeks emergency medcine course, the rest is a "review" of int med ,surgery and family med with emphasis on symptom presentation, rotations in different departments.
THEN, after 6 years you graduate but still there's a 1 year internship (6 months surgery, 6 months int med) in a hospital and a 6 months intership with a family practitioner and FINALLY you are a fully qualified doctor and can apply for a residency
You DO get paid pretty well both during the interships and as a resident, though!

 

[BellKicker]

I won't list every class and semetser we have in Denmark cuz it's really close to Norway and Sweden.

Lille My, I was surprised to se OB/GYN so early. We have ours on the 13th semester. Something from the olden days, like when you deliver your first baby you're a real doc.

And I know what you mean about being "licensed" when you're still a student. At my psych rotation right now there is a "doctor" who's only 1 semester ahead of us. We suck up to him, anyway, of course.

Lille My and Duderino, what do you call the internship year (year and a half also for us, I guess)? We call it turnus. I forget but someone told me that it's a lottery in Sweden and applications in Norway or is it the other way around? We have lotteries.

And both of you....... Just how much can a kommunel?ge (my spelling, sorry) make way up north? Everyone's talking about how they're going up there to make money after "turnus" (and like 2% actually will!) But how much is it really?

Later everyone.

 

[Lille My]

hi there bellk.!
yes, we call during the 1,5 years after graduation "turnus." (=internship) Each semester, there's a lottery when all the graduating students in norway + norwegians studying abroad + anyone else who has completed medical education abroad and has bothered to learn norwegian (or another nordic language) can take part. The lottery decides the order in which you get to choose the hospital where you do the internship and the region of the country where you do the FP internship. The unlucky ones get to go waaaaaay up north, above the arctic circkle where there's 200 miles to the next physician and 600 miles to the nearest hospital! Lately, so many people have signes up for the lottery that there has been concern that not everybody will get to participate - i.e. will have to wait for the next lottery to get a place. so far there has been no preference for norwegian students studying in norway!
I'm not sure how much a intern makes but i think for a regular work week (40 hours) it's ca 230-240 000 nok and then there's extra for being on call and such. I don't know how much a kommunelege makes excactly, but i should guess in the 300-400 000 nok neighbourhood, depends on how much you're on call (or at legevakt, as we call it)
out of curiosity, are you american or danish originally, your english is sooo god? we have an exchange student (who is norwegian here at the moment who studies in k?benhavn. her name is nina and she was supposed to be in the 13 th semester back there.

 

[BellKicker]

Hey Lille du (deg?).

100% Danish here. Married an American. Going to the US after graduation.

OK, so your system is exactly like ours. Our lottery is also starting to fill up and there's no preference for graduates of Danish schools. That's the only good thing about moving to the US; not having to worry about that (but instead, a million other things).

I was a little disappointed that a kommunelege only makes that much. Maybe what everyone is talking about is more like a temp position in a town that needs a doc right here right now. I was talking to this one doctor, who is actually moving up to Norway. He said he would make 1,2 million kroner a year as a kommunelege. He also said that he could start now, even though he only has turnus and 2 or 3 years of family practice residency (out of 5, I think).

I dunno, I was a little sceptical.

We have quite a few Norwegians here in K?benhavn. I have two friends (from Bergen and T?nsberg) that I did a long group project with 2 years ago. We would fight in Danish/Norwegian all night over the minutest detail. You know how that goes. Made my Norwegian a lot better than it used to be.

I'm an endurance sports freak so all winter I watch skiskydning and langrenn on NRK1. Gaad, I love those 2 commentators; I forget their names. Is it Rike and Kjellsen or something? I always root against the Norwegians, they're just too good at everything. I love hearing the 2 geezers squeal: "Nej, s? bommer Ole Einar Bj?rndalen". You just know they're eating their knuckles, they're that much into it.

Anyway, say hi to the snow for me. Must be just about that time of year .

 

[Lille My]

hey bellkicker,

contrary to popular belief there probably won't be any snow up here in oslo for another 2-3 months, actually we are having like 12 degrees celc. here during the day. it's kind of nice and kind of scary (global warming and all)
rike and carlsen at nrk are hilarious! but waay too patriotic in my opinion and carlsen sometimes has the lamest jokes ( which are kind of funny at the same time cause i like dry humour.)
i have also heard of those outrageoulsy high wages for being a temp fp in the most remote parts of norway. i have heard of this guy who was on call non stop for like 17 days (!!!) and made 100 000 nok from it but that just doesn't sound like responsible medical practice!
i am the research assistant to a danish doctor who graduated from aarhus several years ago. he is just the coolest! ( "hold keft, mand!" + "sgide godt" are some of the more powerfull expressions i have learned from him
lille my does not mean "lille meg" actually. I borrowed the name from this children's book character by finnish author tove jansson (who wrote about mumitrollet also) lille my is softspoken and warm hearted, just like me!

 

[FionaS]

It's been done before, but I'll put it here again :

The degree you get after studying medicine is the MBBS, BMBS, MBChB (Mine) and MBBChir, which all mean basically the same thing, Bachelor of Medicine, Bacherlor of Surgery (Older schools use MBChB versions, newer ones use MBBS versions - it's all about the latin for surgery apparently).

You can study medicine straight from secondary school (=high school) provided you have A level Chemistry and one other science (usually Biology). Grades are high, AAAA is not that unusual. The usual offer is AAB. You can apply to a max of 4 med schools in any one year, via UCAS (who do all the admissions stuff). Nearly all med schools interview and competition for places is tough - normally about 10 people per place.

Most med schools in the UK are systems based at the moment, with a bit of PBL thrown in for good luck. It takes between 5-6 years - the vast majority do it in 5 years, Cambridge takes 5.5 years, and those who intercalate (explained later) do it in 6 years.

So at Birmingham (which is where I am) the course breaks down like this:

Year 1 - Systems based teaching ie Cardiovascular 1, Neuromusc 1, Digestion, Renal & Endocrine 1, Behavioural Sciences 1, Public Health & Epidemiology 1, Ethics & Law 1 and so on (Sure I've missed out a few). You also have an attachment to a general practice for 1 day every 2 weeks throughout the year where you get to learn your clinical skills and see real live patients (the excitement!)

Year 2 - Cardio 2, Neuro 2, DRE 2, Immunology & Haematology, Beh Sci 2, PHE 2, E&L 2 etc etc. GP attachment continues.

Intercalated year - this is optional and is usually taken between the 2nd and 3rd years (but not always). Medics stop being medics for a year and join another relevant degree (usually BMedSc or BSc) in their 3rd (=final year) remembering that an honours degree takes 3 years in the UK). I am doing this at the moment, studying for a BMedSc (Bachelor of Medical Sciences) in Neuroscience. You graduate with this degree. It used to be about 20% of medics took this option, but now the numbers are rapidly increasing. Intercalating is compulsary at a few med schools (Imperial in London and Nottingham).

Year 3 - the mojority of medics go straight here from 2nd year. You spend 6 months in medicine, 6 months in surgery (actually less, because you still have some holidays, but equally proportioned). Medicine might involve resp, cardio, gen med, rheum, diabetes, gastro etc. Surgery might involve orthopaedics, gen surg, uro, gastro, cardiothoracic etc. You spend most of your time at hospitals - at Brum you spend 3.5 days a week at hospital, have Wednesday afternoons off, and spend 1 days a week alternating between all the social sciences etc (Public health, epidemiology, psych, sociology) and your GP attachment.

Year 4 - similar to year 3. Your holidays get shorter and you carry on rotating through med and surgery doing 6-8 week placements. At the end of 4th year at Brum you do your elective, which is an 8 week research project anywhere in the world - you may even have spotted some UK students on elective where you are

Year 5 - Higher med and surg. Again similar to Year 4, just more complicated, and holidays are virtually non existent. Just before you graduate in late June you do a Shadow RPHO job for up to 6 weeks, where you find out what you're going to be doing for the next year...

You get examined at the end of each year, most people pass because they've already weeded out the people with no chance (supposedly) at the interview stage to get a place at med school.

So you've graduated with an MBChB (and possibly also a BMedSc/BSc). Congratualtions, you're a doctor. Well...

After graduation you become a PRHO (pre registration house officer). This means although you can call yourself Dr, you only have provisional registration with the GMC (General Medical Council). You have to successfully complete a year as a PRHO in a hospital to get full registration and become an SHO (senior house officer). PRHO year involves 6 months surgery, 6 months medicine. There are a few schemes which have 4/12 surgery, 4/12 med and 4/12 general practice, but these are quite rare. You rotate in August and February. You usually do your PRHO year in the area your med school serves, but you don't have to (advisable though, going out of the matching scheme is hard work, but entirely possible).

Now you're an SHO. You've got more exams to take, because now you decide whether you're going to be a surgeon or a physician. You spend a minimum of 3 years as an SHO taking your MRCS (Member of the Royal College of Surgeons) for surgery and your MRCP (MRC of Physicians) for medicine. Most people at this stage know what branch or med or surg they want to do, but you still rotate through diff sepcialities every 6 months eg Surgical rotation could be 6 mths orthopaedics, 6 months plastics, 6 months general surgery, 6 months A&E, 6 months Neurosurg, and so on.

Once you pass your MRCS/MRCP you are elegible to apply for an SpR post (Specialist Registrar). You are now a specialist, but you've got at least another 3 years of higher training to do. There is a possiblitly of some private work at this stage, but nothing likely to make you lots of money. You've got yet more exams to take - MRCP part 2, FRCS (Fellow of RCS) until eventually you get your CCST (Certificate for Completion of Specialist Training). Now you can apply for a consultant post.

Consultant - this is the pinnacle of your career. You can work privately and earn mega bucks (or more than the NHS pays you) and there's nothing more to do except sit back and relax. I wish

So, in brief, if I want to be a surgeon:

5/6 years at med school (starting aged 18)
1 year PRHO
3+ years SHO
3+ years SpR
Consultant

The earliest I could be a consultant is aged 30, in practice its much more likely to be age 35 or so, because there are bottle necks from SHO to SpR, and SpR to Consultant, and because the MRCS/MRCP exams are devilishly hard.

Potted history of the UK med system. Feel free to ask for clarification etc and I'll try and explain.

Bet that's long

 

[naija_pinoy]

hi fiona, got a couple of questions, how many years is it between Spr and a consultant position? i heard it kindda varies, could you like tell me the minimum and maximum number of years an individual would have to practice as an spr before eventually becoming a consultant. i asked one of my friends (he 's from a former british colony) and he said something like i'd have to wait for one of the older consultants to peg off (die) before i could become a consultant.

will u be staying in england for residency or are u thinking about going elsewhere?

i'm kindda having trouble deciding where to go, the states or england, i mean i love england and it'll be natural for me to go that route but the states is like an adventure, totally new territory. know what i mean.

anyway, later...........

 

[Josh Deb Barman]

Originally posted by FionaS
Once you pass your MRCS/MRCP you are elegible to apply for an SpR post (Specialist Registrar). You are now a specialist, but you've got at least another 3 years of higher training to do. There is a possiblitly of some private work at this stage, but nothing likely to make you lots of money. You've got yet more exams to take - MRCP part 2, FRCS (Fellow of RCS) until eventually you get your CCST (Certificate for Completion of Specialist Training). Now you can apply for a consultant post.

I hate to say it, but you may be hanging around being an SpR for longer than you think - the training scheme for SpRs is actually 5 years and it's not longer than that...i.e. if after 5 years and maybe a few months to get a consultant's post you are unable to do so, you will either have to accept a staff grade post (which is effectively the end of the ladder) or retrain in another speciality as an SpR...all very scary! This all came about after Sir Kenneth Calman's reforms in the 1990s...he was the then Chief Medical Officer.

 

[Galli]

I am sorry for not adding anything new to this thread...but I just wonder how med school works in Germany. Does anybody have any information?
Thanks!

 

[yimfong]

although hong kong is a part of china, nevertheless, we have an absolutely different medical educational system with China. The best medical school in far east, University of Hong Kong, which offers the bachelor of medicine and bachelor of Surgery (MBBS). It is a 5-year course which is veru similar to the british curriculum.

An Introduction to Health and Disease Block will be run in the first semester and the first month of the second semester. The block provides an introductory overview of the structure and function of the human being, based on the theme of a "hierarchy of systems". Students examine the interaction between different levels in the system and take a holistic view of human biology. The Block also gives an overview of processes of disease. Therapeutic strategies for modulating disease processes are also introduced. From the beginning of the course students are encouraged to develop an understanding of the ethical and economic implications of modern medical care, as well as the importance of an approach to patient care that is based on sound scientific evidence.

For the second, third and fourth semesters, the curriculum is based on a "human systems" approach. The eight interdisciplinary modules, each lasting for six weeks, include the following: cardiovascular system, respiratory system, gastrointestinal system, urogenital system, musculoskeletal system, central nervous system, haematology and immunology system, and endocrine system. Once again students examine clinical problems from a variety of viewpoints, and from an understanding of the basic science to the implications for individual patients as well as the population as a whole.

In the first part of the fifth semester (i.e. the beginning of the third year), an integrated block adopting a "life-cycle approach" to studying multi-system problems is introduced. The aim is to help students integrate the knowledge they have acquired during the earlier parts of the course and prepare them for the subsequent clerkship.

For the remaining semesters, the emphasis shifts to the clinical management of patients. Students proceed from the core clerkship programme that takes up the second part of the fifth semester and the sixth semester, to the extended clerkship programme in the seventh semester and the advanced clerkship programme in the eighth and ninth semesters. During the period of advanced clerkship, students are required to reside in the Madam S.H. Ho Residence for Medical Students or in an approved teaching hospital for specified periods. An assistant internship scheme permits fourthand fifth-year undergraduates to accept appointments as assistant interns, and so gain valuable clinical experience.

The 10th semester is a revision block preceding the Final Examination, and the last special study module (SSM) takes place after the Final Examination. During the SSM period, students have the opportunity to explore areas of individual interest by means of either clinical attachment or laboratory/clinical research. Thanks to the donors of various scholarships, the Faculty is able to provide financial assistance to a proportion of students taking clinical attachment overseas.

In September 1997, the Faculty of Medicine undertook the most extensive revision of its medical curriculum since its foundation in the 19th century. In line with modern educational trends, the new curriculum emphasises student-centred, small-group, problem-based and integrated approaches to learning. The goal of the new curriculum is to produce doctors with demonstrated competence in the understanding and delivery of effective, humane, economic and ethical medical care together with a commitment to life-long learning, and who are ready to proceed to postgraduate training.

Now for the Chinese University of Hong Kong

The MBChB degree is system-based with great emphasis on both horizontal and vertical integration. The basic medical and scientific knowledge and skills plus the clinical sciences will be introduced to students.

 

[FionaS]

I hate to say it, but you may be hanging around being an SpR for longer than you think - the training scheme for SpRs is actually 5 years

Arrgh!! When did that happen?! *Goes to check little book about this stuff* Oh. Yes. I remember now

Basically, you are waiting until a consultant retires or a new job opens up. What with the number of expanding consultant posts at the moment it's not as hard to get a consultant post where you want as it used to be. And most SpRs I know who have finished training work as locum consultants until they get a substantive post that they like.

As for me, probably staying in the UK, possibly going to the Netherlands, France, Belgium (those areas) after I've finished my training. Intend to spend at least one year of my training (about SHO/SpR level) abroad - maybe 6 months US (just to see what it's like to have unlimited money ) and 6 months in Australia, or I might stay in Europe. Who knows? It's all in the distant future at the moment

 

[Thewonderer]

A interesting, yet inflammatory, thread I digged up from other parts of the forum....

http://www.studentdoctor.net/forums/showthread.php?s=&threadid=45527&perpage=15&pagenumber=1

I find the thread very informative in regards to pre-clinical curricula elsewhere in the world. However, I hope to hear more about what students do on clinical rotations in the latter part of their training elsewhere in the world because of the couple anecdotes I heard:

1) I hanged out with a couple med students from Taiwan and Germany last year while on rotations. Apparently, their first couple years of clinical experiences consist mostly of "shadowing." In other words, they take little patient responsibilities and can ask residents questions but do not get their hands "dirty" and do not get to lead the course of pt treatment. Then, in Taiwan, their last year of med school is called "internship," but the duties consist mostly of what 3rd year med students do in the US. Hence, even though in Taiwan, they have 3 years of clinical rotations, they don't seem as rigorous as the 2 years of clinical rotations mandated by American schools. I did not get to clarify this point with the student from Germany.

2) A third-year medicine resident also joined my medicine team to eat lunch one day and mentioned his 2-month away experience @ Oxford (i.e. The Radcliffe Infirmary). He was horrified at how difficult it is to get the med students over there to "pre-round" on the pts (i.e. you collect vital signs and follow up on overnight hospital course before residents or attendings get to the patients) and how little reponsibilities they had in terms of pt care. However, that could be team-dependent.

I wonder if anyone can please confirm or refute the stories above.

In the US, they do prescribe to the philosophy of throwing students onto the wards and ask them to be an integral part of the team right away. In some aspect this speeds up the learning curve but that also makes the situations very stressful for students.

 

[Josh Deb Barman]

Originally posted by Thewonderer
2) A third-year medicine resident also joined my medicine team to eat lunch one day and mentioned his 2-month away experience @ Oxford (i.e. The Radcliffe Infirmary). He was horrified at how difficult it is to get the med students over there to "pre-round" on the pts (i.e. you collect vital signs and follow up on overnight hospital course before residents or attendings get to the patients) and how little reponsibilities they had in terms of pt care. However, that could be team-dependent.

I wonder if anyone can please confirm or refute the stories above.

I can't comment about Oxford Radcliffe since I'm down in London, but I believe they have the same system that everyone else does in the UK in this respect.

We don't have the same degree of patient responsibility as the US students do although we do have quite a lot of patient contact, unlike some other countries. Actually our 'responsiblities' are practically zero...the consultant might ask us to clerk some patients pre-round, but not always and we aren't given patients to manage under supervision (not in years 3 & 4 anyway). We're not officially part of the health team in the same way US students are...unless the consultant is particularly pro-active.

Since I'm actually looking at electives in the US at the moment and reading what former students have written about their experiences there, it's striking how they write that the US is a completely different situation; how they treat the students like House Officers (i.e. first year pre-registration junior doctors) over here. It's really a scary experience at first since we don't have the experience of actually being responsible (albeit under supervision) of named patients, but many students find this eventually a very rewarding elective experience - even though they probably shorten their lifespan worrying and stressing at first

Another thing I've seen in US students who come over here for electives is that they are used to doing a lot more procedures which we don't know how to do, and which they can't do over here either since no one will take responsibility...it can be frustrating for them since they are probably as good at e.g. lumbar punctures as our House Officers or even Senior House Officers if not better.

 

[neilc]

i also agree that the US throws the students into a "physician" role sooner.

it does make for a steep learning curve, and i think a third year med student in the states is more adept clinically then a third year med student anywhere.

just remember, though....a steep curve is great, but different approaches with different methods and time frames result in physicians with the same level of training. in other words a 6 year program (which i think is more the norm than a 4 year) produces an excellent doctor in 6 years. a 4 year program can do the same in 4 years. neither program is better or worse for it, just different.

 

[Thewonderer]

you know, i would not mind having one year of shadowing to get some transition. That way, it will be like learning from your books with pts right on your side!

The problem with the US system is that you get sidetracked by pt care (i.e. blood draw, writing admissions orders, writing admissions notes, TRYING TO STAY AWAKE, etc.) immediately when you get thrown on the wards. You have to squeeze book learning into your busy schedule (and US med students do that with various success, and that shows when you take the end-of-the-rotation exams.....). Eventually, you will NEED to do all these blood draws, admissions orders... but in the beginning, I feel that it is best to ease the students in and allow them the freedom to have both books and pts on their sides.

2 years of shadowing seem a bit too long, however

Also the second half of 4th year is like shadowing (i.e. electives) and vacations anyway. So it is really only 1 1/2 years of working you to death (before residency starts, of course).