On request: the Dutch system of med school

[Dutch Doc]

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Hello All,

On request here's how the med school system works in the Netherlands.

After highschool you need to enter a 'lottery' first to get into med school. There are two other ways to enter - by grade average over 8 (our system scores from 1 to 10) and by being interviewed in person by specific universities.

When you're lucky, you get in and you can start at one of the 7 universities that have a medical school. The first four years are theoretical, a lot of book reading and lectures and practical training like anatomy and physical examination. After four years you enter the clinical fase, two years of internsip in which you rotate from department to department. You start with an introductory rotation (I did mine in ob-gyn) followed by 8 weeks of internal medicine. Also in those two years you have four week courses of 'reflection' on how you performed during the internships. You also learn new skills during those courses, like the specifics of neurologic examination etc.

After a total of six years in med school, you can call yourself a doctor and then you can specialize. Those trainings are variable in length, three years for GP, up to ten years for surgeon.

This is how it works at my university (Nijmegen). There are minor differences at other universities.

Please reply and tell me what systems in other countries are like! I'd love to know!

Bye bye,

Dutch Doc, yes indeed, native Dutch.

 

[Long Hair and a Beard]

Hey the lottery system is not very clear..

You mean out of all the students that want to get in medicine, they pick them at random? Or only the college is allotted at random?

Seems very bizarre, either of the two... 😕

 

[Dutch Doc]

Hello Long Hair & Beard,

Yes indeed, they pick future med students at random. You receive a number at random and they only accept everyone with a number under, like, 2500. You do get to say to which university you'd like to go. There's also the part where someone who is accepted does not want to go into med school anymore, for instance because he or she started a study in some other field. In this case someone with a number over 2500 is accepted in that place at that university and you don't get to choose anymore.

It's an insane system, I have to say, but the current situation with too many applicants year after year made it so. In the Netherlands we believe everyone should have a shot at university, and not just the ultra- super- smart people.

🙂 Dutch Doc

 

[Long Hair and a Beard]

Hmmm that still doesn't make sense..

After four years of medicine, I have come to understand that smartness is not a pre-requisite for medicine. But still, there is a thing called an aptitude for a particular profession. There is a lot of glamour associated with the medical profession (at least in India there is), and everyone here is supposed to make at least one try at getting into medical college. So there must be so many people not actually suited for the medical profession that get in by the lottery system.

Then again, you get into medical colleges just after high school, don't you? Do you think people are emotionally mature enough at that age (18?) to decide on entering a degree course that takes six years and doesn't have much freedom to diversify/change after that if you find it doesn't suit you? At least I wasn't that mature when I entered college. 😛

 

[Dutch Doc]

Hello,

Now don't go attacking me on the system we have in this country. I never said I agreed on it, did I?

You're right about not being mature enough at 18, I know I wasn't. God how many times I thought about quitting. But I think this goes for a lot of things in society, people are forced to make life-changing decisions at very young ages, but this is food for another discussion.

So what exactly is the US system like, please enlighten me.

Dutch Doc

 

[Skip Intro]

DutchDoc, thanks for posting. This is how I remember it being explained to me before as well. I think it's interesting for people to see how different medical education systems work throughout the world. Many people tend to be "U.S.-centric" when it comes to medical education. I've interacted professionally with doctors from all over the world. Like the U.S., there are great ones and there are not-so-great ones to be found everywhere. And, everyone has their strengths and weaknesses.

Of the three Dutch physicians I knew and worked with, two were excellent and one couldn't diagnose a cadaver as being dead. I guess that's just the way it goes. Of course, two U.S.-trained physicians I also worked with (one went to UGA the other Georgetown) I wouldn't send my gerbil to.

Some additional clarification, though, please. From what I understand too, if you don't make it in the lottery the first time, you can re-apply like once or twice more (?) before you can no longer sit for it. Is that right?

And, lastly, correct me if I'm wrong, but you DO have to have a certain minimum level of achievement to even be considered for the lottery in Holland, right? It's not like they accept ANYONE into the lottery system.

I think most would agree with me that it's up to the person, not the system, to become a good doctor.

 

[Skip Intro]

Originally posted by Dutch Doc
So what exactly is the US system like, please enlighten me.

Too many applicants for not enough spots. Tends to select for the overachievers, ultra-competitive-would-step-on-their-mother's back-to-gain-an-acceptance-self-absorbed-self-important jock-types, and eggheads.

As a result, 24% of all practising physicians in the U.S. are foreign-trained. Five new D.O. schools have been built in the past seven years. Huge malpractice premiums threatening to close certain schools. And, despite all of that, there is a projected doctor shortage by the year 2020. The U.S. system is far from perfect.

🙁

 

[Dutch Doc]

Ah, yes, that's the missing fact. Here in the Netherlands we have different sorts of highschools. You've got low level to high level and they each have a name. To get into med school, or to get to university in general, you need to do highschool in the highest level.

But still, WHAT is the US system if there's no lottery??

No one still explained this to em.

DD

 

[Skip Intro]

Originally posted by Dutch Doc
But still, WHAT is the US system if there's no lottery??

It's a "free-for-all" type system, in that anyone is welcome to apply regardless of age, sex, race, undergrad school attended, etc. After you complete high-school in the U.S., which you do wherever you happen to live, and depending on how well you do, this determines what caliber college/university you get into. At University, you do four years of undergraduate work. You have to take "pre-med" courses (Biology, Chemistry, Calculus, Physics, Organic Chemistry, and labs) and a standardized test called the Medical College Admissions Test (MCAT). Then, you apply (with a few exceptions) via a standardized application clearinghouse called the American Medical College Application Service (AMCAS). Depending on your initial review at each school you select, you are sent a "secondary application" to complete. If the admissions committee likes what they see, they then will grant you an interview. If you pass the interview and approval of the admission's committee, you're in.

Gaining an admission to medical school depends on four things:

(1) How "good" the University you did your undergraduate work is.

(2) What you majored in while in University, and what Grade Point Average (GPA) you received in your major and your pre-med courses, and what extra-curricular things (research, clubs, etc.) you participated in.

(3) What scores you got on the MCAT.

(4) What state you live in, when you applied, and what the application pool was like during the year you applied.

Some students gain multiple admissions to several different schools, based on their numbers and how the interviewed. Many very competitive students do not gain admissions because they happen to live in a state that has few spots. Some students who don't gain admission either go to graduate school to improve their future chances, or they seek alternative pathways such as studying abroad.

[FLAME-SHIELD ON]

The spots usually go to the most competitive applicants. It is purely a competition-based process. Some applicants, however, are well-connected and/or outstanding for other reasons than pure numbers, and they get admissions despite potentially inferior applications.

In some instances, there appears to be no rhyme or reason why certain applicants get spots and others don't. There appears to be a somewhat "arbitrary" selection process, especially when certain applicants are otherwise very equal on paper. For example, someone may misspeak or make a gaff during an interview - something not necessarily reflective of their capabilities as a future physician - and they are not given a spot. Also, there used to something in the U.S. called "affirmative action" that afforded spots to minorities and women, who on occassion did not have as competitive applications as their non-minority counterparts. This practice is now considered illegal.

[/FLAME-SHIELD OFF]

I am only scratching the surface here. This is a general overview of how it works. I'm sure that others will have things to add and/or provide additional clarification and/or want to debate me on the 'opinion' part of this post. Likewise, there are alternative paths to becoming a physician in the U.S. (such as some 6-year programs that accept students after their sophomore year, osteopathy school, transfer in from a foreign-based program, graduating from a foreign school and getting ECFMG certification, etc.), but discussion of those 'alternate routes' are beyond the scope of your question and this post.

 

[Long Hair and a Beard]

Hey DD, Of course I wasn't attacking you, only thinking aloud about the system..

Another thing.. What is the ratio of number of applicants to seats? I mean what chance does a really motivated person have of NOT getting in?

Hey Skip Intro, I didn't know about AA getting banned.. When did that happen? The last thing I remember about it was a loooong flame war raging on SDN on the issue.

 

[Stephen Ewen]

Dutch Doc:

Thanks for posting this type of info, and thanks to the people who replied asking clarifications.

Simply put, it is valuable for readers here to have an "insiders view" of how "different" medical contexts works. Thanks again.

You mentioned how you made this post "upon requent."

Now, to make a further request, but of others.

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 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 knowledge of what I suppose we could call "comparative medical education systems."

I will bend the Forum rule about cross-posting on this in a new post where people may reply.

 

[angelic02]

I don't like the idea of the Dutch system at all. But then again, that's just my humble opinion...

 

[Skip Intro]

Originally posted by Long Hair and a Beard
Hey Skip Intro, I didn't know about AA getting banned.. When did that happen? The last thing I remember about it was a loooong flame war raging on SDN on the issue.

Sorry, LH&aB, I just saw this.

I should clarify. AA is not "banned", per se, in all 50 states. Neither is it a law, per se, but more of a practice. It is allowed, and in some instances encouraged, mainly per executive mandate.

However, it HAS been officially outlawed in several states.

A few states have passed laws or taken executive action to eliminate affirmative action in higher education. In 1996, California passed Proposition 209 amending the state constitution to specifically prohibit public universities from granting preferential treatment to any individual or group on the basis of race, sex, color, ethnicity or national origin (Article I, Section 31). In 1998, Washington State voters passed Initiative 200, which barred the consideration of race or ethnicity in college admissions decisions (similar to California's Proposition 209). In 1999, as part of his ?One Florida? initiative, Governor Jeb Bush issued Executive Order 99-281 banning all use of affirmative action in admissions to state schools.

http://www.ecs.org/html/issue.asp?issueID=9

Furthermore, the U.S. Supreme Court is possibly going to soon hear a case which will determine whether or not AA policies violate the Constitution. If they rule against such polices, this will be tantamount to a federal ban of AA practices in all fifty states, at least in regards to the admission's processes at state and/or federally supported institutions of higher learning.

Hope that clarifies.

-Skip