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thoreau_fan

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I was just wondering what specialties we have here in the States that differ or are nonexisit in the United Kingdom. I know that for example that pediatricians are considered specialists while here there are more PCP. Anymore differences? Thanks!:)
 

neuro2bjc

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I was just wondering what specialties we have here in the States that differ or are nonexisit in the United Kingdom. I know that for example that pediatricians are considered specialists while here there are more PCP. Anymore differences? Thanks!:)

i think in the uk, they really don't go for their md, but some other type of degree called mbbs, try looking mbbs on wikipedia and it will tell you about the uk and what it's countries like scotland and england do in terms of a degree; this mbbs is not 8 years like it is here but it is 6 years and if a doctor has that degree and wants to come to the usa, they have a residency training for 2 years; i have also been thinking of going to the uk for medical studies but some students believe the usa offers the best medical education because it is really intense compared to their programs; don't quote me on this, it's just some info i found out researching
 

ramekin

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i think in the uk, they really don't go for their md, but some other type of degree called mbbs, try looking mbbs on wikipedia and it will tell you about the uk and what it's countries like scotland and england do in terms of a degree; this mbbs is not 8 years like it is here but it is 6 years and if a doctor has that degree and wants to come to the usa, they have a residency training for 2 years; i have also been thinking of going to the uk for medical studies but some students believe the usa offers the best medical education because it is really intense compared to their programs; don't quote me on this, it's just some info i found out researching

The MBBS/MBChB/etc is equivalent to the US MD. Somebody with an MBBS degree practising in the US can use the letters MD in the USA but not the UK, since it is not a true doctoral qualification.

The MBBS in the UK is an undergraduate degree where students are admitted from high school and study for five years. The British MD is a postgraduate research qualification open to those already holding a medical degree and is examined and awarded in a similar fashion to the PhD.
 

neurodoc

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The MBBS/MBChB/etc is equivalent to the US MD. Somebody with an MBBS degree practising in the US can use the letters MD in the USA but not the UK, since it is not a true doctoral qualification.

The MBBS in the UK is an undergraduate degree where students are admitted from high school and study for five years. The British MD is a postgraduate research qualification open to those already holding a medical degree and is examined and awarded in a similar fashion to the PhD.

Perhaps I'm missing something... You say the MBBS/etc "is equivalent to the US MD" but "is an undergraduate degree" and "not a true doctoral qualification." The US MD is a doctorate, and I presume is recognized as such in the UK. :confused:

Nick
 

efex101

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I have seen all British docs here at my instituion with MBBS
 

leorl

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Perhaps I'm missing something... You say the MBBS/etc "is equivalent to the US MD" but "is an undergraduate degree" and "not a true doctoral qualification." The US MD is a doctorate, and I presume is recognized as such in the UK. :confused:

Nick

MBBS = MD (in the US).

In the UK, an MD is a post-graduate degree conferred after the MBBS following a period of research or whatever else is required in a university's MD program. This is because an MBBS is an undergraduate degree. However, the same medicine/skills is learned in an MBBS as a US MD degree.

It's just that in the US, we are made to do an undergrad degree before embarking into medicine, so for us, and MD is post-graduate. The UK MD would be like us doing a PhD after we've completed our MD.
 

leorl

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To the OP - specialities like PM&R (physiatry) don't really exist elsewhere in the world. Paediatrics is more specialist as you say, and is quite competitive to get into (which differs in the US).
 

ramekin

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The US MD is a doctorate, and I presume is recognized as such in the UK. :confused:

Nick

The US MD is not a true doctorol qualification and would be recognised in the UK and Europe as equivalent to an undergraduate medical qualification, the MBBS.

A true doctorate requires independent research, investigation and the production of a publication-worthy thesis, none of which is required by any MD curriculum in the US, as far as i'm aware.

So to summarise:
- UK MBBS and US MD = both are honorary doctorates, ie in the sense that the degree-holder may style themselves as 'Dr'
- an MD in the UK and EU is awarded to medical doctors who undertake higher research and study akin to what is required for a PhD

efex101 said:
I have seen all British docs here at my instituion with MBBS

The MBBS, and variations thereof, is awarded not only by British medical schools but medical institutions the world over.

It is up to the individual whether or not to retain their original letters; some might do so to avoid confusion, others to maintain their sense of individuality. Since MBBS graduates practising in the US write the same qualifying exams as US MD graduates they are entitled to use the letters MD in practice.
 

neurodoc

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The US MD is not a true doctorol qualification and would be recognised in the UK and Europe as equivalent to an undergraduate medical qualification, the MBBS.

A true doctorate requires independent research, investigation and the production of a publication-worthy thesis, none of which is required by any MD curriculum in the US, as far as i'm aware.

If that is the case, then there is a problem with the European system. US MDs are graduate doctoral degrees (4 years of study after the Bachelor's Degree). It's true that most medical schools do not require a publishable thesis, but neither do such European programs (as Italy) which offer the "Laurea in Medicina" (a doctoral degree in medicine). When I got my MD from SUNY Brooklyn, the Degree was awarded "with Distinction in Research," because I had submitted a senior research thesis that in fact was published...

Does that mean that the UK would recognize my degree as a "doctorate?"

Who the heck cares? What I'm getting from this thread is that there's potentially a big difference between Brits and other Europeans who enter med school after "high school" at 18-19 years of age and US students who typically earn a college degree (BA/BS) before enrolling (at 22-24 years of age) in a 4 year med school program.

This seems like a pretty significant difference.

Nick
 

leorl

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What difference? We're all learning exactly the same things. Some subjects are slightly more emphasized here, some in the US. There basically is no difference. What I'm viewing is people taking offense that there are two systems and that one recognizes medical training as an undergraduate degree, and the other as a post-graduate degree. There are pros and cons to both approaches.

Try to leave ignorance out of it. There isn't a "problem" with the European system. Those in Europe and I include those US students in Europe, may view the US system as being "problematic" in that the US doesn't grant the opportunity to engage in medical studies after high school (or very few programs do). As I said before, there's pros and cons to both systems. But ask your fellow IM cardiologists who trained overseas or in the UK who are younger than you and smarter than you whether they found their european education to be a "problem."
 

ramekin

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Why should there be any "problems" (and i infer you mean, in this case, deficiencies) in either system? Certainly in the UK educational system individuals are taught to consider differing entities on their individual merits. The UK and EU view professional studies (such as Medicine and Law) as undergraduate pursuits, whereas the US as postgraduate disciplines; neither practice is without flaw.

I think very few academics would view the US MD degree as anything more than a professional qualification; any bozo can study medicine - the difficulty is with getting a place at medical school, once obtained, only sheer motivation and perseverance of the individual will equate to qualification; medicine isn't a conceptually challenging discipline. To study at a doctoral level demands an entirely different set of personal qualities, aptitudes and skills in addition to those for medicine alone.

Medical training in Europe is traditionally undertaken at the undergraduate level, Italy is no different; the "Diploma di laurea in medicina e chirurgia" or Diploma of graduate in medicine and surgery is a professional qualification pursued at the undergraduate level, it is NOT a doctoral degree, its literal translation of 'diploma of graduate in doctor of medicine and surgery' simply refers to the fact that the particular individual is a graduate in medicine and surgery much in the same way as an MBBS-holder is a graduate of the degree of Bachelor of Medicine, Bachelor of Surgery. Graduate-entry medical programmes in the UK, incidentally, do not confer 'postgraduate' qualifications to their graduates, they are, like non-graduates, awarded the MBBS/MBChB/etc.

The fact that you've written a thesis is irrelevant; medical students in the UK who intercalate - either as a mandatory part of their studies or by choice - are compelled to spend an additional year undertaking independent lab-work, field-work, or literature-based research in a specific area of medical science culminating in a dissertation and viva voce, yet they are not conferred a doctoral qualification. In fact, most undergraduate students (whatever the degree subject) are required to complete a dissertation in their final year before being allowed to graduate; they are conferred 'honours' with their BA/BSc in recognition of this - oddly enough, the MBBS is not an honours degree, though students can obtain honours by spending an additional year intercalating, in which case they graduate with two degrees.

This is essentially a dispute about terminology; a medical degree is a medical degree, whether it's an MBBS or an MD, neither of which are true doctorates in the academic sense.
 
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neurodoc

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What difference? ....

Try to leave ignorance out of it....As I said before, there's pros and cons to both systems. But ask your fellow IM cardiologists who trained overseas or in the UK who are younger than you and smarter than you whether they found their european education to be a "problem."

First of all, I'm not an "IM cardiologist." I'm a USMG and US trained ABPN certified neurologist. I also spent two years in medical school in Europe (Italy) before I transferred to a US medical school, so I know a bit about both the European and the US systems. And while I was a med student in Italy I worked in the laboratory of one of my professors and published 5 peer-reviewed reports, so I know something about European medical research.

Your glib comment about IMG colleagues who are "younger than you and smarter than you" is laughable...I can hear you grinding your battle-axe.

I think it is pretty clear that US med schools are in general more competitive than European schools. There may be some advantage to bypassing a college education and going directly to med school from high school, the gymnasium, or whatever else they call it in Europe. But it's also clear that the US system, which takes 17-18 yo HS grads and makes them do 4 more years of college to get a Bachelor's degree, leads to med students who are more academically sophisticated and mature than a system that allows 18 year olds to matriculate in medical school. Of course you can criticize the US secondary school system and say that European high schools are the "equivalent" of US colleges. Good luck. My undergraduate work was done at UC Berkeley, and I doubt that there are many European high schools that provide a better education. ;)

Nick
 

leorl

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Just for background, I'm a US IMG who chose to go abroad to try to understand a bit more of the world than my rather enclosed surroundings. I went to an excellent high school (it was ranked in the top 10 in the US during my time there, if you put any stock into the often laughable criteria used for these rankings), and I also went to an excellent undergrad, at which I took some medical courses in addition to my regular undergrad ones. I wasn't kidding with the "younger and smarter than you" remark, and I don't mean "you" personally, more of a general "you." I've always achieved pretty high goals academically, but I've found myself wishing that I was as smart as some of the kids I'm surrounded by - obviously, going to a European school with the MBBS system isn't a problem for them. Now, I don't really know what it's like in Italy and the Italians have a different system altogether.

But while I also thought the UK system could be faulty because of immaturity both socially and in academic sophistication, I was wrong. Now, maybe one or two kids aren't mature enough to be doctors, but the rest are just like those of us with more experience, and I see no difference in their management of patients than ours. And even when I'm home working in the hospital alongside the other overseas doctors, who are younger than me, I realize their non-US education hasn't hindered them at all. The idea that the US offers more maturity and sophistication in education, and therefore producing more capable doctors, is absolutely bollocks.
 

leorl

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I would also say though that given the choice between entering med school at 18 and entering at 22, I would choose to do an undergrad degree first. I enjoyed being able to delve deeper into the other subjects I was interested in, without being "trapped" into medicine straight out of high school.
 

ramekin

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The irony in neurodoc's petty commentary is rather funny; until one learns that he is actually a board-certified neurologist.
 

neurodoc

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The irony in neurodoc's petty commentary is rather funny; until one learns that he is actually a board-certified neurologist.

???:laugh: You may have found my "petty commentary" "rather funny," but "daft" would be a good British term to describe your comment. Could you clarify what you meant?

Cheerio,

Nick
 

Su Little

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The debate regarding MBBS vs MD is somewhat irrelevant. The real irony is the length of post-graduate training between the two countries. It is just as well that UK med students are 18-19 when they enter med school because they will be at least 35 (if they are lucky) to reach attending position (and that's only if a current attending or 'consultant' retires or dies).

In the UK, beer-guzzling, binge-drinking, rugby playing students who socialize with the 'old boy' consultants can get through med school by just 'showing their face' once a week and reach a consultant position faster and easier than the conscientious and mature medical student who finishes at the top of the class. It is no wonder that a in a survey conducted by the British Medical Association about Leaving the Medical Profession that 75% of the responders said that they would stay in medicine but not stay in the UK (Moss et al; BMJ 2004; 329(7477):1263-65)

My personal viewpoint :idea: , after growing up and completing medical school in the UK and nearing the end of residency in the US, is that the US med students are certainly more mature and rounded but also much more hard-working and enthusiastic in their medical education. I believe the main reasons for this is the post-graduate entry as well as the high cost of medical education compared to the UK.

IMG (UK) Neurology Resident
 

PathOne

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Having trained in Europe (being a European) and working in the US, my general observation is, that US medical education is more patient/practically oriented, while many European programs are somewhat more academic/theoretical. However, it's hard to distinguish a freshly minted US MD from a European MBBS, MD, whatever.
The real advantage for the US system is the Residency system. First of all, the vast majority of grads go directly into a structured Residency program, while many Europeans can linger for years in junior house officer or other such positions, which really aren't bringing them closer to board certification.
Secondly, US residency programs are much more compressed, efficient (and with longer hours) than in Europe. Some years ago, they instituted a statute in the UK, whereby they tried to limit Resident working hrs to 56 hr/week. In the US, the similar statute (not always adhered to) is 80 hrs/week. In Northern Europe, religiously clinging to a 37 hr/week is not uncommon.
Obviously, someone working 80 hrs/week in a structured program will learn more than someone working 40-50 hrs/week in a less-structured program.

Thus, my observation is, that the average board eligible US-trained physician is more qualified than a European counterpart. However, among attendings, these differences tend to disappear over time.
All that being said, I think it's fairly obvious, that the US medical system - for those that are fully insured - is superior to any system in Europe, mainly because so much more money is spent on healthcare. Certainly, I would personally prefer to be treated in a US hospital (by a US or foreign grad) than in a European hospital.
 

leorl

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I'd agree with points made in both the above posts. I personally, having had European training with US electives am not sure how significant the difference is on any level. UK students will work hard when pushed to work hard, but it is true that during education, the UK system does not demand as much as the US system does. I don't think this is particularly detrimental though, as the "catch-up" period is very quick.

Although the US system spends much more money on healthcare, the outcome is not different from other countries (ie. mortality / morbidity rates are not any better in the US). As a matter of fact, the US fares worse than some countries, despite the money being poured into healthcare and despite having the best facilities. The only reason I would choose a US hospital over an EU one (IF I was fully insured), would be easier and quicker access to treatment options (ie. imaging, etc.) without the wait associated with socialized medicine. However, this discussion doesn't bring into account the 1/3 or so of the US population who do not have healthcare insurance. And in my brief time doing US electives...I've seen the very sad side of what happens to patients who cannot afford to be treated and there's little anyone can do for them at times. The training among senior house officers and above is basically the same, although not as structured as US residency. Training among junior doctors might be lower than that of US interns.
 

PathOne

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True, dat. It's probably fair to argue that the AVERAGE patient (if such a creature exists) is probably equally well served by a US hospital and a European hospital. The European advantage would be that the standard of care will be better for the poorest parts of the population, while the US standard of care would be better for the fully insured patient.
Thus, it's clearly better to be a poor diabetic in Europe than a poor diabetic in the US, while the well-to-do cancer patient would absolutely receive better care/treatment options at say MSKCC or MD Anderson than anywhere else in the world.
Also, it must be acknowledged, that some of the best current and future physicians from all over the world choose to work in the US, for both financial and professional reasons, while much fewer international physicians choose to migrate to a European country.
Bottom line is probably that Europe has a more efficient health system. It's the Volkswagen or Toyota of healthcare, while the US system is a Ferrari. It can do some amazing things, but isn't necessarily a practical or fair creature.

However, going back to the previous discussion of the European 5/6-yr from HS graduation vs. the US bacc.+4-yr system, I think it's really hard to argue that there's solid and significant differences, that would render either system superior to the other. I've trained 20-yr old European students who were responsible and mature, and I've taught 24-yr olds at a top-15 US medical school, where I had to remind students that they were in medical school, not cosmetic school, and that they should at least try to act in a mature way.

However, it's interesting to see that the US model is increasingly being accepted and implemented, at least in part, in Europe. One country after another is introducing PBL and multiple-choice exams, rather than the previous systemic approach and oral/essay type exams. So at the end of the day, it's not unlikely that most med students in the western world would ultimately be trained on an essentially US-based system.
 

f_w

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However, going back to the previous discussion of the European 5/6-yr from HS graduation vs. the US bacc.+4-yr system, I think it's really hard to argue that there's solid and significant differences, that would render either system superior to the other. I've trained 20-yr old European students who were responsible and mature, and I've taught 24-yr olds at a top-15 US medical school, where I had to remind students that they were in medical school, not cosmetic school, and that they should at least try to act in a mature way.

I find the people who tout the college education prior to medschool as a sign of greater maturity entertaining to no end.
The majority of people aiming for medschool in the US will do exactly the number of courses they either need for admission or that are helpful to get in. Most are biology majors who spend their extra time drilling for the MCAT, don't find too many who get a true liberal arts education. On the contrary, looking at the medstudents I had the opportunity to work with over the years, only 2-3 stand out as people who had a life and interests beyond passing the next mc test.
 

leorl

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However, going back to the previous discussion of the European 5/6-yr from HS graduation vs. the US bacc.+4-yr system, I think it's really hard to argue that there's solid and significant differences, that would render either system superior to the other. I've trained 20-yr old European students who were responsible and mature, and I've taught 24-yr olds at a top-15 US medical school, where I had to remind students that they were in medical school, not cosmetic school, and that they should at least try to act in a mature way.

However, it's interesting to see that the US model is increasingly being accepted and implemented, at least in part, in Europe. One country after another is introducing PBL and multiple-choice exams, rather than the previous systemic approach and oral/essay type exams. So at the end of the day, it's not unlikely that most med students in the western world would ultimately be trained on an essentially US-based system.


Yes, I find your last point particularly irritating, I view that schools are "caving in" to US domination. I can see the usefulness of PBL, but ONLY when each and every thing across all subjects are coordinated perfectly. And when does that happen? Never. Especially in European countries where efficiency may not be strong. And it's useful ONLY after a couple years of solid pre-clinical teaching, not straight off from the first day. The end result is that students ultimately have to wade through reams of information unguided, not experienced enough to know what the important salient facts are and wasting much-needed study time. I fortunately was in the last year of my school's traditional teaching, and am very glad to have escaped PBL.

Regarding maturity, I agree with fw and PathOne. Americans don't have higher maturity than European students. There is no significant difference. I think this is because maturity and growth curves plateau between the ages of 20 and 30, so mixing is easier. However, I also think it's a reflection on American culture that overall societal upbringing is leading to delayed onset of maturity. I have come across American med students who I think are appallingly unprofessional, one-sided without the ability to think outside their own bubble. Whereas I've met European students younger than me who are older than me ;). I think perhaps that travel experience is a major component of maturity. Live in your own bubble too long, things (knowledge, friendships, relation to the outside world) starts becoming incestuous.
 
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