Medical school in the United States is a graduate program with the purpose of educating physicians in the undifferentiated field of medicine. Such schools provide a major part of the medical education in the United States. Most medical schools in the U.S. confer upon graduates a Doctor of Medicine (M.D.) degree, while some confer a Doctor of Osteopathic Medicine (D.O.) degree. Most schools follow a similar pattern of education, with two years of classroom and laboratory-based education, followed by two years of clinical rotations in a teaching hospital where students see patients in a variety of specialties. After completion, graduates must complete a residency before becoming licensed to practice medicine.
Admission to medical school in the United States is generally considered highly competitive, although there is a wide range of competitiveness among different types of schools. In 2021, approximately 36% of those who applied to M.D.-granting U.S. medical schools gained admission to any school. Admissions criteria include grade point averages, Medical College Admission Test scores, letters of recommendation, and interviews. Most students have at least a bachelor's degree, usually in a biological science, and some students have advanced degrees, such as a master's degree. Medical school in the United States does not require a degree in biological sciences, but rather a set of undergraduate courses in scientific disciplines thought to adequately prepare students.
The Flexner Report, published in 1910, had a significant effect on reforming medical education in the United States. The report led to the implementation of more structured standards and regulations in medical education. Currently, all medical schools in the United States must be accredited by a certain body, depending on whether it is a D.O.-granting medical school or an M.D.-granting medical school. The Liaison Committee on Medical Education (LCME) is an accrediting body for educational programs at schools of medicine in the United States and Canada. The LCME accredits only the schools that grant an M.D. degree; osteopathic medical schools that grant the D.O. degree are accredited by the Commission on Osteopathic College Accreditation of the American Osteopathic Association. The LCME is sponsored by the Association of American Medical Colleges and the American Medical Association.
History
Many of the early medical schools in the United States were founded by alumni of the University of Edinburgh Medical School, the oldest medical school in the United Kingdom and one of the oldest medical schools in the English-speaking world. A majority of these schools were established within Northeast colleges that today make up the Ivy League, and modeled after their founders' coursework at Edinburgh. The nation's first medical school opened in 1765 at the College of Philadelphia by John Morgan and William Shippen Jr.; this school developed over time into the University of Pennsylvania's Perelman School of Medicine. At the College of Philadelphia, the first ten physicians in the United States graduated in June 1768 with the Bachelor of Medicine degree. In 1767, Dr. Samuel Bard, an alumnus of then-King's College, opened a short-lived medical school that ultimately was forced to close in 1776 at the onset of the American Revolution. The school reopened in 1784 and, after a period of struggle, merged with the New York College of Physicians and Surgeons to become Columbia University's Vagelos College of Physicians and Surgeons in 1814. By the turn of the 19th century, four medical schools had been established in the United States, with Harvard Medical School opening in 1782, followed by Dartmouth Medical School in 1797. Dartmouth, founded by Nathan Smith, was the first medical school established outside of a major US city, and the first medical school founded in the independent United States after the end of the revolutionary war. Smith went on to also establish three other New England medical schools: the Medical Institution of Yale College (1810), the now-defunct Medical School of Maine (1821), and the University of Vermont College of Medicine (1822). Brown University continued the growth of New England medical schools by establishing the Brown School of Medicine (1811). The first public medical school in the United States, the University of Maryland School of Medicine, was founded in 1807 as the College of Medicine of Maryland and became the founding school of the University System of Maryland.
As medical colleges began to proliferate across the young nation in the 19th century, the American Medical Association was formed in 1847. Almost thirty years later in 1876, the Association of American Medical Colleges was established to develop a set of standards for the education provided at US medical schools.
In 1910, the Flexner Report reported on the state of medical education in the United States and Canada. Written by Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation for the Advancement of Teaching, the report set standards and reformed American medical education. This report led to the demise of many non-university based medical schools.
After World War I, the standard practice of completing an internship after medical school became a commonplace requirement to practice medicine, and a list of approved hospitals for the training of interns was complied. In 1928, the AMA published a set of guidelines for residencies.
In 1940, the Report of the Commission on Graduate Medical Education was published, which first described the overworking of interns and residents. The Liaison Committee on Medical Education was established in 1942.
Combination programs granting a bachelor's degree and medical degree are relatively rare in the US. Baccalaureate-MD programs opened for the first time in 1961 at Northwestern University Medical School and Boston University School of Medicine. By the 1990s, 34 programs had opened, and in 2011, these programs were offered at 57 medical schools. Several of these schools offer programs in combination with more than one undergraduate institution, for a total of 81 programs. In all current combination programs admitting graduating high school students to receive both a bachelors and a medical degree, the medical education portion is four years in length. 80% of the programs are 8 years in length, giving no time advantage to students over the standard process, but 21% offer a compressed 6- or 7-year program. This is different from the programs of the 1990s, where 42% of programs were 8 years, 32% were 7 years, and 23% were 6 years.
For years following the Flexner report, medical education in the United States has followed a standardized pattern, with two years of classroom education, followed by two years of clinical experience. Since the early 2010s, the idea of shortening medical school to three years once again has been raised as a solution to the massive debt facing medical graduates and the growing shortage of physicians in primary care specialties. A small number of universities are experimenting with three-year programs. New York University offers a 3-year program with an early acceptance into a residency program for students that wish to apply for a specific specialty before beginning their medical education. A handful of universities, including the Penn State College of Medicine, University of California Davis School of Medicine, and Texas Tech University Health Sciences Center School of Medicine, offer these programs for students that commit to entering a family medicine residency.
Admissions In general, admission into a U.S. medical school is considered highly competitive and typically requires completion of a four-year bachelor's degree or at least 90 credit hours from an accredited college or university. Many applicants obtain further education before medical school in the form of master's degrees or other non-science-related degrees. Admissions criteria may include overall performance in the undergraduate years and performance in a group of courses specifically required by U.S. medical schools (pre-health sciences), the score on the Medical College Admission Test (MCAT), application essays, letters of recommendation (most schools require either one letter from the undergraduate institution's premedical advising committee or a combination of letters from at least one member of the science faculty and one non-science faculty member), and interviews.
Beyond objective admissions criteria, many programs look for candidates who have had unique experiences in community service, volunteer work, international studies, research, or other advanced degrees. The application essay is the primary opportunity for the candidate to describe their reasons for entering a medical career. The essay requirements are usually open-ended to allow creativity and flexibility for the candidate to draw upon their personal experiences and challenges to stand out amongst other applicants. If granted, an interview serves as an additional way to express these subjective strengths.
Since 2005, the Association of American Medical Colleges has recommended that all medical schools conduct background checks on applicants in order to prevent individuals with convictions for serious crimes from being matriculated.Appel, Jacob M. "Should Convicted Murderers Practice Medicine?" Cambridge Quarterly of Healthcare Ethics, Vol. 19, No. 4, Oct. 2010
Most commonly, the bachelor's degree is in one of the biological sciences, but not always; in 2020, nearly 40% of medical school matriculates had received bachelor's degrees in fields other than biology or specialized health sciences. All medical school applicants must, however, complete undergraduate courses with labs in biology, general chemistry, organic chemistry, and physics; some medical schools have additional requirements such as biochemistry, calculus, genetics, psychology and English. Many of these courses have prerequisites, so there are other "hidden" course requirements (basic science courses) that are often taken first. Concerns have been raised that these stringent science requirements constrict the applicant pool and deter many potentially talented future physicians, including those from groups historically underrepresented in medicine, from applying.Appel Jacob M. Medical School: The Wrong Applicant Pool. The Hastings Center Report 49(2):6-8 · March 2019
A student with a bachelor's degree who has not taken the pre-medical coursework may complete a post-baccalaureate (postbacc) program. Such programs allow rapid fulfillment of prerequisite course work as well as grade point average improvement. Some postbacc programs are specifically linked to individual medical schools to allow matriculation without a gap year, while most require 1–2 years to complete. Post-bacc programs have become popular among applicants to medical school. The New York Times reported that in 2011, more than 15 percent of new medical students had gone through such a program. Studies have shown that graduates of post-baccalaureate programs were more likely to be providing care in federally designated underserved areas or to vulnerable populations.
Several universitiesAAMC: Schools Offering Combined Degree Programs in BS/MD across the U.S. admit college students to their medical schools during college; students attend a single six-year to eight-year integrated program consisting of two to four years of an undergraduate curriculum and four years of medical school curriculum, culminating in both a bachelor's and M.D. degree or a bachelor's and D.O. degree. Some of these programs admit high school students to college and medical school.