Medical school typically lasts four years. Some industrious students finish early by squeezing all electives into the first three years. For others, medical education takes longer because students attend graduate school, are in a dual-degree program or take time off to do community service or research projects. The first two years of medical school are devoted to building an understanding of the scientific basis of clinical practice, with the majority of time is spent learning the science of medicine and the variety of social, cultural, ethical and economic issues that affect the health and illness of patients, families and communities. Medicine is an elegant blend of the science and humanities, and the attitudes and skills fundamental to providing compassionate care are taught and modeled by faculty and community preceptors throughout the first two years.
The first year is organized into four blocks integrating traditional disciplines and emphasizing the application of basic biomedical sciences to the practice of medicine. All four blocks focus heavily on clinical correlations. Students learn the fundamentals to medical interviewing, physical diagnosis, clinical reasoning and patient counseling and gain a better understanding of the social and human dimensions of illness. Additionally, each student spends two weeks, one in the fall and one in the spring, working with a local practitioner in a North Carolina community. After the first year of medical school, students will have roughly three months of free time over the summer. Many students use this time to do research or service projects locally and abroad. Essentially the last summer off, this is probably the best time to schedule that big family vacation.
Similar to first year, the second year is organized into a block system, with 11 blocks. Material is presented in an integrated fashion and emphasizes multidisciplinary care, with more time for small group discussion and less time in lecture halls. Second year students spend three weeks working in the community. The second year ends in early to mid May and the third year begins in early July. Students use this time to study for the United States Medical Licensing Examination “Boards.”
In the third year of medical school, students leave the classroom almost totally behind and receive hands-on education by rotating through wards. These clerkships (also known as rotations) give students exposure to specialty areas and their first taste at extensive patient contact. The third-year curriculum involves rotations in internal medicine, outpatient medicine, obstetrics and gynecology, family medicine, psychiatry, neurology, surgery and pediatrics.
Students work under the supervision of interns, residents and attending physicians. Students will accompany the resident on rounds, observe procedures and possibly assist in minor procedures, do patient histories and physical exams. The demands on the student vary from clerkship to clerkship. Even when students are not on call, they are expected to stay until their duties are completed, even though this may mean leaving the hospital at 10 p.m. or later. Some rotations require that medical students attend lectures and/or rounds on weekends. With all the new responsibilities, you can expect to see considerably less of your medical student during the third year.
Rotations are done at UNC Hospitals and at hospitals across the state, and students are required to take at least one internal medicine rotation in Charlotte, Greensboro, Raleigh or Wilmington. An effort is made to schedules those students with child care responsibilities at a facility within daily driving distance. Some students request to do the majority of their rotations "away." When students go on away rotations, they are responsible for making living arrangements. The central AHEC (Area Health Education Center) office will make housing recommendations and each AHEC has some type of local housing option. Meals are usually available in the medical center cafeteria - sometimes at a discount, sometimes full price - and some AHEC locations have cooking facilities. Usually students have a roommate and family or pets do not accompany students at AHEC sites.
After completing the third year, all students are required to take and pass the Clinical Performance Examination, which evaluates clinical skills and professional behaviors.
In year four, students begin focusing on a specialty. The fourth year is composed of four-week long selectives and electives. Selectives are required courses that are offered in a limited variety of settings and specialty areas. Electives are rotations that students choose individually, depending on career interest and schedule. Students are required to take eight fourth-year courses: an Area Health Education Center (AHEC) Acting Internship Selective, an Science in Medicine Selective, a Surgery/Critical Care Selective and four electives. There are ten, four-week elective periods in the fourth year. Research projects, community health projects and combined-degree programs provide additional opportunities for students to explore individual areas of interest and career pathways. Extra time is included in the elective schedule to allow students time for visiting residency programs or taking additional electives.
The National Resident Matching Program (NRMP) links residency applicants to residency programs. Upon selecting a specialty, students apply to programs and wait for an invitation to be interviewed. UNC medical students typically interview with between 8-20 programs and must pay out of pocket for travel costs. Once the interview process is complete, students and residency programs submit lists ranking their top choices and the NRMP uses an algorithm to “match” candidates to positions. Each March at the often emotional Match Day, students receive notification of their residency placements.
In the spring of year four, students are required to take week long capstone course. Commencement is held in early to mid May and is when a medical student officially becomes an M.D.
Internship and Residency
Internship is often used to refer to the first year of residency, and during this time your student (who is now a doctor) is called an intern, first-year resident or PGY1 (post graduate year one). The first year of residency is not always done in the same place as the remainder of residency. All internships used to be "floating internships" - similar to third-year rotations but with more responsibility, longer hours and a salary (albeit a relatively small one for hours worked). Many internships are still floating or traditional with the intern working on several different services during the year, but most are "preliminary" or part of a full categorical residency program. More oriented toward the practice specialty of the student, these internships allow the student to work primarily with the specialty area in which he or she plans to continue. The internship year is required before a medical student can practice and receive a regular license. It involves hard work and long hours - and many say it is the hardest year of the medical education journey.
Residency programs may begin immediately following medical school or following a one-year internship program. Residency is medical specialty training, and the length varies with the specialty ranging from three to ten years. Although technically residency is optional, today it is rare to find an MD who has not completed or is not completing a residency. Internship and residency salaries generally range from approximately $38,000 to $44,000.
After residency, a doctor may choose further sub-specialty training as a fellow. Fellowships can last one, two or more years and are particularly common for those planning careers in academic practices (university medical centers).