Medical education

I was happy to meet young Felix Cabrera a few weeks ago. Felix arrived home to Saipan after completing his first year of medical school. He is here to perform some research with public health during his summer vacation. It’s always encouraging to see new local talent coming into the medical profession. It’s clear that we need more indigenous physicians returning home to the CNMI to serve the community. Young people often ask me what it takes to become a doctor. Here is a brief summary of the steps to becoming a medical doctor.

First of all, you need to go to college. Under most circumstances, you’ll need to complete a bachelor’s degree. Although some universities offer a “premed” major, this is rare. You can major in anything you want, and still be well prepared for medical school. Generally, you need to take a year each of general chemistry, organic chemistry, physics, calculus and biology. Beyond that, you can take any classes you want and major in anything that you want. In fact, medical schools look very favorably upon people that come from majors like art history, or literature or music. They like to see candidates that are well-rounded and who can relate well with other people. As an undergraduate, one of my majors was the History and Literature of Religion. I pursued a course of study that was interesting to me and it was one of the things that helped me get into medical school.

During the undergraduate years, you need to get good grades—lot’s of A’s, some B’s, maybe one or two C’s. And no D’s or F’s unless you’ve got a really good reason. It’s not that you have master every subject you ever study in order to be a good doctor, but being a good doctor requires the ability to rapidly digest large amounts of information, and I guess medical schools think that good grades are a sign that you can handle information.

About a year before going into medical school, you’ll have to take the MCAT, or “Medical College Admission Test.” The test covers the science and math courses and examines your ability to comprehend and interpret data. The better your score, the more likely you are of getting into medical school.

So, after your four years of university and a bachelor’s degree, you start medical school. Traditionally, the curriculum included two years of classroom work. The first year is spent learning the way a normal body works, and the second year is spent learning about the abnormal body and diseases and their treatments. The third year is then spent almost exclusively taking care of patients in a hospital, under close supervision. There are core services that one rotates through during the third year—typically three months each of surgery, internal medicine, pediatrics and obstetrics-gynecology. The fourth year is also a clinical year, but it’s a chance to take some electives. I remember that during my fourth year I spent a month on the plastic surgery service, a month on the neurosurgery wards, a month doing pediatric infectious disease work, and a month in the emergency room, dermatology, neurology, ophthalmology (my favorite) and rural medicine. Medical education has changed some since the time I graduated in 1988. Now you may spend more time with patients as a first year student, and also instead of spending one year on the normal body and the next year on the abnormal body, you’ll spend a month on different systems. For example, you’ll spend a month studying the heart—the normal heart, the abnormal heart, the treatment for various heart conditions, and even get to see some patients with heart conditions. Many schools are now using this “systems” approach or a “problem based” approach.

So, you graduate from medical school in four years and you’re a Medical Doctor—MD. But you still can’t practice medicine! You need more training. If you want to become a pediatrician, you’ll need to spend three years in a pediatric “residency.” During this time, you are again working under the supervision of more experienced doctors to take care of patients and learn about a particular specialty. This is one of the purposes of the electives you take during the fourth year of medical school—to help you decide what specialty you want to enter. The big six are family practice, pediatrics, surgery, internal medicine, obstetrics-gynecology, and emergency medicine. There are also specialties like neurology, psychiatry, dermatology, radiology and ophthalmology that you can enter. Many of these specialties require one year of general training and then three to four years of specialty training. For example, I did one year of internal medicine training as part of my training in ophthalmology.

So far you have four years of university, four years of medical school and three, four or five years of a residency (depending on the specialty) under your belt. Believe it or not, you still might not be finished. Although at this point you can go out and work as a full-fledged specialist, many doctors choose to go on to get even more specialization. They will do a “fellowship”—extra years to become a sub-specialist in their field. For example, after five years of a surgical residency, you decide you want to become a heart surgeon – that’s five to seven more years. Or after three years of an internal medicine residency, you decide to become a pulmonologist (lung specialist)—that’s three more years. Each major specialty has bunches of subspecialties that require more years of training.

Felix has gotten his bachelor’s degree and a year of medical school under his belt. He’s got at least three more years of medical school and three years of a residency ahead of him, and perhaps a few years of sub-specialty training before coming home for good. It may seem daunting, but no matter what, the time will pass. Spend the years diligently, with discipline and determination, and it can be an opportunity to serve the people of the CNMI as a physician.

(David Khorram, MD is a board certified ophthalmologist, and director of Marianas Eye Institute. Questions and comments are welcome. Call 235-9090 or email eye@vzpacifica.net. Copyright © 2005 David Khorram.)