I was struggling for inspiration as to what to write this weekend, really did not have a clue. Fortunately twitter came to my rescue. A conversation with an American Medical student/blogger (read her blog here) resulted in us both admitting that neither of us knew anything about the medical education system in the others country. As I check my stats on this page every day (ok, every 10 minutes), I reckon that over half of the people who read my blog are American. So, I thought that I would write a post explaining the course of medical education in the UK for any Americans that were passing through that were interested and remember, Americans can apply to UK universities as well!
So, in the UK there are two main routes to becoming a doctor. One is the traditional school-leaver 5 year course (which I will go over quickly as I don’t actually know much about it), where at 18 you apply to a medical school after your A levels (kind of our end of high school exams) and hopefully get accepted. You then spend between 2 and 3 years of pre-clinical work (generally, medical schools vary quite significantly) where you do your learning in lecture theatres and seminars. A lot of UK medical schools are starting to move away from the traditional one bloke at the front talking and moving more towards group problem based learning where you are given a clinical scenario and you have to work through it in your small groups. If you pass your exams you then enter into your clinical phase of your degree, where you learn from doing things on wards under the supervision of a consultant (I believe Americans call them Attendings).
I’ll come to what happens after you qualify in a minute.
The other route may seem quite familiar to Americans. It’s our Graduate Entry Medicine (GEM) course. This is where you apply to medical school having already completed a degree in another subject. We do not have a “pre-med” course here, the closest we probably have is biomedical science – essentially the course which people do because they failed to get into medical or dental school, I only know 2 people that actually applied to it because they wanted to be a lab technician.
So, as you may have guessed from my twitter handle.. I am a graduate medic. I am on a GEM program in the south of England and currently in my second year. This is where it gets a little bit more complicated. Each GEM course is run differently, we all have our quirks. From what I hear there are two other GEM courses that run their course the same way as we do. Basically the first 18 months of our degree are “pre-clinical”, we do most of our learning in the lecture theatre.. I say most because I do 2 days a week in the hospital learning things from a consultant (mine is awesome). As of January, providing I pass my ETAs (End of Term Assessment) then I will move into Phase B, our clinical time where we spend 2.5 years (Oh yeah, GEM courses are only 4 years.. like the American system) learning in a hospital full time.
So, the only real difference between the two is that GEM courses are shorter, but you qualify later. They also (bizarrely) work out cheaper than an undergrad course (Have a look at this blog for details). There are no differences in the degree title or anything like that. Oh yeah.. I learned this weekend that in the US you have DO and MD.. I’d only ever heard of MD (House, obviously). Here we have MBBS, MbChb and a few other variations of that, but they all mean the same thing: Bachelor of Medicine and Surgery. An MD over here is a doctor of medicine, doctor being used in the proper sense, as in they have done a PhD in medicine.
Ok, so what happens after you pass your finals? Well, you actually have to sort things out long before then. In the January of your final year we sit a test called the Situational Judgement Test (SJT), which is designed to test how we would react in certain situations and is used to rank medical students against one another to determine our placements. It’s a national test, sat on the same day across the country and I think it is a load of bollocks, but it’s an easy load of bollocks to get a good mark in and therefore boost your chances of getting the placement that you want.
So.. these placements you ask?
On our job application forms we have to list everything we have ever done, ever that might get us extra points to go with our score from the SJT and our academic score from the university, we also have to list each of the 26 (or 28, can’t remember) deaneries in our order of preference. A deanery is essentially a further extension of medical schools, but focuses only on our postgraduate training. Which deanery we are placed in depends on our application.
So… you get a job. You therefore have entered the Foundation Programme as a FY1 doctor (Foundation Year 1). This is the equivalent of the US intern year. You are everyones bitch. All you do for a year is PR exams, take blood and write up peoples notes. I should probably say here that we don’t choose our specialty here either (as Greys Anatomy has me believe that you guys choose medicine or surgery at this point). We are instead on a set of 6 rotations (across F1 and F2) where we will experience a wide range of specialties before making our ultimate decision about which training programme to apply for at the end of F2.
I don’t want to go any further than that, because frankly it gets complicated. If anyone has any questions, feel free to drop a question in a comment and I’ll answer it as best I can!