The United States of America is a preferred education destination of international students and in particular students from India and China, who form a large part of the traffic there for MS and MBA programmes more than any other courses. Medical education in the US is advanced compared to any other country but students outside of that country are not particularly encouraged to pursue their education there. One of the reasons could be that the students are not much familiar with the Medical College Admission Test (MCAT), which seems to be a poor cousin compared to ‘fancy’ words such as GMAT (Graduate Management Admission Test ) or GRE (Graduate Record Examination). Do our students fear that MCAT is a formidable test to clear and therefore look at easier destinations like Russia? Or is the fear of expenses in America for medical education holding them back?
The basics
Unlike schools in India, medical study in the US begins only after completion of a four-year undergraduate degree. While only less than half of US applicants themselves gain admissions to the medical schools there, the number is even more dismal for international students — it stands at two per cent and is, naturally, extremely competitive — possibly explaining why the traffic towards MS or MBA courses is higher than that of medical studies.
Usually, a majority of international applicants are those who have secured an American undergraduate degree. But that need not deter other applicants. Admission to US Medical Schools is made difficult by the fact that the schools receive large Government funds and are expected to give preference to local residents. There are also some state-supported schools that don’t welcome international applications at all. However, If you are someone with a never-say-die attitude and are intent on studying in the US, you can give it a shot — not after Class XII, like in India, but after a Bachelor’s in Science and additional courses that you can do in the US to satisfy the four-year degree criterion required of an MCAT aspirant.
The process
The Association of American Medical Colleges (AAMC), a non-profit organisation based in Washington DC, which administers MCAT, says that degrees in almost any discipline are acceptable as long as the student’s course load covers the required number of prerequisite courses in the Biological Sciences, Chemistry, Mathematics, Behavioural, Social Sciences and Humanities. In case, you haven’t completed all these pre-requisite courses in your undergraduation, you will have to enrol in an undergraduate programme in the US to complete the same. Additional requirements include an excellent undergraduate academic record, English fluency and extracurricular activities such as work experience and volunteer experience, apart from a satisfactory MCAT score. Candidates are eligible to apply for four streams — Allopathic, Osteopathic, Podiatric and Veterinary Medicine.
Details at www.aamc.org.
Cost of education
A medical education in the US is a costlier affair than that of an MS or MBA. While the latter costs about $36,000 (approx `22 lakh) a year, the former comes at about $50,000 (approx `36 lakh) annually. Without working out the living and other maintenance expenses, tuition fees alone comes to a staggering `1.04 crore. First-level medical studies in the US typically lasts for four years, after which you would graduate with a Doctor of Medicine degree (MD). The pedagogy combines classroom experience with observation and clinical work. Considering the cost factor, it makes sense to thoroughly analyse options before contemplating studying medicine in the US. Scholarship options besides university sources include external aids from United States India Educational Foundation, Rotary Scholarships, Inlaks Scholarships and such.
Options after MD
The Accreditation Council for Graduate Medical Education, responsible for accreditation of graduate medical programmes in the US, recommends options such as residency and additional fellowship training in a subspecialty area. Residency is a professional training programme under the supervision of senior physician-educators, and spans about three to seven years. The length of residency training depends on the specialty chosen — family practice, trauma care, general surgery, cardiology, orthopaedics, paediatrics and so on. For example, Paediatrics requires three years of training and General Surgery about five years. You can also apply directly to residency programmes. For example, a doctor who has completed their training and practice in India can apply for residency in the US, and this works out easier than doing an MD in the US.
However, you are not done; you cannot call yourself a doctor unless you obtain the certificate of the Education Commission for Foreign Medical Graduates (ECFMG) after your residency. This certification is to assure both the US public and the directors of residency programmes that applicants from foreign medical schools have qualifications comparable to that of US medical school graduates. This applies to doctors from all countries, including Canada. As part of the ECFMG certification, you are also required to pass two Medical Sciences exams and Clinical Knowledge and Clinical Skills Exams. The Medical Sciences exam is an eight-hour computer-based, multiple-choice exam covering knowledge in the basic Medical Sciences, such as Anatomy, Behavioural Sciences, Biochemistry, Microbiology, Pathology, Pharmacology, Physiology and interdisciplinary topics.
The Clinical Knowledge Exam is a nine-hour, computer-based, multiple-choice test that covers clinical sciences including diagnosis, the understanding of disease mechanisms and care management principles. Clinical Skills is a practical exam designed to ensure that graduates of medical schools demonstrate the ability to gather and interpret clinical patient data and communicate effectively at a level comparable to their counterparts from US institutions. The day-long exam must be taken at clinical skills evaluation centres in US.
Further, if you want to become highly specialised in a field of your choice, you might also opt for additional training of one to three years in a subspecialty. Queries about studying in the US can be posted to usiefchennai@usief.org.in
MCAT
Jaideep Gupta, Co-Founder, Univariety, an admissions planning service, based in Hyderabad, gives edex the lowdown on MCAT.
What is MCAT?
A standardised, multiple-choice examination, it is designed to assess a student’s ability at problem solving, critical thinking and his/her knowledge of science concepts and principles prerequisite to the study of medicine. Scores are reported in the categories of Physical Sciences, Verbal Reasoning and Biological Sciences. Almost all US Medical Schools and many Canadian schools require applicants to submit MCAT exam scores. Many schools do not accept MCAT exam scores that are more than three years old.
Examination pattern
The MCAT is a 300-minutes test, which is conducted more than 25 times a year. It is an online test and can be taken in India. The score ranges from 0-45, and a score of 30+ is considered good.
Difficulty level
The difficulty level of MCAT can be adjudged on two levels. You have to be a subject-matter expert. But, mere knowledge of the subject is not enough. One has to be sure as to where and how to apply the knowledge on the MCAT content. This contains a fair amount of critical thinking on the student’s part.
Make note
There are certain changes that are going to take place in the pattern of these exams from 2015. The new MCAT will first be conducted in Spring 2015. Students aspiring to join medical schools in 2016 will be taking the test in 2015.
• The Natural sciences sections of MCAT 2015 will reflect the changes in medical education that have already taken place
• A separate section for social and behavioural sciences will be added
• There will be an additional section on critical analysis and reasoning skills
Students who want to apply for medical school admissions before 2016 may appear for the older version of the MCAT exams (till December 2014).
Fee and results
The AAMC and the MCAT Programme Office will use all available and reasonable means to release scores approximately 30-35 days after each test date. The basic registration fee for the MCAT exam is $275 (approx `16,000), which covers the cost of the exam, as well as distribution of your scores. Details at www.aamc.org/students/applying/mcat.
shilpa.vasudevan@newindianexpress.com
Top residency programmes in america
Ranked as per QS World University Rankings 2014 released recently
1. Harvard University, Massachusetts
Harvard Medical School looks at extracurricular activities, research, and community-service experiences in the field of healthcare, apart from your MCAT score. The application pack enlists information required of Academic Records, Essays, MCAT score, Extracurricular activities, Summer Occupations, Life Experiences, Experience in the field of Health like Research or Community Work and Letters of Evaluation (Reference Letters). Details at www.hms.harvard.edu/departments/admissions.
2. Stanford University, california
History has it that Stanford was started in memory of Leland Stanford Junior, who was a student at Harvard and died at a young age of 16. Following Harvard in the rankings too is the prestigious Stanford School of Medicine, which offers dual degrees, Master’s, MD and PhD courses. Applications are to be made via American Medical College Application Service (AMCAS) by October 15. Details at www.aamc.org/students/applying/amcas. MCAT score, recommendation letters and personal essays form an integral part of your application at this stage. There are also interviews to be cleared before you can step into this reputed institute which has been at the forefront of research besides imparting world-class education. Details at www.med.stanford.edu.
3. University of California, Los Angeles
David Geffen School of Medicine offers MD, MD-Combined, Post-MD Graduate programmes and PhD degrees. Prospective candidates are selected on the basis of their undergraduate record, MCAT scores, interviews, letters of recommendation and life experiences in the form of research, volunteering work, etc. Details at www.dgsom.healthsciences.ucla.edu.
4. Johns Hopkins University, baltimore
The School of Medicine of the University offers MD, PhD and combined MD-PhD in a variety of medical disciplines. Application is again via AMCAS and has to be made by October 15. Admission pre-requisites include MCAT score, letters of recommendation from faculty and non-faculty. Details at www.hopkinsmedicine.org.
5. Yale University, new haven
Yale School of Medicine offers MD, MPH (public health), MMSC (Social sciences), MHS (health science) and PhD programmes. Admission is again via AMCAS and requires letters of recommendation and MCAT scores. There’s also a secondary application to be completed from Yale. Details at www.medicine.yale.edu.
the benefits
Kashyap Trivedi, who did his MD from San Diego School of Medicine, University of California, Los Angeles, US, in 2003 and has been practising as a Gastroenterologist for more than a decade now, says, “I would definitely say that studying medicine in the US has an advantage, considering the kind of facilities available, the networking opportunities it provides and the entrepreneurial spirit that thrives here. It’s definitely challenging but at the same time stimulating too.” Trivedi consults with the Los Alamitos Medical Center, Long Beach Memorial Medical Center and Long Beach Veterans Affairs Medical Center and also has his private practice where he specialises in abdominal pain, colorectal cancer, gallbladder surgery and inflammatory bowel diseases, among other things. He is also associated with the American Board of Medicine and American College of Gastroenterology and has published a couple of papers on the impact of post-infectious functional gastrointestinal disorders and symptoms and mapping biochemistry to metabolism.
the flip side
Medical education should be seen as a commitment to mankind but of late, is becoming too elusive and expensive, says Dr Pradeep Kumar, Dean, Kasturba Medical College, Manipal. “I wouldn’t advise our students to break their heads about doing a Degree in Medicine in America, as it is about three-four times more expensive than studying in India. Residency would be a better option as even NRI kids do that after completing their degrees in the Caribbean or Asian countries, as US schools have very rigid rules.” Dr Kumar is also against students looking at Russia or China as an option, if India doesn’t work out. “Most of the curriculum is taught in the local language, and the standards seem to be poles apart, when compared with India, as I have seen many of the students from there failing to clear the Medical Council of India’s test.”
Dr V Kanagasabai, Former Dean, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, compares the two countries and picks India as a better option to pursue studies. “The disease patterns and genetics of the countries are starkly different. Even if you happen to go to America for residency, you will have to start all over again, as the diseases that are prominent here like arthritis, cancer and other infectious diseases, might not be that prominent there and could offer less scope for research and knowledge. However, I do recommend America as a strong research destination for our doctors who have already proved themselves.”