What are the steps to becoming a doctor?
Becoming a doctor is the ambition of a lifetime, and one that requires years of hard work and dedication. It’s cliché, but true! Before you go any further, you need to be sure that medicine is the right career for you. Do you understand what the job involves, and how your training will look as you progress through the various stages of medical school and beyond?
In this article we are going to discuss the main stages of becoming a doctor. The path to an MBBS/MD/MBBCh degree is variable depending on your individual circumstances. The main themes that will be discussed aim to clarify the requirements for success during the various phases of your pre, during and post-medical school career.
- How does medical school work?
- Preclinical years
- Clinical years
- Postgraduate study
How does medical school work?
The art of medicine is a topic that has been discussed since the time of Hippocrates. As well as having the clinical knowledge to prescribe the right medication or the surgical skills to repair a bleeding vessel, a doctor must be able to communicate with compassion, care, and common sense. If you are not interested in improving a person’s quality of life and helping them, then medicine is very unlikely to be for you. Always remember, there is a world of potential jobs out there, and there is certainly no shame in being honest about what your main goals and passions are in life.
So what does it take to pursue a career in medicine? Being gifted academically will give you a strong foundation when pursuing the path to becoming a doctor. In this realm, there is simply no substitute for hard work. You do not need to be the next Einstein, but you do need to be performing well in the vast majority of your subjects, with strong grades.
This includes good proficiency in basic subjects like Physics, Mathematics, Chemistry, and English, at both GCSE and A level (in the United Kingdom). The international Baccalaureate also requires you to perform to a very high standard. Whatever exam board, or country you are studying in, you need to excel to the best of your ability and be motivated to succeed academically.
As well as your academic career, it is imperative that you develop a good range of extracurricular activities and hobbies. This may be playing sports for your school team, or local team. This could also be charity work or volunteering. Anything that involves communication with a range of people and a large number of people from the general public will do e.g. a cashier at a shop, or a coffee shop barista.
This will improve your communication skills and get you used to speaking to a variety of strangers with ease. This is what medicine is about. Speaking to people you may not know very well, and making them feel comfortable and reassured enough to discuss their health concerns.
Any opportunities at school or outside of school that take on leadership responsibilities are highly recommended. The same advice is encouraged for teamwork activities. Play in a team, work in a team at work, sing in a choir or play in an orchestra. All of these are examples of things that will demonstrate your abilities to work well in a cohesive teamwork structure and demonstrate your leadership skills when they are required.
Alternative application options
If, despite your hard work, you are really struggling with your grades, or you chose non-medical subjects for A level, or have only recently decided to come to medicine, this is not necessarily the end of the road. Many universities offer a year 0, where they will bring you up to speed in the science subjects, e.g. Biology, Chemistry and Mathematics. At times, you’ll be asked to reapply to the medical program using the grades obtained from year 0.
This also extends to those who are from disadvantaged backgrounds, or went to poor secondary schools. Many universities make allowances in your grades if you have a background like this. If either of these apply to you, the importance remains in doing your research. There are many paths to becoming a doctor, which you are encouraged to explore thoroughly.
Sometimes, despite your best efforts, finding a place to study medicine may seem impossible. If you are certain that medicine is the career you want, then don’t give up! You can always do another degree and apply as a graduate. A career in a field allied to medicine is also an option, such as a physician’s assistant, a healthcare scientist, or a biomedical scientist. Sometimes you may not know you enjoy something until you explore other options!
If you choose to do a bachelor’s degree before you apply to study medicine (as is the compulsory "premed" system in the US), then you will have a different pathway to your degree. In the United Kingdom this will be in the form of a graduate degree. This is an accelerated four-year degree that compresses the preclinical years into one. Your first year will be a lot more stressful than that of an undergraduate. You will essentially be expected to learn years worth of undergraduate knowledge in one year.
Application for a place on graduate courses is understandably competitive, with many students choosing medicine at a later stage. Motivations for choosing medicine at a later stage in life will almost always vary, and each candidate will be unique. Previous employment will also have a significant bearing on one’s practice at medical school, with experience in the areas of teamwork, leadership, organisation, and others of utmost importance.
The application process for getting into medical school and achieving success at your interview are discussed in other articles, so discussed further will be what your time at medical school will involve.
The initial medical school years are spent learning the physiology underpinning the human body and it’s normal functioning. This is an essential right of passage in your path to becoming a doctor. The teaching you will be exposed to will teach you the normal functioning of the body and its systems, and will also introduce you to the abnormal function of the human body. This will most likely be covering the major diseases that affect the human population i.e. diabetes, heart failure, myocardial infarctions (heart attacks), stroke, chest infections, urinary tract infections, and so on. The majority of the teaching you will receive is generally focused on the topics mentioned above.
It is likely that the main focus of your examinations will be on your knowledge of these areas of academic understanding. The clinical side of your knowledge (patient history taking and examinations) will be something that will be in its early stages. This is not the case with all universities, some of whom may place a heavier emphasis on your clinical acumen at an earlier stage. When it comes to learning, the key is to know what works for you. If you are a visual learner, then utilise that fact, but don’t limit yourself to it. Read lecture slides, draw diagrams, and brainstorm topics.
If you consider yourself more of an "auditory learner", then listening to lecture recordings may be helpful for you. Another point I would make, is to not neglect online resources. The internet has millions of websites dedicated to offering high quality information on physiology, anatomy, and clinical conditions. You can use YouTube, Google, and any other search engine or online platform to cement your understanding with reputable sources.
The key to being successful at medical school is understanding. Memorization also plays a key role, and there are some things that you will simply have to memorize before understanding them. For example, the brachial plexus; you need to memorize all the name of the branches and their relative location before knowing what part of the arm each branch will innervate. But there is no replacement for understanding a topic. If you understand something, you can apply those principles to any topic. You will be more capable of thinking on your feet and answer questions that require you to think laterally (outside the box) during your examinations.
The later medical school years involve the learning of clinical science and medicine in the way we traditionally think of it i.e. symptoms, investigations, examinations, and management. This is when your path to becoming a doctor will start to feel real. You will be expected to learn a large amount of information and this will certainly be the most challenging part of medical school. These medical school years are largely comprised of regular hospital based placements/residency and clinical contact with patients.
During placement/residency, students will be encouraged to clerk patients (take a thorough clinical history, formulate a diagnostic and management plan, etc). This is incredibly beneficial, as each patient offers another learning opportunity. This could be in the form of a condition you are unfamiliar with, or a medication you have not yet heard of. By interacting with patients, your communication skills will remain of a high quality. This will prepare you for your examinations, where you are likely to be asked to take a clinical history from a patient and gain an understanding of their condition. How long is residency? Usually this will take place in the last two years of your studies, but this may vary between universities and countries.
Patients are the eternal fountain of clinical knowledge, so do not try and learn everything from your textbooks. You will obviously need to read both widely and thoroughly, as well as see how these conditions impact every day patients. Make an effort to see how these conditions are managed on hospital wards and clinics.
Another point to take into account on your path to becoming a doctor is the importance of intellectual curiosity. You will get out of learning experiences what you put in. It is very easy to follow a ward round and learn nothing, or sit in a clinic for four hours and learn little. If you ask questions, show interest and behave professionally, it is truly amazing how much you can learn in the duration of a few hours.
A technique that you are encouraged to use during medical school is reading about the conditions you see in patients you meet on the ward or in clinic during residency/placement. This has the effect of cementing your knowledge, and rather than learning the empty facts about a disease, allow you to associate the information with a person. This information therefore becomes easier to remember and utilise.
For every condition listed in your list of learning objectives, or your curriculum outline, you should know the following minimum facts: signs and symptoms (S/S), diagnosis (Dx), and management (Tx). This should be the pattern by which you learn every single disease.
Learning other elements of a disease are also very useful, especially in your med school exams, where critical thinking can give you an edge. These areas include pathophysiology, risk factors, aetiology, genetics, classification, prognosis, complications, and follow up. Having this deeper bank of knowledge for each disease will put you in a very strong position to approach the med school exams.
In the later clinical years, your focus should be on perfecting the skills you have already developed. You may know the steps of a cardiovascular exam, but do you know the precise sequence? Are you able to put the patient at ease while you perform the examination? These are points of refinement that will improve your marks in examinations, and separate you from the bulk of your academic year. Do not neglect your clinical skills. Work on both your levels of knowledge, and your ability to communicate and establish a good history. Both are required to become a good doctor, so work on both equally.
Skills and knowledge
Clinical examinations (also known as OSCEs- Objective Structured Clinical Exams) are often the most challenging of exams but are a crucial experience for preparing you to become a doctor. In these exams, you are on the spot, expected to know how to examine proficiently, expected to communicate proficiently and expected to maximize the amount of marks you get. It is understandable to feel nervous, and depending on your medical school, you may be expected to sit these exams in your preclinical years as well.
The key to doing well in an OSCE is remaining calm. It is ok to feel nervous, but this should not be hindering you from talking and performing well. When you approach each station, ensure you read the full station and use all the time you are allocated for this. There are no prizes for rushing through the station, in fact there are marks to be lost if you find yourself with time at the end of the station and nothing else to say. Think about follow up questions you could ask and think about what else may be relevant to your examination.
In terms of your examinations, there is simply no substitute for practice. Your examinations should be second nature to you and you shouldn’t be having to second guess the sequence of steps you are taking. The same principle goes for history taking. You will learn a firm foundation, most likely in your third year.
This foundation is:
- presenting complaint - This is a one sentence summary of what has brought the patient into hospital/clinic.
- history of presenting complaint - You should spend the majority of your time on this part of the history. This is where you establish the onset, duration, and progression of the presenting complaint. You must also establish any associated symptoms, such as nausea, vomiting, or diarrhea. Remember to screen for systemic disorder i.e.: tuberculosis or cancer, then ask about night sweats and weight loss.
- past medical history of the patient - Ask about heart disease, lung disease, cancers, and previous surgeries. Screen for other major diseases such as diabetes, high blood pressure, and strokes, If these are relevant to the history.
- drug history - Establish what medication they are on and what they have been on in the past. Ask about over the counter medications and vitamins/supplements. Some herbal treatments can contain dangerous chemicals, especially if purchased over the internet or another unreliable source. There also might be interactions which would be a contraindication.
- family history - Ask about siblings, parents, cousins, aunts, uncles, grandmothers, and grandfathers. You should ask specifically about the disease that may be linked to the presenting complaint. For example, the patient may have presented with weight loss and bone pain, in which case you should ask about family cancer history. Also, ask about pregnancy, past or present, no matter the level of discomfort.
- social history - This includes asking if the patient smokes, drinks, or takes any recreational drugs. Also how the disease is impacting them and their relationships, affecting their work, and if they are having any financial problems because of their illness. This section of the history may come much earlier if you feel the patient's primary concern is the impact of the disease on their life, and not just the primary illness.
As you go through medical school you will learn about the specific elements of each history in each area i.e.: a falls history, a hearing loss history, etc. These skills are best picked up on placement in these specialty areas and practicing on real patients who actually have the diseases you have been reading about. There is simply no substitute for this method of learning. Med school exams are notoriously hard work, but with preparation and a good attitude, you'll be well placed to succeed.
Some doctors decide that, after successfully completing their med school exams and becoming a doctor, they still want to pursue a higher degree such as a Master’s or a PhD. This is particularly beneficial if they are pursuing an academic career.
It is also a positive if considering a career in surgery or hospital medicine. It may give you the edge in a certain area when you apply for a competitive job. However, this is certainly not a compulsory part of a medical career, and the options will become much more tangible once you qualify.
Becoming a doctor is the ambition of a lifetime, and one that requires years of hard work and dedication. However, medicine is about so much more than being clever. You have to visualize and practice medicine as both a science AND an art.
Prior to attending medical school, you need to be gifted academically and have strong grades, especially in science subjects. If your results are not satisfactory, you can spend a year in certain universities during which you are brought up to speed in the science subjects. Alternatively, you can obtain a degree and do medicine after that, as a graduate.
As well as your academic career, it is imperative that you develop a good range of extracurricular activities and hobbies. Any opportunities at school or outside of school that take on leadership responsibilities are highly recommended. The same advice is encouraged for teamwork activities. Medicine is about speaking to people you may not know very well, and making them feel comfortable and reassured enough to discuss their health concerns. Therefore, improving those areas through extracurricular activities is a necessity.
Medical school itself is roughly divided into preclinical and clinical years. In the first stage you learn about the normal and abnormal functioning of the human body. It is mainly theoretical, so understanding rather than memorizing is essential. In the second stage, you are placed in hospitals where you have clinical contact with patients. You begin to improve your communication skills even more and put all the previously learned knowledge to practice.
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