Medical Education

Students must study and work for many years to become a doctor in the United States. Working conditions are often very difficult. I'm Mary Tillotson. And I'm Steve Ember. Today we tell about doctors in training on the VOA Special English program, THIS IS AMERICA.

Men and women in the United States who want to become doctors attend four years of college or university. They usually study science intensively. They study biology, chemistry and other sciences. If they do not, they may have to return to college for more education in science before trying to enter medical school. Some students work for a year or two in a medical or research job before they try to seek a place in a medical college.

There are one-hundred-twenty-five medical colleges in the United States. More than sixty-six-thousand students are attending medical colleges. It is difficult to gain entrance to them. Those who do the best in their studies have a greater chance of entering medical school. Each student also must pass a national examination to enter medical school. Those who get the top scores have the best chance of being accepted. Most people who want to study medicine seek to enter as many as ten medical schools. This increases their chances of being accepted by one.

Last year, about thirty-five-thousand students applied to medical schools in the United States. About seventeen-thousand were accepted. A medical education is very costly. It costs as much as thirty-thousand dollars for each year.

After entering medical school, students spend the next four years studying only medical sciences. The first two years of medical school are spent mainly in class. The students learn about the body and all its systems. They learn about chemistry and medicines. And they begin studying diseases and how to recognize and treat them. Many students say the first year of medical school is the most difficult. They must remember a great deal of information. For example, many schools require that students remember the names of every bone in the body.

By the third year of medical school, students are ready to use their knowledge to begin helping sick people in a hospital. These students work under the guidance of experienced doctors. Students observe the treatment of patients. They also examine patients and advise treatment. As the students watch and learn, they think about the kind of medicine they would like to practice when they become doctors.

Do they want to care for children? Or do they want to care for pregnant women and assist at the birth of babies? Do they want to treat patients with broken bones? Or do they want to operate on the body or the brain?

During the fourth year of medical school, students begin seeking to enter a medical training program in a hospital. This training program is called a medical residency. Medical school graduates face strong competition to gain a resident position at the hospitals they want most. Hospitals want the top medical school graduates.

Most states require that a person complete at least one year of medical residency before being permitted to take examinations to practice medicine. Some doctors work for many years as residents in hospitals, depending on which medical field they have chosen. For example, surgeons spend many years as medical residents to gain the needed experience performing operations. Some doctors work in hospitals as residents for as many as ten years before they begin working on their own.

These medical residents provide hospitals with needed services in return for not much pay. They work under the supervision of medical professors and more experienced doctors. Medical residents treat patients. They carry out tests. They perform operations. They complete records. In hospitals with few nurses, residents also do work formerly done by nurses.

During their first year of residency, these doctors in training work in a number of medical services. For example, they may work in emergency care for one month. Then they may care for children. The next month, they may work in the operating room. During this time they get a chance to decide what kind of doctor they want to become.

Some medical residents work one-hundred or more hours in a single week. They often work for more than thirty-six hours at a time before they can rest. Critics of this system say medical residents work too long and do not get enough rest. They say these young doctors may be too tired to provide the best care for their patients.

Now, however, an organization that supervises the training of medical residents has decided to change this policy. The Accreditation Council for Graduate Medical Education says it will limit the number of hours that residents can work. It acted because of concerns that hospital workers are responsible for many serious mistakes.

The new work limits will begin in about a year. They will affect about one-hundred-thousand medical residents. Most doctors in training will be limited to eighty hours of work each week. They will have work periods of no more than twenty-four hours at one time. They will have ten hours of rest between work periods. Medical residents will have one day each week when they do not have to work. Any work they do outside their hospitals will be limited. Experienced doctors and medical professors will closely supervise the residents to make sure they are not too tired to work.

Many medical residents welcome the new policy. They say they often work under tense conditions. Their decisions may mean the difference between life and death. A young family care doctor in the state of Virginia says she learned a lot as a medical resident at a southern hospital. But she says she might have learned even more if she had not been so tired.

Some residents, however, oppose the changes. They say they need extended time with patients to note changes in their conditions. And some believe they need to work as much as they can to gain the experience they need to become good doctors.

Reducing working hours for residents means that other people will have to do some of their work. Some hospitals will have to employ more doctors, nurses and other medical workers. This will mean increased expenses for hospitals around the country. About thirteen years ago, the state of New York passed a law similar to the new policy. It limited the work of medical residents to eighty hours of work each week. The state spent more than two-hundred-million dollars a year to carry out the law.

Three years ago, the Institute of Medicine of the National Academy of Sciences studied deaths in American hospitals. Its report estimated that mistakes in hospitals kill at least forty-four thousand Americans each year.

There are no estimates of how many medical residents may have been responsible for these deadly mistakes. However, its seems likely that a doctor who has not slept in days might make a mistake. Some hospital investigations reportedly have blamed tired residents for ordering the wrong amount of medicine for their patients.

Even with their new, reduced hours, medical residents will be working much longer than most Americans. Most Americans work about eight hours a day. They work about forty hours a week. Some young doctors in hospitals will be working two times as many hours a week.

However, experts say this is not just a problem of long hours. A medical educator in the state of Illinois has worked with medical residents. Paul Rockey says medical residencies today are more difficult than they were in the past. This is because patients do not stay as long in the hospital as they once did. Doctor Rockey says this change puts a lot of pressure on young doctors to learn quickly from their patients.

Doctor Rockey says the difficulties of modern medical education may be great. But he says young people get great satisfaction in seeing themselves gain the knowledge and experience to become good doctors.

This program was written by Jerilyn Watson. It was produced by George Grow. I'm Steve Ember. And I'm Mary Tillotson. Join us again next week for another report about life in the United States on the VOA Special English program, THIS IS AMERICA.