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What are the main differences between UK and US Medical Training Systems?

By Dr Mohamed Gamal-Eldin, MBBCh MSc MRCGP MRCP(UK), General Practitioner- East Kent

I am a freelance GP in Kent having attended medical school at Cairo University in Egypt. Following my graduation, I worked in the NHS in England as a junior doctor. After years of hospital work, I joined a GP training programme in Kent to finally become a GP in 2016. Recently, I have become interested in comparing both the UK and the US medical training systems. I am writing this article for medical students to share my understanding of the main differences between both systems.

As for the quality of education, UK undergraduate medical training is generally of high quality and lasts typically for five to six years. Students start medical school after completing their A levels. As for the postgraduate medical training known as junior training, it tends to be protracted. For example, training to become a specialist takes about ten years after graduation with an absolute minimum of five years for general practice training. One reason for that long training duration is the fact that UK doctors spend two years in foundation training, as junior doctors, before being allowed to commence their speciality training. Speciality training itself in the UK is heavily geared towards service delivery and learning on the job. Traditional UK training programmes tend to focus less on academia and basic science and more on a practical approach of delivering patient care. There are relatively small numbers of academic clinical training programmes that combine both academic and clinical training, but those are not the standard training path.

Compare this to the US where you can only join medical school after having first completed another university degree, including specific university level courses in science. While medical school curriculum there is very comprehensive, I think probably more than that in the UK, it takes typically only four years to finish medical school. Students in the US tend to be older and have strong scientific grounding having already finished one undergraduate university degree. There is a huge emphasis on basic sciences and their clinical applications during medical school years. Medical schools in the US are mostly allopathic MD schools with a significant number of osteopathic DO schools. Both types of schools produce physicians that are qualified to continue with postgraduate medical training.

The practical clinical training component at medical school level in the US is probably briefer compared to some UK schools. However, it ensures attention to detail and excellent level of clinical knowledge. You cannot move from being a medical student to becoming a doctor without taking a series of exams known as the USMLE (US medical License Examination) commonly referred to as “the boards”. Students take those exams in basic sciences, clinical sciences and clinical skills in order to be able to start junior doctor training. Those exams are standardised and centralised nationwide regardless of the medical school attended. These are a seven-hour-exam in basic sciences, an eight-hour-exam in clinical sciences and about a six-hour- exam in clinical skills. Students usually take those during their medical school years. There is one more much longer exam over two separate days that is taken later on, typically about a year after becoming a junior doctor. This is the last of the USMLE series.

Once a junior doctor in postgraduate training in the US, you can become a specialist in as little as three years, but could be much longer depending on the speciality. The number of training years in postgraduate training is generally considerably shorter than the UK. However, junior doctors known as “residents” in the US usually work about eighty hours a week. Compare this to the UK, where I used to work as a junior doctor an average of about forty four hours a week. The focus of junior doctor training in the US includes academic publications and knowledge of the rare as well as the common. In order to complete residency training, a doctor would normally to have to one or more exams known speciality board exams.

International medical graduates from all across the world generally do well in the US postgraduate medical training system. The residency training seems to accommodate doctors from different cultures and people of all colours and backgrounds. My impression is that hospitals and specialities that do not want foreign doctors in US simply will not hire them! However, hospitals and specialities that do take international doctors train them to highest standards. The concept of working as a junior doctor who is not in formal training, which is common in the UK, is pretty much non-existent in the US.

I have to say that this article reflects my own understanding and the impressions I made about both the UK and the US medical training systems. It is based on my experience working in the NHS as well as visiting a US hospital on a period of observation. I am sure that both systems have their own advantages and disadvantages, although I find that the New York City lifestyle is certainly unbeatable!

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