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House Call: The long road to becoming a doctor

Tue., July 22, 2014

Last year, I became one of four faculty guides for second-year students in the new medical school program in Spokane. We now have all phases of medical training here, and you will likely encounter medical students, residents and fellows in your doctor’s office or at the hospital as they rotate through these locations to gain clinical experience with local physicians. You are an important part of helping them become full-fledged physicians.

The path to becoming a physician begins at a four-year university where premed students take the chemistry, physics and biology courses necessary to enter medical school. Premed students can major in any subject as long as they also take the required science courses. The next step is taking the Medical College Admission Test.

Medical school begins with 18 to 24 months of preclinical classes in anatomy, pathology, pharmacology, ethics and more. Students also see patients under direct supervision of a physician to learn basic clinical skills – like how to question and examine a patient – and to become comfortable in the role of health care provider. After this period, students take the first of three steps of the United States Medical Licensing Exam, covering what they have learned so far. They must pass all three steps to obtain a medical license. Following the first step, students begin more involved clinical training.

Each student, in the clinical years of medical school, does required rotations in specialties like family medicine, surgery and pediatrics, and elective rotations in specialties or locations (overseas or rural) of interest to the student. They see patients, learn technical skills and study a lot. Students are expected to read up on each disease they encounter, get to know each patient they interview and be prepared to answer and ask appropriate questions when they discuss patients with each other and their supervising physician. The second step of the licensing exam is usually taken during the final year of medical school.

Students apply for a residency in their chosen specialty during the fall of their fourth year as part of a nationwide process called “the match.” Interviews take place during the winter. At the end of this process, students and residency programs rank each other (first choice, second choice, etc.), this data is entered into a computer, and a match is made. All of the students and the residency programs across the country find out the results at exactly the same time, in March. Residencies begin shortly after graduation from medical school.

In Spokane, we have family medicine, internal medicine, radiology and psychiatry residencies. Some of our family medicine residents also go to Colville as part of a rural training track. Following the first year of residency, known as the intern year, doctors can take the third step of the licensing exam to become eligible for a medical license. Further board exams occur after residency to qualify a physician to practice within their specialty. Fellowships are special training tracks beyond residency for subspecialties within a specialty, such as pediatric rheumatology. Most specialties also require recertification with board exams periodically throughout a physician’s career.

July is a transition month for medical students and medical school graduates. Preclinical students move to clinical rotations. Fourth year students begin applying for residencies. Newly graduated doctors enter residency training. Each milestone along the way in a medical career is significant and celebrated by those who are in it. When you meet one of our local students or residents, you’ll have a reason to celebrate, too, knowing what a significant role the Spokane community plays in educating and training physicians.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.

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