Doctor of Medicine

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Physician
The Doctor Luke Fildes crop.jpg
"The Doctor" by Luke Fildes (detail)[1]
Occupation
Names physician, medical practitioner, doctor of medicine, medical doctor or simply doctor
Type Profession
Activity sectors Medicine, Health care
Description
Competencies the ethics, art & science of Medicine, Analytical skills, Critical thinking
Education required see Medical education
Fields of employment Clinics, Hospitals
Related jobs General practitioner or Family physician, Surgeon, other Medical specialists


Doctor of Medicine (MD, from the Latin Medicinæ Doctor meaning "Teacher of Medicine") is a doctoral degree for physicians (medical doctors). The degree is granted by medical schools.

It is a professional doctorate / first professional degree (qualifying degree) in some countries, including the United States and Canada, although training is entered after obtaining from 90 to 120 credit hours of university level work (see second entry degree) and in most cases after having obtained a Bachelors Degree. In other countries, such as United Kingdom and India, the MD is an advanced academic research degree similar to a PhD or a higher doctorate.[2] In Britain, Ireland, and many Commonwealth nations, the qualifying medical degree is instead the Bachelor of Science in Medicine, Bachelor of Medicine, Bachelor of Surgery (MBBS, BMBS, BM BCh, BM, MB BCh BAO, or MBChB).

Contents

History of the medical degree

According to Sir John Bagot Glubb, Syed Farid Alatas, and S. M. Imamuddin, the first medical schools to issue academic degrees and diplomas were the teaching Bimaristan (Hospitals) of the medieval Islamic world. The first of these institutions was opened in Baghdad during the time of Harun al-Rashid. They then appeared in Egypt from 872 and then in Islamic Spain, Persia and the Maghreb thereafter. Physicians and surgeons at these hospital-universities gave lectures on Medicine to medical students and then a medical diploma or degree was issued to students who were qualified to be practicing physicians.[3][4][5]

According to Douglas Guthrie,[6] who bases his account on L Thorndike,[7] medical men were first called "Doctor" at the Medical School of Salerno. He states that the Emperor Frederick II decreed in 1221 that no one should practice medicine until he had been publicly examined and approved by the masters of Salerno. The course lasted 5 years, and to start one had to be 21 years old and show proof of legitimacy and of three years study of logic. The course was followed by a year of supervised practice. After the laureation ceremony the practitioners could call themselves "magister" or "doctor."

Academic degrees for physicians by country

United States and Canada

The first American medical program was established at the University of Pennsylvania in 1765. The MB or Bachelor of Medicine was also the first type of medical degree to be granted in the United States and Canada. The first medical schools that granted the MB degree were Penn, Columbia, Harvard, Maryland, and Toronto[citation needed]. These first few North American medical schools that were established were (for the most part) founded by physicians and surgeons who had been trained in England and Scotland. University medical education in England culminated with the MB qualification, and in Scotland the MD, until in the mid-19th century the public bodies who regulated medical practice at the time required practitioners in Scotland as well as England to hold the dual Bachelor of Medicine and Bachelor of Surgery degrees (MB BS/MBChB/MB BChir/BM BCh etc). North American Medical schools switched to the tradition of the Ancient universities of Scotland and began granting the M.D. title rather than the MB begining in the late 1700s. The Columbia University College of Physicians and Surgeons in New York (which at the time was referred to as King's College of Medicine) was the first American University to grant the MD degree instead of the MB.[8]

Within the United States, MDs are awarded by LCME-accredited medical schools.[9].[10][11] The Liaison Committee on Medical Education is an independent body sponsored by the Association of American Medical Colleges and the American Medical Association, the AMA.

Admissions to medical schools in the United States are highly competitive, with 17,800 of the approximately 47,000 applicants matriculating to any medical school. Before entering medical school, students must complete a four year undergraduate degree and take the Medical College Admission Test (MCAT). Before graduating from a medical school and achieving the degree of Medical Doctor, most schools require their students to take the United States Medical Licensing Examination (USMLE) Step 1 and both the Clinical Knowledge and Clinical Skills parts of Step 2. The M.D. degree is typically earned in four years. Following the awarding of the MD, physicians who wish to practice in the United States are required to complete at least one internship year (PGY-1) and pass the USMLE Step 3. In order to receive Board Eligible or Board Accredited status in a specialty of medicine such as general surgery or internal medicine, then undergo additional specialized training in the form of a residency. Those who wish to further specialize in areas such as cardiology or interventional radiology then complete a fellowship. Depending upon the physician's chosen field, residencies and fellowships involve an additional three to eight years of training after obtaining the M.D. This can be lengthened with additional research years, which can last one, two, or more years. The Doctor of Osteopathic Medicine or D.O. degree is the only other legal and professional equivalent to the M.D. degree in the United States. The major differences between the M.D. and the DO degrees lie in the distinctive osteopathic philosophy and osteopathic manipulative treatment (OMT) and the difference in requirements for admission to the respective programs.

In Canada, the M.D. is the basic medical degree required to practice medicine. At McGill University in Montreal, M.D., C.M. (Medicinae Doctor et Chirurgiae Magister or a Doctor of Medicine and Master of Surgery sometimes also written MDCM) degrees are awarded.

Even though the M.D. is a first professional degree and not a doctorate of research (i.e. Ph.D.), many holders of the M.D. degree conduct clinical and basic scientific research and publish in peer-reviewed journals during training and after graduation. Medical Scientist Training Programs (MSTPs) are offered at many universities which are a combined medical degree and Ph.D.. Some MDs choose a research career and receive funding from the NIH as well as other sources such as the Howard Hughes Medical Institute. A few even go on to become Nobel Laureates.[12]

Ireland and some Commonwealth countries

In Ireland (and many Commonwealth countries) the MD is a postgraduate research degree in medicine. At some universities, this takes the form of a first doctorate, analogous to the PhD, awarded upon submission of a thesis and a successful viva. The thesis may consist of new research undertaken on a full- or part-time basis, with much less supervision (in the UK) than for a PhD, or a portfolio of previously-published work.[13]

In order to be eligible to apply for an MD degree from a UK or Commonwealth University one must hold either an MBBS, MBChB, or an equivalent US-MD degree and must usually have at least 5-years of postgraduate experience.

At some other universities (especially older institutions such as Oxford and Cambridge) the MD is a higher doctorate (similar to a DSc) awarded upon submission of a portfolio of published work representing a substantial contribution to medical research.[2]

In the case where the MD is awarded (either as a first or higher doctorate) for previously-published research, the candidate is usually required to be either a graduate or a full-time member of staff, of several years' standing of the university in question.[14]

The University of Buckingham,[15] the only private university in Great Britain, has announced an Indian-style two year full-time taught course for a "Clinical MD" in internal medicine. This is designed for non-European Union graduates, who are no longer to be allowed to take accredited training posts in UK hospitals. This degree will be awarded first in 2010. The entry-level first professional degree in these countries for the practice of medicine is that of Bachelor of Medicine and Bachelor of Surgery (MBBS, MB, MB BCh BAO, BMBS, MBBChir, or MBChB). This degree typically requires between four and six years of study and clinical training, and is equivalent to the North American MD degree.

The University of Melbourne[16] in Australia has announced plans to introduce the Doctor of Medicine (MD) in 2011 as their first professional degree in medicine for graduates of the Bachelor of Biomedicine or a Bachelor of Science degree. The university will become the first in Australia to leave the Bachelor of Medicine and Bachelor of Surgery (MBBS) and offer the MD as a first professional degree in medicine rather than as a research degree.

Argentina

In Argentina the First Degree of Physician or Medic Title (Título de Médico)[17] are equivalent to the North American M. D. Degree with 6 year of intensive studies followed by usually three or four years of the residency as a major specialty in a particular empiric field, compounded of internships, social services and sporadic research. Only by holding a Medical Title and having achieved the residency stage the postgraduate student might apply for the Doctor degree through a Doctorate in Medicine program approved by the National Commission for University Evaluation and Accreditation[18].

China

In the 1980s, China's higher education achieved considerable progress. By the end of 1992,China had 1,075 full time institutions of higher learning with 881,000 graduated. So far, there are 1,700 research institutions of natural sciences run by universities, 220 research institutes and 540 research centers of social sciences, 400 key disciplines and 99 national laboratories. Up to 2005, there were 150 medical schools in China.

China's universities fall under either the jurisdiction of the Ministry of Education, over ministries of the Central government, provinces, autonomous regions, municipalities or certain major cities. Universities and independent institutes are all institutions of higher learning on the same footing.

In China, a strict entrance examination system has been introduced with a view to ensuring the quality of new entrants to universities. More information from (doctorhelps)[19]

The academic year of full time universities is separated into two-three semesters.The first semesters begins in September and the second in February. Each semester has about 20 weeks and each week has five school days. Universities operate normally on other anniversaries and traditional fetes.

India

In India, the MBBS degree represents the level of training required to be licensed as a physicians, and the MD degree is a higher postgraduate degree, representative of specialty training. The equivalent training in the US or Canada would be residency training carried out after the completion of a medical degree, and approved internship. Eligibility for the MD course is restricted to medical graduates holding the MBBS degree (which has a duration of five and a half years), and training is obtained in medical disciplines which are non-surgical in nature (e.g.: Internal Medicine, Radiology, Pathology, etc). After three years of study and the successful completion of an examination which includes both theoretical and practical elements, in a pre-clinical or clinical subject of a non-surgical nature, the candidate receives an MD degree.

The research element is not extremely prominent here, as this is primarily a clinical qualification resembling the professional doctorates of the USA. In general surgery, orthopaedics and gynaecology the equivalent degree is Master of Surgery (MS).

A third qualification, termed DNB (Diplomate of National Board), is considered equivalent to the MD and MS degrees. This can be obtained by passing the exam conducted by the National Board of Examinations after completing 3 years of post-MBBS residency training in teaching hospitals recognised by the board.

After obtaining the first postgraduate degree, that is MD/MS/DNB, one can go for further specialisation in medical or surgical fields. This requires three years of hard training and study and then passing an examination, both theory and practical, and the degree awarded is DM (Doctor of Medicine), like DM in Cardiology, Neurology, Nephrology, Gastroenterology, etc. For surgical subspecialities the degree awarded is MCh (Master of Chirurgiae), like MCh in Cardiac Surgery, Neurosurgery, etc. A third qualification in subspecialities is DNB (superspecialties), offered by National Board of Examinations, like DNB in Cardiology, Neurology, Cardiac Surgery, Neurosurgery, etc.

The DM and MCh degrees or DNB in super-specialties are equivalent to the Fellowship training in the US and are considered "postdoctoral" degrees in India, similar to the PhD.

Pakistan

In Pakistan equivalent degree is MBBS (bachelors of medicine and bachelors of surgery). MBBS is awarded as the basic medical qualification after completing five years of study. This comprises two years of basic science subjects which include anatomy, physiology, and biochemistry, with a particular emphasis on human anatomy. Subsequently, there are three years of clinical internship and courses on medicine surgery and pharmacology. Finally, the student is required to work for one year under a professor, before one is awarded Degree of MBBS with license to practice. For specialization, one has to pass Fellow of College of Physicians & Surgeons Pakistan (FCPS) exam-1 in field in of specialization and obtain an internship in the field for 3–6 years. Next, one can take the FCPS exam part 2, which includes intensive practical exams. Upon successful completion a fellow of the relevant specialty is awarded. Tough entry tests are passed successfully before entering in to a medical college. Medical colleges and foreign medical qualifications are supervised by the Pakistan Medical and Dental Council (PMDC). Specialized degrees are awarded by the Pakistan College of Physicians and Surgeons.

Russia

(And all former Soviet Countries at present)
After completing 12 years of "school" (there is no differentiation between grammar, Jr. and Sr. high school), one takes medical entrance exams. Upon obtaining a sufficient score, one may be admitted to a six year program leading to the degree Общиее врач (generic physician). There are two institutions, one in St. Petersburg and one elsewhere, which graduate pediatricians. These graduates receive the same medical degree, but take extra (otherwise elective) credits specifically for pediatric medicine. After receiving a degree, the candidate may elect to continue for a specialization in surgery or other medical specialty, as elsewhere.

Equivalent degrees in other countries

  • In Italy, the title of "Dottore in Medicina e Chirurgia" (literally "Doctor in Medicine and Surgery") is awarded on graduation; physicians then simply use the title "Dott." or "Dr." before their name.
  • In Germany physicians can obtain the degree "Dr. med., Doktor der Medizin" which is a higher academic research degree.
  • The Czech and Slovak title doktor medicíny, or MUDr. (Medicinae Universae doctor).
  • In Poland the title of lekarz (medic) or "lek." (previously lekarz medycyny or "lek. med."). In contrast, a higher doctoral academic research degree in medicine resembling a PhD is named "dr n. med." or doktor nauk medycznych,
  • In Mexico, schools of medicine award the "Titulo de Medico Cirujano" degree after completing either 6 or 7 years of study. This curriculum includes a rotating internship year and a year of social service providing care to an underserved community.
  • In Nepal, an MBBS degree is awarded.
  • In Iran the professional degree in Medicine or MD is awarded upon completion of seven years continuous study started with 5.5 years university education include 2.5 years basic sciences,1 year physiopathology and 2 years clinical courses followed by one & half year of internship in accredited hospitals plus thesis.
  • In China and Hong Kong, some medical schools award MBBS to foreign students while all medical schools award Bachelor of Medicine to nationals. MD is a higher academic research degree.
  • In Colombia, the medicine faculties of the universities awards the title of "Medico Cirujano" after taking 10 and a half years at least of studies on sciences, genetics, clinical studies, general surgery and an internship in hospitals, plus a thesis and another internship on the coutryside hospitals. Some specialities are taken by physicians after receiving their degrees to award an specialist title, i.e. "Medico Cirujano Especialista en Anestesiologia".

Other postgraduate clinical degrees

There is also a similar advanced professional degree to the postgraduate MD: the Master of Surgery (usually ChM or MS, but MCh in Ireland, Wales and at Oxford and MChir at Cambridge).

In Ireland, where the basic medical qualification includes a degree in obstetrics, there is a similar higher degree of Master of the Art of Obstetrics (MAO).

In East Africa, the medical schools in Kenya, Tanzania and Uganda award the degree of Master of Medicine (MMed) degree in both surgical and medical specialty disciplines following a three year period of instruction.

In West Africa, the West African College of Physicians and the West African College of Surgeons award the Fellowship of the West African College of Physicians (FWACP) and the Fellowship of the West African College of Surgeons (FWACS) in medical and surgical disciplines respectively after a minimum of four year residency training period.

References

  1. In 1949, Fildes' painting The Doctor was used by the American Medical Association in a campaign against a proposal for nationalized medical care put forth by President Harry S. Truman. The image was used in posters and brochures along with the slogan, "Keep Politics Out of this Picture" implying that involvement of the government in medical care would negatively affect the quality of care. 65,000 posters of The Doctor were displayed, which helped to raise public skepticism for the nationalized health care campaign.|http://correspondents.theatlantic.com/abraham_verghese/2009/06/the_ama_conflicted_in_its_interests.ph>
  2. 2.0 2.1 CF Hawkins, "Write the MD Thesis" in "How To Do It" London: British Medical Association 2nd ed. 1985 ISBN 0-7279-0186-9
  3. Sir John Bagot Glubb (cf. Dr. A. Zahoor (1999), Quotations on Islamic Civilization)
  4. Alatas, Syed Farid (2006), [Expression error: Missing operand for > "From Jami`ah to University: Multiculturalism and Christian–Muslim Dialogue"], Current Sociology 54 (1): 112–32, doi:10.1177/0011392106058837 
  5. Imamuddin, S. M. (1981), [Expression error: Missing operand for > Muslim Spain 711-1492 A.D.], Brill Publishers, p. 169, ISBN 9004061312 
  6. Douglas Guthrie, A History of Medicine. London: Thomas Nelson 1945, p. 107
  7. L Thorndike, History of Magic and Experimental Science. New York 1934 - 41, Vol. 2 of 6
  8. Columbia.edu
  9. Physician Education, Licensure, and Certification. American Medical Association.
  10. Registering with the NRMP. National Residency Matching Program. Accessed 15 March 2008.
  11. Whorton, James. Counterculture Healing: A Brief History of Alternative Medicine in America. 4 November 2003. WGBH Educational Foundation. accessed 25 December 2007.
  12. ED.gov
  13. See, for example, Otago.ac.nz
  14. See, for example, UQ.edu.au
  15. Buckingham.ac.uk
  16. UniMelb.edu.au
  17. Coneau.edu.ar Comisión Nacional de Evaluación y Acreditación Universitaria.
  18. National Commission for University Evaluation and Accreditation
  19. [ http://doctorhelp.weebly.com/1/post/2010/03/chinas-higher-education.html]Master medicine from china .
  20. Dennis L. Kasper, Eugene Braunwald, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Kurt J. Isselbacher, Eds. Chapter 10. Complementary and Alternative Medicine Harrison's Principles of Internal Medicine, 16th Edition. 2005. McGraw Hill.

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bg:Доктор по медицина cs:MUDr. da:MD (læge) de:Doktor der Medizin (Berufsdoktorat) eo:MUDr. fa:دکتری پزشکی fr:Doctorat en médecine mk:Доктор по медицина nl:Doctor of Medicine ja:博士 (医学) si:වෛද්‍ය ආචාර්ය sk:Doktor všeobecného lekárstva simple:Docter sv:Medicine doktor th:แพทยศาสตรบัณฑิต zh:医学博士 ar:M.D

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