Becoming a doctor is a lifelong dream for many people. This dream fades for many once they see the requirements necessary to become a licensed doctor of any kind. The road to becoming a doctor is one that requires a large commitment of time, energy, and effort, not to mention the costs. Being a medical student is akin to having a full-time job. This is due to the many academic steps a student must go through while increasing their responsibilities. Once someone becomes a medical student, they must be aware of their responsibilities and requirements as one. If a student violates a requirement or fails to uphold a specific responsibility, then he or she can put their academic and future career in jeopardy.
There are several reasons why a student can perform poorly in one area of medical study when compared to another. The following is a discussion regarding the requirements to become a doctor, how a student may face difficulties, and what he or she can do to overcome their issues. If you are a medical student and are facing the potential of academic or criminal sanction, then it is important to speak to an experienced attorney as soon as possible.
Who Is the ACGME?
ACGME is short for Accreditation Council for Graduate Medical Education. The ACGME is a private, non-profit organization that sets the requirements and responsibilities of medical students and lays out their roadmap to becoming a doctor. The ACGME also determines which institutions meet the requirements necessary for accreditation. The overall purpose and goal of the ACGME are to ensure the delivery of safe and high-quality medical care across the country.
The educational and programming standards for medical schools and students are described in the ACGME Common Program Requirements. There are separate program requirements for the following programs:
- Residency Common Program Requirements
- Fellowship Common Program Requirements
- One-Year Fellowship Common Program Requirements
- Post-Doctoral Education Common Program Requirements
The information found within these guidelines describes the required oversight, personnel, resident appointments, educational programs, evaluation, and the learning and working environments of various medical programs. If a program fails to adhere to these requirements, then the program can lose its accreditation for medical education.
General Requirements to Become a Doctor
The first step of becoming a doctor is getting into medical school. A student must first complete a bachelor's degree before being accepted to medical school. While there are no specific requirements on the type of degree the student must complete, it is common for students to select programs that are focused on chemistry and biology. These types of programs are chosen because they help the student prepare for the Medical College Admission Test (MCAT).
The MCAT is the exam that is required for entry into medical school. It is a five-hour exam that tests a student's knowledge in the areas of biology, physical science, verbal skills, and critical thinking. The score that the student gets on the MCAT is a major part of a student's admission into medical school, and a top score can also lead to admission into a top program.
Once a student is accepted into medical school, he or she will then have to complete a minimum of a four-year medical training and educational program. The first two years of medical school are dedicated to book study and laboratory work. A medical student in their second year is required to take the first portion of the United States Medical Licensing Exam. This portion of the exam is known as Step 1. Step 1 is a pass/fail examination. The second two years of medical school are clinical in nature. Students will work under licensed doctors and complete rotations at medical facilities. Students must complete the second portion of the United States Medical Licensing Exam in their fourth year of study. This portion of the exam is known as Step 2.
Once a student completes school, they must complete an internship period known as residency. A doctor completes his or her residency within 3-7 years, depending on the type of specialization chosen. The final United States Medical Licensing Exam is administered in the first year of residency. A doctor can then pursue a fellowship as a narrower specialty of their residency concentration. Once these requirements are completed, an individual can then apply for a state license authorizing the practice of medicine. Doctors must also complete continuing education as required to maintain their medical licenses. In total, it takes between 11-14 years to become a doctor in the United States. The different segments of medical school and potential student difficulties are discussed in detail below.
What Is the Didactic Portion of Medical School?
The didactic portion of a medical education largely focuses on information conveyed in lectures and books. Didactics in medical school also traditionally includes case discussions, simulations, and grand rounds. This is the more study-oriented part of medical school, where a student does not spend time with patients or doing lab exercises. This instructive period of medical school is where medical students get their base knowledge before they move to working with live patients or in a laboratory. This period is at the beginning of medical school and ends once the student starts clinical work in the third year of study.
The approach to the curriculum of each medical school can vary, where some offer a traditional curriculum while others offer a systems-based curriculum. In a traditional curriculum, students are first taught what the normal functions are across all bodily systems. Once students have this knowledge base, they are then taught about what can go wrong within these systems and finally how to treat someone with an issue. If a medical school offers a systems-based curriculum, then the student will be taught specific organ systems one at a time, which includes both the potential problems within the systems and the treatment options for these problems. The areas covered within both curriculums include pulmonary, gastrointestinal, and cardiovascular systems, among others.
What Are Potential Difficulties Students Can Face?
The first year of medical school represents the biggest transition that a student has to make from being a college student. The volume of material that will be thrown at the new medical student can be overwhelming and lead to significant stress. Once a student weathers this initial storm, he or she typically also learns that the first year of study also allows the most free time when compared to future years in medical school that are spent doing more hands-on work. This is the time when a student must develop his or her best approach towards studying, learning, and, most importantly, retaining the information covered. Students often explore study groups, but some can find that studying with others can be more distracting than productive.
The students who enjoy book study and less social interaction often do well in the didactic portion of medical school. Students who are more social and prefer hands-on learning may find the didactic portion uninteresting, which can lead to difficulty in retaining information. If a student is unable to focus in class for extended periods, then that student has an increased risk of performing poorly during the didactic phase. This period of medical school is the most self-driven, as lecture schedules are generally given to the students to follow.
Good study habits are critical, and it is on the student to make sure he or she is following along with the pace of instruction. If a student does not regularly attend lecture sessions, then he or she can face potential sanctions. In many cases, a student will be given the opportunity to catch up and remedy their issues. Sometimes, a student can fall too far behind and be in jeopardy of being removed from the class and the medical school altogether. If you are facing the potential of school sanction, then it can be helpful to speak to an experienced attorney who can advise you.
Medical School Didactics in the COVID-19 Era
The COVID-19 pandemic has led to many changes in our collective lives across the globe and across all types of activities. Schools have been affected at every level, from early schooling all the way through to college and professional-level education. In medical schools across the country, a shift towards remote learning has taken place. Many exercises in didactic education are being conducted remotely with the use of Zoom and other connectivity tools. These changes have not been without hiccups, as both educators and students have had to adapt to these new measures to continue their work. It is the responsibility of educators and the school to ensure that any remote learning is appropriately and effectively conducted, so the students are not at a learning disadvantage by attending remotely.
What Are the Academic Requirements of Medical School?
The academic requirements to be admitted to medical school are among the most difficult of any post-graduate educational program. It is expected that you graduate near the top of your class and score competitively on the MCAT if you want to attend medical school and eventually become a licensed physician. Once you get into medical school, your requirements to maintain a specific level of academic excellence continues. This can include maintaining a specific grade point average or simply passing the classes that you take if they are pass/fail.
Medical schools will either grade a student or award a pass/fail for a course or clinical to ensure that the student is progressing academically as expected. If a student is not achieving satisfactory grades, then the student can be placed on academic probation. When a student is placed on academic probation, he or she faces the possibility of failing out of school if grades don't improve. A clock will also start, and if the student is not able to be removed from academic probation within a specific period, then he or she can face dismissal. This can take place during any point of medical school, regardless of whether it is the didactic or clinical periods of education. If you are facing the potential of dismissal due to academic issues, then it can be helpful to speak to an experienced attorney who can help you understand your options.
It is also critical that a medical student stays clear of issues related to academic misconduct. Medical school can be a competitive environment, and that can lead some to try to get ahead in improper ways. Medical schools will require students to adopt and follow an honor code, which demands that students work and live honestly, advance on their own individual merit, and show respect for others that they come into contact with within any program. If a student violates the honor code of his or her medical school, then several sanctions are possible, including dismissal if the violation is serious enough.
Academic misconduct is some form of dishonest activity that equates to some form of cheating. This can include collaborating with others without permission, copying another's work, or falsifying a document for personal gain. Any action by a student that undermines the academic integrity of the school can be considered academic misconduct. If a student is found responsible for academic misconduct, then the student can face severe punishment. Academic misconduct becomes part of your permanent record and can be reported to employers and other schools. Examples of academic misconduct include:
Punishments for academic misconduct can vary and largely depend on the facts and circumstances of the case. Lesser violations will generally result in less severe punishments. If alleged misconduct is also the basis for criminal charges, then the punishments can be more severe.
What Are the Potential Difficulties Students Can Face?
The stresses of medical school can carry a heavy burden on its students and cause several potential difficulties. Medical students are often overworked, which can lead to unhealthy habits, which can include overeating, eating unhealthy food, and not getting the proper rest. These unhealthy habits can also cause other issues such as depression, fatigue, and a loss of confidence. The stress associated with medical school can also lead some students towards alcohol and substance abuse.
Risk Factors for Substance Abuse
Medical students face many stressors that can increase their risk for substance abuse. There are several reasons why medical students can be at an elevated risk for substance abuse. Some of the most common reasons for medical students include:
- Just being a medical student: this singularly carries a level of stress. Medical students commonly face pressures to succeed from family, friends, peers, and themselves. These pressures can lead to unhealthy habits of inadequate sleep and poor eating, which can open the door for substances to help manage.
- Stress from patient interaction: while most students love the feeling of being able to help someone, as doctors, they must also deal with the emotional effects of dealing with patients who they cannot save. This stress can open the door to turning to substances to cope.
- Failure to report: medical students are commonly reluctant to admit that they have problems with substance abuse. Students are also reluctant to report a fellow student who appears to have problems with substance abuse. Unreported, these issues can become worse over time.
Whenever there is a heightened level of stress or distress for someone over a period, the potential for substance abuse generally increases. It is important to recognize these risk factors to help medical students avoid having problems with substance abuse. It is also important to understand how the side effects of any prescribed or illicit substances can affect your schoolwork and academic performance.
What Is the Clinical Portion of Medical School?
The clinical portion of medical school is the hands-on part of the training process to become a doctor. In most cases, the clinical period of medical school takes place once two years have passed. In others, medical schools may administer the clinical portion earlier in the student's career. Some schools do this in an attempt to help the student get familiar with the practice of medicine sooner to help lead to earlier success. Clinical experience is paramount to a student's development into becoming a licensed doctor. Some of the types of clinicals that a medical student will have to complete include rotations involving:
- Internal medicine
- Emergency medicine
- Family medicine
Medical students completing the clinical portion of their education will learn how different medical facilities operate from the doctor's perspective. Students will interact with staff, patients, and other students on clinical rotations. When a medical student is doing a clinical rotation, there are several tasks that the student will perform, including:
- Seeing patients
- Taking notes about patients
- Assisting in surgeries in the operating room
- Helping suture a patient
- Observation of doctors and residents
There is still some study as students who complete clinical rotations must pass exams regarding each rotation. Typically, these clinical rotations take place during the third year of medical school. Once these are completed, then the student goes onto the final year of medical school, where the remaining rotations are electives.
The main focuses of fourth-year medical school are preparing a residency application and completing sub-internships. Sub-internships are rotations that the medical student performs at other institutions. These rotations are viewed as long-term interviews for the student who is hoping to be accepted into a residency program. Any medical student hoping to be accepted into a residency at their sub-internship should expect to be fully committed to helping the residents and making their jobs easier. This is the time when a medical student can make a good impression with the people that he or she hopes to work with in the near future. If the student does well during his or her sub-internship, then it can lead to a long-term residency for the student.
What Are the Potential Difficulties Students Can Face During the Clinical Phase of Medical School?
Medical students who start their clinical program will experience a major change in their focus in school. The focus of study turns away from lectures and books, and the medical student starts to learn on the job during clinical rotations. This transition can be difficult for some students as they will experience an entirely different side of medical school. The clinical portion of medical school is where a medical student can sharpen their interpersonal skills and learn how to best help patients in need.
Being pushed into the action can be exciting for many medical students, but it can also be intimidating and can incur heavy emotional costs for some. A hospital or clinic has patients suffering from a variety of medical issues, some of which cannot be cured by modern medicine. This sort of harsh reality is one that medical students expect but also may not be emotionally prepared for. This can lead to a variety of personal and emotional issues that were previously nonexistent.
It is important for a medical student to seek help when necessary. Many students may choose to internalize their issues as they either think they can handle these issues on their own or don't want to seek help because they are worried about potential consequences. Small difficulties can quickly turn into bigger difficulties that can affect a student's ability to focus, learn, and be successful.
Residency Applications and Interviews
Once a student is ready to submit his or her residency application, it is done so online through the Electronic Residency Application Service (ERAS). Residency applications are accepted starting in mid-September on ERAS. A residency application is expected to include:
- A personal statement
- Letters of recommendation
- Work information
- Activities information
A residency application is similar to the medical school application filed with the American Medical College Application Service (AMCAS) to get into medical school. Once applications are accepted, then residency interviews will take place. These interviews can take place anytime between October and February and are based on specialty. After residency interviews are completed, both the medical student and residency programs submit their Rank Order List (ROL) to the National Resident Matching Program (NRMP). A ROL is a list of preferred choices in decreasing preference.
If a medical student is submitting a ROL, then it is a list of residency programs that he or she would like to attend in order of preference. If a residency program is submitting a ROL, then it is a list of applicants that the program would like to recruit in order of preference. The NRMP uses a matching algorithm that matches the prospective residents to the programs that also chose them. Once the students match with the available programs that want them, they are informed on Match Day. This is the day when the student and residency matches are revealed. This is an important day as students learn where they will be working for the next 3-7 years, depending on specialty.
The residency match system is based on an algorithm whose creators actually won a Nobel Prize for its usefulness in economics. It was designed to alleviate the previous issues of residency programs and their inability to efficiently fill spots in their programs. In the past, students would delay their acceptance of offers as they tried to get more desirable offers. Residency programs countered this by making offers that had to be decided upon within 24-48 hours. As neither of these systems worked well, the match system was adopted, and the first match day took place in 1952.
Not all students match with a residency. Those who do not match with a residency then participate in the Supplemental Offer and Acceptance Program (SOAP). During SOAP, candidates that did not match are connected with residency programs who have unfilled positions. It is common for these applicants to accept a one-year residency in a program that will accept them, allowing the applicant to reapply during the next residency application cycle.
ROL Myths and Inaccuracies
The residency interview process is both competitive and stressful. There are only so many residency spots available at each institution, so it should come as no surprise that students often try to game the match system so they can give themselves a higher chance of getting matched with the residency program of their dreams. The following is a list of Rank Order List myths and inaccuracies common among medical students looking to gain an advantage on match day.
- Rank Every Residency Program Where You Interview
The interview process is one that allows residency programs to get to know their potential residents and one that allows potential residents the chance to learn more about the programs being offered. While this shotgun approach may lead to getting a match, it also can lead to the resident going somewhere he or she didn't really want to go or into a program that doesn't truly interest them. It is better to go unmatched for a year than to go somewhere where you won't be happy.
- The Matching Algorithm Prioritizes Residency Programs Over Students
This used to be true. The matching algorithm did favor the rank lists of residency programs over applicants in its calculation up until 1995. Since 1995, the matching algorithm has been applicant-proposing and proposes matches based on the Rank Order Lists of applicants, not residency programs. This has led to students being matched with the highest-ranked programs possible.
- Make Last Minute Changes to Your Rank Order List
Your Rank Order List should be well thought out and completed in advance of the date it's due. It is important to prioritize your happiness and satisfaction at a residency program over making sure that you get a match. Any decision you make on your Rank Order List should be made after all important personal factors are considered. Making a last-minute change can lead to an unfavorable match.
- Rank Residency Programs Based on How You Think They Ranked You
One of the biggest myths in the residency interview process is that students should order their Rank Order Lists based on how they think residency programs ranked them. Don't sell yourself short by thinking from the residency program's perspective. This can lead to an unfavorable match where you could have matched with a more desirable program. There are times when this approach can be successful when applying for more specific specialties with fewer applicants. It is important to have professional guidance when making and submitting your Rank Order List.
Common Reasons Why Medical Students Don't Graduate
There are many reasons why a medical student might not graduate and fully realize their goal of becoming a doctor. Situations and preferences can change over time, making it impossible for the student to finish. The following are the most common reasons why a medical student may not make it all the way through medical school.
- Changes in Life Conditions
Medical school is a lengthy and substantial commitment. An individual can spend up to ten years in medical school before becoming a licensed doctor. During this period, it is normal for an individual's life and conditions to change. This requires the student to make adjustments as life continues to come their way. Common changes include a change in financial conditions, the death or illness of a loved one, and even falling in love with someone else. All of these situations are real and won't go away simply because you are in medical school. For some medical students, these changes overwhelm them and prevent them from completing medical school.
- Unaffordable Tuition
At the beginning of medical school, students are not immediately facing the effects of the financial commitment required to complete law school. As time goes on, the costs can increase, which can lead to an untenable financial situation. Tuition and expense only increase over time, which can cause medical students to seek part-time work to help pay the bills. This can lead to the student overextending themselves and causing more harm than good to their medical aspirations. Financial difficulties can lead to increased stress, which can lead to an inability to focus and maintain their progress as a student.
- Lack of Academic Capacity
One of the main reasons why the Medical College Admission Test (MCAT) is so heavily weighted in determining who is accepted into medical school is that it tends to weed out the students who don't have the capacity to be successful in medical school. It should be difficult to become a doctor; you will have a direct effect on other people's health and lives once you are licensed. It is critical that only the most committed and prepared students are offered the opportunity to become a doctor. Some students realize after they get to medical school that they do not have the academic capacity to finish. This isn't a knock on their abilities, but a realization that the student simply cannot keep up for various personal reasons.
- Excessive Absence
Medical students are given a lot of freedom when it comes to determining their schedules and how they approach their classes. The more a medical student misses classes, the more that he or she can fall behind. It is difficult enough to maintain the necessary academic progress in medical school without having to also play catch up because of excessive absences. Some students may take a scheduled leave of absence from school. When this happens, students must return by a specific date, or they can be removed from their programs. In some instances, medical students decide that they do not want to go back to school and choose to continue in another direction.
- False Perception of the Medical Profession
There are several reasons why people want to become doctors. Many of these reasons can lead to a false perception of what it truly is to become a doctor. Television and movies can glamorize certain aspects of the practice of medicine to the point where the profession becomes a sort of fantasy. Some think becoming a doctor is the most guaranteed ticket towards a large salary. While doctors can and do make a good living, simply choosing to go to medical school for the money can leave someone very unfulfilled in their decision. In order to become a doctor, you must be committed to the work and purpose of becoming one. False perceptions can lead to early exits from medical school.
- Lack of Academic Discipline
Most medical students have always been at or near the top of their class. School has often come easy for these students, as they have always outshined their classmates growing up. Medical school is a great equalizer for many. Bad habits from high school and college can lead to a lack of academic discipline. You have to put the time and effort in to be successful. When a student fails to do so, then he or she faces an increased risk of not completing medical school.
A medical student can also be dismissed or remove themselves from school due to various forms of misconduct or personal issues. Unfortunately, some medical students turn to drugs and alcohol as a coping mechanism to deal with the stresses of school. Others may have run-ins with the law and can face legal issues that prevent them from completing their programs. Life comes with many potential pitfalls and roadblocks along the way. It is important for a medical student to maintain appropriate behavior or seek help if he or she needs it.
What If Your Medical School Difficulties are Due to a Disability?
Medical students can face difficulties in medical school for several reasons. In many cases, the difficulties are either self-inflicted due to a lack of effort or because of an inability to understand certain points or issues. In other cases, a medical student's disability may be a partial or complete reason why the student is not performing well in class or during clinical rotations. If a medical student suffers from a disability, then he or she is afforded protection under the Americans with Disabilities Act.
The Americans With Disabilities Act (ADA) Explained
The Americans with Disabilities Act (ADA) is a civil rights law passed by United States Congress that outlaws discrimination based on disability. The ADA went into effect in 1990 and was passed to ensure that people with disabilities are given the same rights and opportunities as those without disabilities. The ADA forbids discrimination against “qualified individuals with disabilities” in both the employment and educational sectors. The ADA is broken into five sections:
- Public Services: State and Local Government
- Public Accommodations and Services Operated by Private Companies
Education is under the governance of the ADA. If a medical school is not ADA compliant, the school can face sanctions from the federal government and potential civil suit from an individual facing discrimination due to a disability. Once a medical school is made aware of a disability, the ADA requires that the school makes all reasonable accommodations to allow the disabled individual to fully participate in all medical school activities. This includes both the didactic and clinical portions of a medical school curriculum.
How the Americans with Disabilities Act Relates to Medical School
The Americans with Disabilities Act can relate to medical school when a medical student is at a disadvantage or is being treated unfairly due to his or her disability. If someone is diagnosed with a mental or physical disability, then this diagnosis can be a basis for treatment pursuant to the ADA. If a medical student takes a specific medication for their physical or mental disability, then they can be protected under the ADA. If a medical student is protected by the ADA, then his or her medical school is required to make reasonable accommodations to allow full participation of the student in all school activities.
The Accommodations Required Under the ADA
Under the ADA, medical schools must make reasonable accommodations to ensure that educational opportunities, extracurricular activities, and all school facilities are available and accessible for all students. “Reasonable accommodations” under the ADA include things such as:
- Adjustment of class schedule
- Additional time allowed for exams
- Particular computer equipment
The ADA also requires that the buildings and grounds of a medical school must also be in compliance with specific standards. Some of these standards required by the ADA include:
- Installing ADA compliant access ramps
- Installing grab bars in bathrooms
- Installing elevators
- Making door openings and buildings wheelchair friendly
The ADA gives those with a disability legal recourse if they face discrimination due to their disability. The ADA is viewed as a continuation of the civil rights act in an effort to make it illegal to discriminate against someone for almost any reason. If you have faced discrimination due to your disability, then it is important to speak to an experienced attorney.
What to Do if Your Medical School is Not Complying With the ADA
Any medical student that has a disability under the definition of the ADA is eligible to receive accommodations. An individual with a history of academic success is not precluded from being considered disabled under the definition of the ADA. It is important to view a disability as an obstacle and not a limitation on ability as all medical students are high achievers, while some are disabled. If your medical school is not properly complying with the provisions of the ADA, then you can either file charges with the federal government or directly in court. If your school is found to have violated the ADA, then the school can be required to pay money damages to the person discriminated against. The school can also be forced to make accommodations and even change policies.
An Example of an ADA-Related Lawsuit
Students are often denied when they request more time to study for a test, and it can turn into a lawsuit based on a violation of the ADA. In Dean v. University at Buffalo School of Medical & Biomedical Sciences 804 F.3d 178 (2d Cir. 2015), a medical student had been diagnosed with depression and was currently being treated requested more time to study for his Step 1 of the United States Medical Licensing Exam. His depression diagnosis led the student to request additional time for his medication to regulate and become normal in his body before he could start studying for the exam. His school rejected the request, which resulted in the student filing an ADA lawsuit in federal court. The federal Second Circuit Court of Appeals ruled that his case could continue to trial as the school did not demonstrate how this requested accommodation would impose an undue financial or administrative burden on the school. In this case, prescribed medication and the underlying diagnosis were the basis for an ADA-related lawsuit to ensure discrimination does not take place.
When Would a Medical Student Need an Attorney's Help?
If a medical student is facing sanction or potential dismissal from a medical school, then he or she could likely benefit from the help of an experienced attorney. Medical school spots are extremely limited and are given to the most qualified among a competitive group of applicants. Dismissal from a medical program can be critically harmful to a medical student, as it can prevent him or her from being accepted into another program at another school. It is important to understand that if there is an issue with a medical student, then he or she faces the potential of losing everything. If the student is sanctioned or removed from school, then all of the time, money, and effort he or she spent towards school will be for naught as they will end up with nothing for their efforts.
How Can an Attorney Help?
The role of an attorney in many cases is to be a problem solver and advisor. While an attorney cannot do your schoolwork for you, he or she can help you devise a plan and approach so you can be successful in your medical school. An attorney can help you read and understand your medical school's policies and regulations, so you are sure of whatever steps you take and the choices you make going forward.
If you are facing an allegation of academic misconduct, then an attorney can help represent you through any misconduct hearings or proceedings. All schools operate with a published guide that details the processes of a respective school whenever there are allegations of academic misconduct. While many schools have a similar academic misconduct process, each has its own rules and regulations, so it is important to be aware of what you could be facing.
If your academic issues are due to a reason that is out of your control, then you may have a legal remedy. If you are having difficulties in school due to a disability and your school is not taking the appropriate measures to assist you, then a lawsuit based on a violation of the ADA might be necessary. If your academic issues are due to the actions or conduct of another student, then it is important to understand what actions you can take to prevent this student from negatively affecting you any further. An attorney can help you with any or all of these things, depending on the attorney's level of experience. If you have questions, then call us at the Lento Law Firm today!
Why Hiring Lento Law is the Right Choice
If you are a medical student who has legal questions regarding an issue that can affect your academics, then it is important to seek the advice of an experienced attorney. Attorney Joseph D. Lento has helped students across the country with various legal issues. Call the Lento Law Firm today at 888-535-3686 to learn why hiring Lento Law is the right choice to help you with your case.