no sense
To work all those years with no compensation,
And wondering when you will bring home the bacon.
The days are so long and rewards long in coming,
The work is quite hard and the hours are numbing.
The MD degree is just too hard to reach,
I think I'll just go be a bum on the beach.
Now I can imagine that most people don't give two hoots and a holler about the education of a surgeon, but I want to spend a little time on this subject so you know what the surgeon has gone through for the privilege of taking out your gall bladder, repairing your heart or removing your cancer. I have mentioned that the first doctors or “medicine men” were more connected with the “spiritual,” using chants, incantations and “witchcraft,” with folklore passing down from one individual to the next, such as the art of repairing fractures and treating wounds.
The education of the healer was through observation and a type of apprenticeship that lasted for centuries, up until the development of great schools of learning. The first of these appeared in Salerno, Italy in the early 1200's, with the support of Holy Roman Emperor Frederick II. At the Salerno school, the physicians were taught how to fix hernias and fractures and perform amputations. For the most part, they were taught diagnosis for diseases they could do little about. They often prescribed rest, bathing or diet, or gave emetics (drugs to make people vomit), and frequently “bled” patients to remove evil humors. Their knowledge of narcotics allowed them to give opium for pain relief, along with near toxic doses of alcohol.
In the Middle Ages, great hospitals were established throughout Europe, usually affiliated with religious institutions, such as abbeys, convents and monasteries. Most of the physicians were religious personnel, since they usually represented the major portion of the educated populace who could read during that period. Books were all hand written, making them rare and expensive, and information about medicine and surgery, if not passed down from person to person, could only be read by those who understood Latin (in which most books were written). The literate few during this period were the monks and other ecclesiastics, and healing was a combination of physical and spiritual modalities. Throughout this period, childbirth and what we know as obstetrics today was practiced only by the midwives.
With the invention of the printing press and moveable type by Johannes Gutenberg and the first printing of the Bible in 1455, books became more available. The first fortyfive years saw a tremendous upsurge in the writing and printing of books, called incunabulae (the first of anything is called an incunable), and these books often were printed to look like hand written manuscripts. With the massive increase in relatively cheap books, the populace became more literate, while the universities and medical schools grew rapidly and were inviting, not just to the clergy, but to the many upper class individuals who, prior to this time had, for the most part, been unable to read. Great medical schools arose in Europe with major centers in Pisa, Leiden, Oxford, London and Edinburgh, to name a few. By the seventeenth and eighteenth centuries, regular curriculae for anatomy, physiology, pathology, and pharmacology (the study of drugs) were established, and the remaining specialties found their way into the medical schools over the subsequent two centuries.
In the United States a sentinel occurrence was the Flexner report in 1910, supported by the Carnegie Foundation for the advancement of teaching. Flexner essentially took medical education out of the closet of mystery and outlined the need for trained fulltime academic teachers in medical schools, emphasizing the need for libraries, laboratories for anatomy and science, lecture rooms, and access to a hospital where students could learn by being in contact with physicians treating “real” patients.
Now I won't bore you with more details about the history of the schools because I want to outline for you briefly the education of a physician and surgeon at the beginning of the twentyfirst century. It is important to recognize that, until that last quarter of the twentieth century, most medical students were male, whereas now a significant percentage of women graduate with M.D. degrees.
The requirements for entering medical school vary slightly from college to college, but the basics are pretty much the same. Except for the rare program that combines undergraduate and medical school in a single facility for only six years to the M.D. degree, most undergraduate college students will be required to achieve a Bachelor of Arts or Science degree (B.A. or B.S.) and usually a good grade point average (A's and B's) and in the top ten percent of their graduating class or higher. This does not take into account the many programs established throughout the United States to help minorities get into medical school, and for many years special emphasis has been placed on recruiting African American, Native American, and other minority groups to fill a noticeable cultural and ethnic gap in the physician force of today. Although the premedical courses may stress the inclusion of biology, physics, inorganic and organic chemistry, and zoology, the medical schools are also seeking well-rounded individuals with an additional knowledge of literature, history, English, and philosophy. In addition to the grades of an applicant, the medical schools usually require recommendations from teachers and community leaders and a personal interview, as well as the scores from the Medical College Admission Test. To all this I must add that many Medical Schools only accept 5% of the applicants, and students may have to take further postgraduate studies or work in laboratories or hospitals to make their application “look better” before reapplying. Getting into a medical school is only the first hurdle!
Most medical colleges have a four-year curriculum divided into two sections, the first two years being preclinical, namely, the studying of the science of medicine, and the last two years being the clinical years, where the student learns by being in contact with patients and practicing physicians.
The first year, the student is bombarded with a massive amount of information in Embryology (about the development and formation of embryos), Gross Anatomy (which usually involves dissecting a human cadaver under the careful instruction and guidance of the professor, while memorizing all the parts!), Microscopic Anatomy (seeing what the tissue looks like under a microscope—i.e., brain cells, kidney cells, skin, bone), Physiology (functions of the parts of the body—i.e.,, how a muscle works, why kidneys can excrete waste, how the stomach functions and produces acid), and Biochemistry (the study of the chemistry of life processes, i.e., how cortisone is produced, sex hormone production, thyroid function). And that's not all; the first year student also studies Cellular and Molecular Biology (how things work at the cellular level and, even smaller, the molecular level), Neuroscience (the study of brain and spinal cord, and nerve anatomy and physiology), Genetics (the study of genes, heredity, and variation) and then a broad introduction to medicine and society.
The students that complete the first year (and who don't throw in their marbles and go into some other business) can look forward to the interesting second year and a whole new set of courses. These include Microbiology (the study of microorganisms like Staphylococcus and the germs that cause TB or syphilis or a sore throat), Immunology (your body's defense system to help fight off disease), Nutrition, Pathology (the study of abnormal anatomy — i.e., cancer, pneumonia, diabetes mellitus), and Pharmacology (the study of all the drugs used today, like digitalis, pain medicines, and hormone replacements). Then there's Epidemiology (the study of the causes of disease), Introduction to Clinical Medicine (such as how to use a stethoscope to listen to the heart or lungs and how to use an otoscope to look into ears), Family Practice Introduction, and a course of behavioral sciences. Some programs also have lectures in Alternative and Complementary medicine (modalities including psychosocial interactions and the more unusual nonWestern medical practices like acupuncture, diet therapy, meditation, etc.).
So you've survived the first two years, somehow, and are then ready to see your first live patient. Quite a frightening experience for most young physicians-to-be! The last two years of medical school introduce you to the various specialties of medicine (the surgical ones,
