Clinical - This time is spent in a teaching hospital and typically lasts two or three years. After this is completed the student doctor is awarded a Bachelor of Medicine (BM or MB) and Bachelor of Surgery (BCh or BS). He/she is now entitled to use the honorary prefix of "Dr", although he/she is not recognised as a "doctor" in the academic sense of the word (see Doctorate).
House Officer (HO) - At this stage the student is allowed provisional registration as a junior doctor, but must complete one year as a house officer in a hospital/general practice environment.
Senior house officer (SHO) - This lasts from between two and seven years depending on the specialty chosen. The doctor is now officially registered and must complete the time in a clinical position in a hospital.
At this stage the doctor can choose to become a General Practitioner (GP) or a hospital doctor with a few filtering off into public health medicine. All routes involve further assessments and examinations. The majority in the UK work as General Practitioners, who are the first port of call for patients. They diagnose illness and refer patients for further examination by specialists if necessary. The majority of patients are managed by their GP without the need for further referral.
Hospital doctors are promoted after sitting relevant postgraduate exams within their chosen specialty (e.g. Member of the Royal College of Physicians [MRCP], Member of the Royal College of Surgeons [MRCS]) from SHO to Registrar and eventually Consultant on completion of the CCST, which is the highest level in a specialty team (with the exception of University-linked Professors). The time taken to get from SHO to Consultant varies from specialty to specialty.
Admissions: Admission into medical school requires either three years of undergraduate study or a a four-year post-secondary bachelor's degree from an accredited college or university, depending on medical institution. Admissions criteria include overall performance in the undergraduate years, performance in a group of courses specifically required by U.S. medical schools (biology, general chemistry, organic chemistry, physics, calculus or sometimes statistics, and sometimes English composition), score on the MCAT (Medical College Admissions Test--a national standardized test), application essays, and interview.
Medical School: Once admitted to medical school, it takes four years to earn a Doctor of Medicine (M.D.) degree. The course of study is divided into two roughly equal parts. Preclinical study generally comprises the first two years and consists of classroom and laboratory instruction in core subjects such as anatomy, biochemistry, physiology, pharmacology, microbiology, pathology, and neurosciences. Once the student successfully completes preclinical training, he or she moves on to the clinical portion. This usually occupies the final two years of medical school and takes place almost exclusively on the wards of a teaching hospital. The students observe and take part in the care of actual patients under the supervision of residents and attending physicians. Rotations on clinical services such as internal medicine, surgery, pediatrics, obstetrics/gynecology, and psychiatry are the foundation of this curriculum, but many specialty electives may be chosen as well. Upon completion of medical school, the student earns the title of doctor, but cannot practice independently until completing further training.
Internship: During the last year of medical school, students apply for postgraduate residencies in their chosen field of specialization. These are more or less competitive depending upon the desirability of the specialty, prestige of the program, and the number of applicants relative to the number of available positions. All but a few positions are granted via a national computer match which pairs an applicant's preference with the programs' preference for applicants. The first year of any residency is known as "internship". Completion of this year is the minimum training requirement for obtaining a license to practice medicine in the U.S.
Residency: Each of the specialties in medicine has established its own curriculum, which defines the length and content of residency training necessary to practice in that specialty. Programs range from three years after medical school for internal medicine to five years for surgery to eight or nine for neurosurgery. Each specialty incorporates an internship year to satisfy the requirements of licensure. All specialties hold a board exam (either written or written and oral) at the completion of training in order to confer "Board Certification" in that specialty.
Fellowship: Certain highly specialized fields require formal training beyond residency. Examples of these are cardiology, endocrinology, oncology after internal medicine; cardiothoracic surgery, pediatric surgery, surgical oncology after general surgery to name just a few. There are many others for each field of study. The training programs for these fields are known as fellowships and their participants are "Fellows" to denote that they already have completed a residency and are "Board Eligible" or "Board Certified" in their basic specialty. Fellowships range in length from one to three years and are granted by application to the individual program or sub-specialty organizing board.
Attendings: The physician or surgeon who has completed her or his residency and possibly fellowship training and is in the practice of their specialty is known as an Attending. These are the physicians who may independently care for patients and are the final arbiters of care. They are responsible for all care decisions and may bill for their services.
However, medicine is an extremely diverse profession with many options available. Some doctors work in pharmaceuticalresearch, occupational medicine (within a company), public health medicine (working for the general health of a population in an area), or join the armed forces.