Doctor of Medicine

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]


Overview

Doctor of Medicine (M.D. or MD, from the Latin Medicinae Doctor meaning "Teacher of Medicine,") is an academic degree for medical doctors.

How the term MD is applied varies between countries - it is a first professional degree (medical diploma) in some countries, for example in the USA and Canada, while in some countries it is a relatively rare higher doctoral academic research degree resembling a PhD, for example in the United Kingdom and Australia.[1]. In the UK and countries following the British model, the equivalent of the American MD degree is the MBChB or MBBS ("Bachelor of Medicine and Bachelor of Surgery" - see Equivalent Degrees, below).

History of the medical degree

According to Sir John Bagot Glubb and Syed Farid Alatas, the first medical schools to issue academic degrees and diplomas were the Bimaristan teaching 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 Islamic medicine to medical students and then a medical diploma or degree was issued to students who were qualified to be practicing physicians.[2][3]

According to Douglas Guthrie,[4] who bases his account on L Thorndike,[5] 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."

United States and Canada

The MB or Bachelor of Medicine was 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, Harvard, Toronto, Maryland, and Columbia. 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/or Scotland. University medical education in England culminated with the MB qualification, and in Scotland the MD, until from the mid-19th century the dual Bachelor of Medicine and Bachelor of Surgery degrees (MB BS/MBChB/MB BChir/BM BCh etc) took over as public bodies required practitioners to have two qualifications. The MB was the oldest and the most traditional medical degree held by physicians and surgeons in England. North American Medical schools began granting the MD title rather than the MB mostly throughout the 1800s.

Within the United States, MDs are awarded by LCME-accredited medical schools.[6][7][8]. 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 competitive, with 17,800 of the approximately 47,000 applicants matriculating to a medical school. Before graduating from a medical school and achieving the degree of Medical Doctor, students have to pass the United States Medical Licensing Examination (USMLE) Step 1 and to take (but not necessarily pass) both the Clinical Knowledge and Clinical Skills parts of Step 2. The MD 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 MD. This can be lengthened with additional research years, which can last one, two, or more years.

In Canada, the MD 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 MD is a first professional degree and not a doctorate of research (ie. PhD), many holders of the MD degree conduct clinical and basic scientific research and publish in peer-reviewed journals during training and after graduation. 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.[3]

Equivalent Degrees

  • In most European countries, but not the UK, Ireland or Italy and Austria, the title Dr. may be used only after obtaining a doctorate (such as a PhD or MD). This holds for medicine as for all other professions.
  • In Germany physicians can obtain the degree "Dr. med., Doktor der Medizin" after twelve semesters of study and passing three state examinations. A candidate must submit a dissertation consisting of a suitable body of original academic research. A candidate also must defend this work before a panel of expert examiners appointed by the university. The dissertation has to be published.
  • The Czech and Slovak title doktor medicíny, or MUDr. (Medicinae Universae doctor), are equivalent to the North American MD degree.
  • The Poles, instead of N. Am. MD, use the title of lekarz medycyny (lek. med.; compare to lekarz weterynarii - a title obtained by graduates of the veterinary degree). What may be confusing for the British is that most of Polish medical schools, which run English-taught units of the medical degree, translate this title as "MD" and not "MBBS".
  • The Norwegian Candidatus medicinae or Candidata medicinae degrees (Cand.med.) are equivalent to the North American MD degree as determined by U.S. state medical boards.
  • In Mexico as well as most Latin American countries, schools of medicine award the "Titulo de Medico Cirujano" degree after 6 years of study. The Mexican "Titulo" is equivalent to the North American MD degree according to the ECFMG. The medical curriculum in Mexico follows the European model of medical education which includes 4 years of study covering the basic and clinical sciences, an undergraduate rotating internship year, and a year of social service providing primary care to an underserved population. Physicians holding the Mexican "Titulo" degree who practice medicine in the USA or Canada use the designation "MD" after their name.
  • IMGs (International medical graduate) or FMGs (Foreign Medical Graduates), who practice medicine in the United States may use the title MD. They can do so only if they have passed the United States Medical Licensing Examination (USMLE) exams, and satisfied any other legal requirements administered by the Educational Commission for Foreign Medical Graduates (ECFMG) as specified under Public Law 94-484, as amended.

United Kingdom, Ireland and some Commonwealth countries

In the United Kingdom and 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 (see, for example, [4]).

At some other universities (especially older institutions such as Oxford and Cambridge) the MD is a higher doctorate awarded upon submission of a portfolio of published work representing a substantial contribution to medical research.[1].

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 (see, for example, [5]).

The University of Buckingham [6], 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 professional degree in these countries for the practice of medicine is that of Bachelor of Medicine and Bachelor of Surgery (MBBS or MBChB). This degree typically requires between four and six years of study and clinical training, and is equivalent to the North American MD.

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).

India, Pakistan and Argentina

In India, an MD is a higher postgraduate degree awarded by many medical colleges to medical graduates holding the MBBS degree, after three years of study and passing an examination which includes both theory and practical, in a pre-clinical or clinical subject of a non-surgical nature. The original research element is not as prominent here, as this is primarily a clinical qualification resembling the professional doctorates of the USA. In surgery, orthopaedics and gynaecology the equivalent degree is Master of Surgery (MS). After obtaining the first post graduate degree, that is MD/MS, 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, superspeciality) eg DM in Cardiology, Neurology, Nephrology, Gastroenterology etc. For surgical subspecialities the degree awarded is MCh, eg MCh (Cardiac Surgery), MCh (Neurosurgery) etc.

In Pakistan an MBBS is awarded as the basic medical qualification after completing five/six years of study. 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.

In Argentine the medical degree Título de Médico[10] are equivalent to the North American M. D. Degree with 6 year of intensive theoric studies followed by three years of the Residencia as a Mayor Especialidad in a particular empiric field, compounded of internships, social services and sporadic research.

References

  1. 1.0 1.1 CF Hawkins, "Write the MD Thesis" in "How To Do It" London: British Medical Association 2nd ed. 1985 ISBN 0-7279-0186-9
  2. Sir John Bagot Glubb (cf. Dr. A. Zahoor (1999), Quotations on Islamic Civilization)
  3. Alatas, Syed Farid, "From Jami`ah to University: Multiculturalism and Christian–Muslim Dialogue", Current Sociology, 54 (1): 112–32 
  4. Douglas Guthrie, A History of Medicine. London: Thomas Nelson 1945, p. 107
  5. L Thorndike, History of Magic and Experimental Science. New York 1934 - 41, Vol. 2 of 6
  6. Physician Education, Licensure, and Certification. American Medical Association.[1]
  7. Registering with the NRMP. National Residency Matching Program. Accessed 15 March 2008.
  8. Whorton, James. Counterculture Healing: A Brief History of Alternative Medicine in America. 4 Nov 2003. WGBH Educational Foundation. accessed 25 Dec 2007.
  9. 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.
  10. CONEAU National Commission for University Evaluation and Accreditation.


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