The Important Things In Life

Between here and East Texas there are approximately 440 miles of asphalt equaling out to just under 7 hours of 70mph driving*. As a medical student and obsessive worrier it has never been easy for me to make the decision to leave town and now that the monster that is Step 1 has is hanging over my head it has become even more difficult. However, every year we look forward to an Easter road trip to visit my husband’s side of the family and this year was no different. I considered passing up on the opportunity because I had have so much studying to get done, but I weighed my options, threw caution to the wind and made the decision to join my husband and get out of town for a while.


So, Friday morning we packed up the car with snacks, study materials, and animals and headed out to the hill country.

Although I spent a lot of the weekend holed up in Starbucks, squinting at a computer and threatening to use my hot coffee as a weapon against whoever made USMLE World’s Q-Bank so dang hard, it really was a wonderful trip. 

We had breathtakingly gorgeous weather & sweet kids who took advantage of it…

Jaxon, our 4-year old nephew.

Jaelyn, our (almost) 4-year old niece.

There were crazy puppies to play with silly, dancing boys.


We had a fun night out with good drinks and great people…

 took a time-out for some family pictures…



and, most importantly, simply enjoyed getting to spend some time with our family.


*Welcome to Texas, where you can literally drive 15 hours North to South (Perryton to South Point) OR East to West (El Paso to Newton) without ever leaving the state. 

Medical School in Egypt

With all the recent news coverage about Egypt and their revolution it’s sometimes easy to forget that there are people just like you over there still managing to live their day-to-day life, which is exactly why I was so excited to find @RaghdaElkattan on Twitter. Raghda is a 21 year old medical student from Maadi, Cairo and she is in her 5th year of medical study. As I’ve said in the past I am incredibly impressed with the English & writing abilities of the med students and doctors who have helped me with this series, and Raghda is definitely no exception. Now, a quick peek into the Egyptian Medical Education system.

Campus of Kasr Al-Ainy Medical School in Garden City, Cairo. Photo Courtesy of Facebook.

Getting In:

How old is one when they begin medical school?
Students join the medical school or “The Faculty of Medicine” -as we call it in Egypt- right after they are done with high school. The average age for a first year student is 17-18 years.
What exams does one have to take to get in?
The selection process totally depends on the scores of final exams in high school. Since joining the faculty of medicine is highly desired in Egyptian culture, those who get accepted are the top students around the state. Acceptance depends on final exams scores, SATs or International General Certificate of Secondary Education (IGCSE) system. The exam subjects include physical sciences (like chemistry and physics), biology, mathematics and languages.

Being In:

How long is it?
Six years
How are the years broken down?
Three years of basic science and three years of clinical training. In the first 2 years we study Physiology, Histology, Anatomy and Biochemistry. The third year subjects are Pathology, Microbiology, Pharmacology and Parasitology. In the last 3 years we start the clinical section and do rounds in Ophthalmology, ENT, Forensic medicine, Public health, Pediatrics, Gynaecology, General Surgery and Internal Medicine.
Describe your typical day.
In the first 3 years it’s all about lectures, practical classes and exams. In the last 3 years we do rounds in the hospital departments and have theoretical lectures and evaluation end round exams.
If you choose a specialty when do you have to decide by?
Students pick their specialty and apply for residency following their intern year, which would be the 7th year of study. 
What are you called at this stage of training?
Medical Student

Getting Out:

What exams do you have to take?
We have to pass the end year exams every year until the sixth year, then we start an internship year in the college hospital doing clinical rotations in its departments for 2 months each and finally we graduate at the end of that year with a bachelor degree in medicine. We are officially called doctors, GPs “general practitioners,” following this graduation.
Do most people graduate?
I think yes. If you happen to fail something you have to do repeats during Summer vacation or else you will have to spend another year to go through the exam again, but eventually most of students do graduate.
Do you have additional training or do you start working immediately?

The internship year is supposed to help us pick our specialty based on the clinical experiences we have. After this year we apply for a 5 year residency program in the specialty we are interested in – acceptance is dependent on grades during which we are supposed to be studying for the master’s degree in that specialty and on competitiveness of the specialty. I have no Idea about the weekly working hours, but I believe it’s around 14 hours a day besides the night shifts. 
What’s the average debt for attendance?

Medical schools in Egypt belong to the public national education. This means that getting into school depends only on your high school scores and the fees are considered nothing compared to the private medical schools, which are not any better than the national schools. So, there is basically no debt for attending school. I’m not sure about the fees for residency programs, but I don’t think they cost a lot.
What are you called at this stage of training?
Resident Physician

Being Out:

What’s the average salary?
Lots of changes are being carried out following the revolution that took place in Egypt on January 25th of this year. A comprehensive reform in physician salaries is being discussed. There is a suggestion introduced to the government to increase the doctors monthly salaries as follows:

  • Residents: 3000 EG.P ($500 USD) – Currently they make about 1500 EG.P
  • Specialists: 4000 EG.P ($670 USD) – Includes all who have masters degree
  • PhD Holders: 6000 EG.P ($1000 USD) 

This is not yet confirmed, but is probable. Doctors are not highly paid In Egypt, but compared to other governmental jobs they are considered in a high salary rank and they can also have their own private clinics.
Is the job security good?
I don’t think most doctors struggle to find a job, but lots of doctors prefer to find a job out side the country at the beginning since the salary rates are great.
Can you go back and choose a different speciality?
I think you can, but you would have to go through the residency application system again and do another residency if whatever you were switching to.
Other post graduation options: Some doctors prefer to apply for the USMLE exams after they have completed school and then follow the American System. Others apply for Membership of the Royal College and follow the UK System. 

Past Medical Education Monday Posts:

Teenage Pregnancy Rates Are Out Of Control…

and pregnancy in highschool-ers is an epidemic! You hear people say it all the time, but do they really know what they’re talking about? Check out this chart I found today showing teen birth rates since the 1940s… 

Information & Image Courtesy of FamilyFacts.org

…probably not what you expected, huh? It definitely took me by surprise. It seems like the dominant assumption in the US is that teen pregnancy rates are currently out of control. However, something seems to be amiss in that idea. According to this data, which came from the National Center for Health Statistics, it would actually appear that the belief is flat out opposite of reality. The teen pregnancy rate is not, in fact, out of control and we may have just recently gotten it under control.

How much of this could be related to the fact that a lot people were married in their teens in and around the 1950s? Some of it can be attributed to that I’m sure, but definitely not all of it – we’re talking a drop of 57.2 per 1000 teenage females since the mid-1950s. That is HUGE. 


But look at the massive drop since 1991…that one definitely cannot be explained by marriage age, so what can we attribute it to? Decrease in abstinence only education? Better sex-discussions by parents (my mom suggested that one – good one mom)? Something else?

Some Facebook friends suggested abortion rates may have increased and skewed the data, but since abortion was legalized in 1973 abortion rates have actually been on a steady decline (especially in the teen age group).  

Information & Image Courtesy of FamilyFacts.org

I find this all very fascinating. Why is this generation considered so much worse than other generations? Why do people assume the pregnancy rates are drastically higher when they are actually drastically lower? It really makes you think about the things people say or assume on a daily basis. It seems like a lot of what we say in such a matter-of-fact manner may be based more on feeling than truly factual information.


I really want to hear from you. What did you think of these statistics? Did it surprise you? Does it make you want to smack your “babies-are-having-babies-and-your-generation-is-disgraceful” granny? Do you think most are under the impression rates have gone up because of the decrease in stigma surrounding the issue? Is there something simple I’m missing that explains it all? I’m so interested to hear y’alls opinions and ideas on this issue, I truly hope if you’re reading this you’ll share yours!

Medical School in Spain

Today’s Medical Education Monday will be highlighting Spain’s medical education system and our guest blogger is Ines, a 19-year-old medical student from Madrid! I’d tell you how awesome her personal blog is, but I can’t read a single word that she’s written. Unlike the incredibly talented multilingual med students & doctors helping me with this series, I am completely lost if we aren’t all speaking Texan English, y’all. However, judging by her fabulously-written explanation of the medical education system in Spain I would be willing to bet that Ines’ blog is a winner – so if you can read Spanish head on over there and tell her hello hola (well, look at that – I can speak Spanish). Ines is currently loving cardiology, while leaving her options open to other things in the future. Keep reading for a superb explanation of Spain’s system of training physicians.


Getting In:
How old is one when they begin medical school?
Normally, people begin when they’re about 18 years old, once they have finished college (equivalent to high school in the US).
What exams does one have to take to get in? Is there any required pre-requisite coursework?

  • Nowadays, it’s really difficult to get into the Medical degree. After having done 2 years of Biological Sciences (Chemistry, Mathematics, Physics, and Statistics) and General Knowledge (such as Grammar, Foreign languages, Literature, Philosophy, History) a Selection Test is required. Once the test is done, you get a final mark that determines if you are accepted into University. You need to get about 9/10 to become a Medical Student.
  • There are public and private universities to study Medicine in Spain. If you didn’t get the mark to go to a public one, you can try with a private one (they are REALLY expensive, so many people can’t afford that option).
  • Depending on the university you want to go to, you’ll need to do a test of Biological Sciences, a test of your level of English and a psychological test.
  • Every test has a mark. All marks are averaged for a final mark and the best marks are accepted to be enrolled.

Is it a competitive occupation?
It’s the most competitive one, to be honest. People study so hard to get in, so hard once they’re in and even harder once they’re out! (Don’t ask your mates for help, they won’t help you!)
What are you called at this stage of training?
Pre-universitario (pre-University student).

Being In:

How long is it?
Six years
How are the years broken down?
3 years of basic sciences + pharmacology, 3 years of clinical training
Describe your typical day.
I can describe it with just one word: STUDYING! I wake up every day at 7am, because I start my lectures at 8am (5/6 hours per day). It is followed by 5-6 hours of studying in the library, before going home (sometimes, to keep studying at night).
If you choose a specialty, when do you have to decide by?
Medical students have 6 years to think about this. It’s normal to change your mind with everything you study! (One day you’d like to be a Neurosurgeon, another one you’d like to be a Pediatrician!!)
What are you called at this stage of training?
Medical Student 

Getting Out:

What exams do you have to take?
MIR test. This test is taken once the Medical Degree is finished and must be completed before doctors can do the residency. Depending on the mark, you can enroll in a specialty in one hospital or another. If you didn’t get the mark you wanted or if you failed, you would be able to repeat it the following year (many years you want to).
Do most people graduate?
I don’t really know the average, but I think lots of people leave the degree before it’s finished (some classmates of mine left it last summer and it was just the first year!)
When are you finally considered a “doctor?”
Once the Medical degree is completed you are called “doctor,” but you cannot work as a doctor until your residency has been completed.
Do you have additional training or do you start working immediately?
You have to do the residency in order to work as a doctor (depending on the specialty, it takes about 2-5 additional years).
What’s the average debt for attendance?
Public universities make you pay money to enroll each course, it’s relatively inexpensive and comes out to about 700€ ($1,000 USD) each year. Private universities are very different. Mine, for instance, charges 18,000€ ($25,732 USD) each year and the rest of private universities are quite similar. Some people can get government money because of their marks or because they can’t manage to pay for the public one, but private universities don’t normally give many loans. (Can anyone else from Spain clarify this? Does that mean if you cannot pay the private school attendance costs on your own you can’t attend?)
What are you called at this stage of training?
Resident doctor or intern

B
eing Out:
What’s the average salary?
This is a difficult question, it depends on the specialty the doctor did and where he/she works. Normally, doctors work in public hospitals during the morning and in private clinics during the afternoon. Doctors who work that much can earn about 120,000€/year ($171,552 USD).
Is the job security good?
It has always been in this country. Spain needs so many doctors nowadays, that’s why foreign doctors come here to find a job.
Can you go back and choose a different specialty?
Yes, you can do it. You can do the “MIR test” as many times as you want to, even if you passed it and you’re working as a doctor within a specialty.
What are you called at this stage of training?
“Assistant doctor” is generally used and in addition you are called by the name of your specialty, for instance: neurologist, cardiologist, etc.

Past Medical Education Monday Posts:

Foreign MD Training: Vita-Salute San Raffaele

    A lot of my classmates have always known what they wanted to be when they grew up – some have been doctors for Halloween every October since they were 5, others took their first steps right through the middle of an OR without touching so much as a single sterile field. I, on the other hand, have been petrified of anything with a needle point or stethoscope since the precise moment when some evil being in a white coat held me by my ankles, slapped my newborn baby booty and shouted “It’s a GIRL!” at my parents.



I didn’t decide until well into college that medical school was what I wanted to do next, so to say I was unprepared when I applied at the same time as my fellow pre-meds would be an understatement. I got one interview that year, followed closely by one rejection and a large dose of reality that left me wondering what to do next.


I briefly considered throwing in the towel, tossed around the idea of improving my application and reapplying, and seriously explored the world of foreign medical schools. While I would highly encourage anyone desiring to work as a doctor in the US to apply to medical school state side multiple times before going out of the country, I did find that some foreign schools had a lot to offer – especially to students who may have decided a little later in the game that medical school was their ultimate goal.


When a representative of Vita-Salute San Raffaele University in Milan, Italy contacted me requesting my help in spreading the word about their International MD program I was a little hesitant. However, after learning about their program and curriculum, I am confident that this could be a good alternative for some of my readers, so I wanted to share the information with y’all. The program is fully integrated with US licensing exams and you can apply to US residencies upon completing the training. 

Vita-Salute San Raffaele 
International MD Program

Vita-Salute San Raffaele University is part of the San Raffaele Foundation which includes Hospitals, Research Centers and the Vita-Salute San Raffaele University.

San Raffaele is well known worldwide for its excellence: it is a highly specialized center for molecular medicine, diabetes and metabolic diseases, as well as biotechnology and bio-imaging. 
The Hospital channels many of its resources into cancer treatment, cardiovascular diseases and numerous acute and chronic-degenerative diseases and a very efficient Emergency Department that serves a vast area. 

The International MD Program builds on the institution’s solid presence on the international scene: San Raffaele healthcare centers can be found in many countries of the world, including Brazil, India, Uganda, Poland, Chile, Israel, Mozambique and Algeria.

This degree course provides medical-scientific education at the highest level, allowing students to improve their skills and to upgrade their knowledge. It also provides clinical and laboratory research opportunities and additional education in humanities and cultural sciences: philosophy, communication skills, cognitive neurosciences and psychology, which are the building blocks of human society, regardless of social status, race, or creed.

The International MD Program is designed to train a new kind of doctor; someone who possesses the necessary human, cultural and professional abilities to actively participate in healthcare and share ideas in today’s globalized world. Unlike other Medical Programs in Italy where clinical courses are held in Italian, the International MD Program is fully in English, including classes, lectures, practicals and all clinical activities.

Students enrolled in the San Raffaele International MD Program have access to all the facilities of the Vita-Salute San Raffaele Institute and the San Raffaele Scientific Institute, including skills labs for practical training, a library with more than 20,000 books and several thousand scientific e-publications and resources, as well as to the clinical and research laboratories of the San Raffaele Scientific Institute, the largest private research institute in Italy, that further expanded with the inauguration of DIBIT, a scientific facility for basic, translational and clinical research. DIBIT is part of the largest biomedical science park in Italy, which includes the San Raffaele Hospital, Science Park Raf, created to support the foundation’s development, and the Vita-Salute San Raffaele University. 

Applicants who wish to enroll in the Internation MD program are required to take an Admission Test prior to applying. 


It will take place on April 28, 2011 in the following locations:

Milan, Italy
New York, USA
Kuala Lumpur, Malaysia

Candidates interested in sitting for the exam can find more information here.

64 places are available for Academic Year 2011-2012:

32 for EU citizens
32 for Non-EU Citizens. 


The deadline to register is April 20th, 2011.
Click Here for guidelines on the admission process for A.Y. 2011-2012.

This post was sponsored by Vita-Salute San Raffaele.
Photo Credit: Student Life Photo Gallery

Medical School in the United Kingdom

If you follow me on Twitter you are likely acutely aware of the outlandish amount of time I spend giving minute-by-minute updates on the painfully interesting things happening in my life (case in point), but what you may not realize is that Twitter is really quite useful for things other than boring the masses and keeping track of #trendingtopics. The microblogging site is also a great place to make connections with all different types of people from around the world, so it was only natural that when I began the Medical Education Monday endeavor I recruit my guest bloggers using 140 characters. I tracked @silv24 down early in my hunt and basically begged her to be interested in my project. Despite the fact that she is an extremely busy first-year doctor, the 26-year-old humbly agreed to give me a glimpse into her world.
Natalie has an undergraduate degree in Biology and works in the county of Warwickshire in the United Kingdom (for all of my fellow geographically-challenged science nerds, Warwickshire would be found smack-dab in the center of England). She is currently rotating in gastroenterology and is trying to decide between Accident & Emergency (A&E) and Intensive Therapy (ITU – similar to Intensive Care, ICU, in the US) as a permanent career. She is passionate about using her talents to give back and working for Médecins Sans Frontières (aka Doctors Without Borders) is her ultimate goal for when she is “grown-up.” Natalie also enjoys baking and is currently revising for the first part of her postgraduate exams (Good Luck!!). As a side note, this is Natalie’s very first blog post and I would just like to say I think she did a phenomenal job. I made a few additions and, like last week, they are presented in orange font.
Warwickshire & Northhamptonshire Air Ambulance
Andy F [CC-BY-SA-2.0], via Wikimedia Commons

Getting In:

How old is one when they begin medical school?
In the UK most medical students begin the course at 18, straight from doing A-levels and most courses are 5 or 6 years in length. There are an increasing number of graduate entry courses though which are 4 years in length. I started my graduate entry course when I was 21, straight after finishing my 3 year undergraduate degree in Biology. This meant a total of seven years at university, expensive but it was worth it.
What exams does one have to take to get in?
This varies between medical schools. Most undergraduate courses don’t have any exams that you need to sit, you apply through a national system and then have interviews for the individual courses. For graduate entry courses there are different examinations, each medical school seems to have a different preference.
Is there any required pre-requisite coursework?
No.
Is it a competitive occupation?
Very competitive. In the UK far more people apply than there are places and it seems that this has been increasing recently.
What are you called at this stage of training?  
When you start you are called a medical student though there are many who think that the title “student doctor” should be used.

Being In:
How long is it?
Most undergraduate courses are 5 or 6 years long, some allow you to do an intercalculate degree whilst doing medicine, which lengthens the course. Graduate entry courses are 4 years long.
How are the years broken down?
Phase One: Pre-Clinical – 18 months in length, involves lectures on all body systems, group work lead by clinicians and academics and basic clinical skills teaching. Phase Two: Clinical – 30 months in length, comprised of eight week clinical attachments. The rotations are in a variety of areas – general medicine and surgery, general practice, psychiatry, paediatrics, obstetrics & gynaecology, an acute block involving time in Accident & Emergency (A&E), and many more. Half way through phase two there is an intermediate clinical examination which you must pass to become a senior clinical medical student.
Describe your typical day.
This very much depends on which clinical attachment you are doing, but you could be in clinic with a consultant, doing ward rounds with the team and having teaching from junior members of the team when they have spare time.
If you choose a specialty, when do you have to decide by?  
Two years after graduation when you have completed the Foundation Programme (see below).
What are you called at this stage of training?
Medical student or student doctor.
Getting Out:

What exams do you have to take?
I only sat finals just under a year ago yet it seems like it was a lifetime ago. We sat both clinical and written examinations and a prescribing assessment. Again, I became unbearable to know for the few weeks leading up to the examinations, but the hard work was worth it to see my name on the pass list and to find out I could add the letters MBChB (Hons) to the BSc (Hons) I already had. (MBChB: Bachelor of Medicine and Bachelor of Surgery; BSc: Bachelor Of Science).
Do most people graduate?
The vast majority of people do.
When are you finally considered a “doctor?”
Depends on who you talk to – either the day you see your name on the pass list or the day you get provisional registration to practice medicine from the GMC (General Medical Council – they regulate all doctors in the UK).
Do you have additional training or do you start working immediately?
You have a period of  “shadowing”, a time period in which you work alongside the junior doctor whose post you will be taking over. All first year doctors start on the same day in August.
What’s the average debt for attendance?
This is extremely variable. At the moment medical school fees are just over £3,000 ($4,907 USD) a year but this is set to rise to £9,000 ($14,721 USD) next year (holy cow that is a HUGE tuition jump in one year!).
What are you called at this stage of training?
For the few weeks between passing medical finals and starting work in August you are in a no man’s land, neither medical student or a doctor.
Being Out:

What’s the average salary?
The basic salary for a first year doctor is £22,412 ($36,659 USD), this rises to £27,798 ($45,469) in your second year & continues to rise as you go through your career and through various grades. However, this is the basic salary, all jobs are graded depending on whether you work more than 40 hours a week and/or work outside the hours of 7am-7pm Monday to Friday. Most jobs in the first year tend to be 1B banded, this means you earn your basic salary plus 40% of this, but some jobs are 1A banded, meaning you earn your basic salary plus 50%. (So, beginning physician pay is very similar in the UK and in the US. One difference is that in the US new doctors typically work ~80hrs/week, often outside of 7a-7p time constraints, without extra compensation. So on an hour-by-hour comparison starting pay would be significantly lower in the US).
Is the job security good?
At present you are guaranteed a job for the first two years (see below), after that it is a competitive process for specialist training.
Can you switch specialties?
All final year medical students in the UK apply through a national application system for Foundation Programme Training. The Foundation Programme is the two year training system that all junior doctors undertake, and it is a requirement of the GMC. This two year system comprises of different rotations, the first year you are provisionally registered with the GMC and after a year (and if you fulfill certain criteria) you become fully registered with a license to practice medicine. After the Foundation Programme you apply for specialist training, it’s a fairly competitive process and one that seems to alter year on year. I will be applying for my specialist training in December.
What are you called at this stage of training?
Foundation year one doctor, house officer (old terminology) or junior doctor.


Past Medical Education Monday Posts: 

Avoid a Speeding Ticket Using Your Dirty Dog

Baby Jaden. Born 4/4/11 – 7lbs, 7oz. Adorable.
I was about an hour into the three hour drive home from visiting one of my very best friends and her absolutely precious new baby boy, listening to Dr. Goljan explain Serous Ovarian Cystadenocarinoma through my car speakers and generally minding my own business when I saw flashing lights make an abrupt u-turn as I passed them.
I silently willed the lights to transform into an ambulance. No luck. I wished my misfortune onto the tan car that had been following me. Still no luck.
@#$)(#@*
 Pause Dr. Goljan and his Gynecology lecture. Roll down window.

Do you know why I’m pulling you over ma’am?
 blank, innocent stare
Speeding. Is there a medical emerge…
HEY! that dog looks JUST like my Cockapoo! confused stare
He’s cute! glance at Wrigley. wonder how he even remotely resembles a Cockapoo.


I kid you not, friends, the officer interrupted his own
onlyspeedinemergencies speech to talk to about my dog. What can I say? He’s just that cute.

So, naturally, I asked him if his Cockapoo was as dirty as the orphan-looking dog riding in my passenger seat who, I’m 90% sure, has not seen sunlight in at least 4 weeks thanks to his neglectful parents failing to secure him a trip to the groomers. I glanced to my right and gave Wrigley an
if-you-growl-at-the-cop-I-swear-I-will-leave-you-on-the-side-of-the-road* look and my obedient animal friend happily wagged his tail and gave his best puppy dog eyes.

Thanks, Buddy. I promise we’ll cut your hair soon.

However, thanks to that haircut issue, I highly doubt anyone could even see his eyes – but, officer, if you could see his eyes I swear they would be big, black, please-don’t-give-my-broke-mom-a-ticket eyes.

Mr. Highway Patrol left with my info and subsequently returned to my window wielding a white piece of paper. He flashed a “you’re welcome” grin at Wrigley and handed me a typed-up warning without saying anything.


Then he stuck his arm through my window to try and pet Wrigley. Again, I willed my constantly suspicious four-legged child not to growl and, miraculously, he obliged. Then Mr. Hwy Patrol and I had a long conversation about what kind of dogs we have and he told me how great he thought dogs were. I agree, sir. I agree…especially when they flash those puppy dog eyes through 12 layers of matted hair to get you out of a speeding ticket.


And, for the record, I happen to think dog-loving officers are really great, as well. 


Tell me your law-enforcement stories! Have you ever gotten a ticket you didn’t deserve? How about gotten out of one you probably did deserve??

*When Wrigley was a tiny little 2 pound puppy he would growl at my fingers and I thought it was SO cute and made him do it all the time. Thanks to my marvelous parenting skills he now thinks growling at people is how he should ask them to pet him. Trip to the park? Growl at small children. Walk in the neighborhood? Growl at neighbors. It makes total sense.

Medical School in Belgium


When I deployed my initial desperate plea for non-US medical students or doctors who were willing to help me out with this series
@bramzo, a 2nd year medical student in Belgium, was the first to agree. He was excited about the series and wrote exquisitely about his interest in Neurosurgery, his experiences in the Belgian medical education system and what he has ahead of him in the next few years. When I read his interview and saw that it was dang-near grammatically perfect, I was sure English had to be his primary language. But oh no, friends, English is not his first language, nor is it his second language…English is his THIRD language. This Belgian rockstar fluently speaks Dutch, French and English and is well on his way to becoming a brain surgeon! Sorry to burst your bubbles, ladies, but you should know that Bram has been with his girlfriend for 6 years now and I get the impression that she’s a pretty great catch. When he’s not studying about a homunculus, Bram enjoys cycling, photography and Mac products…sounds like he and I would get along just beautifully – I hope he’s prepared to house me should I ever decide to make an impromptu visit to Belgium. Keep reading for a great look inside the medical education system in Belgium, I’ve added just a couple of things which are printed in orange.

Photo by Bram. Stolen from his Instagram. 🙂

Getting In:
How old is one when they begin medical school?
Most are 18 years old. Some that don’t pass the entrance exam wait another year and enter the education at 19.
What exams does one have to take to get in?
Everyone applying for medical school (doctor or dentist) needs to pass the entrance exam (one exam for all the Dutch speaking Belgian applying med students). It’s an exam testing the chemical, physical, biological, and math skills that one should have after high school, as well as IQ and reading skills. The best 25% of students get approved. I was one of them. There is a chance to do a redo the exam in the same year after a month or two. Those that fail twice have to wait another year.
Is there any required pre-requisite coursework?
Pre-requisite coursework is not required, but some courses are organized by universities to help students pass for the entrance exam.
Is it a competitive occupation?
Only the top 25% get approved, but at this stage you don’t know the other students.
What are you called at this stage of training?  
Nothing.

Being In:
How long is it?
Basic medical education is 7 years, but the government shortened it to 6 years recently. I’m still in the 7-year program. After that, it’s another 2 years minimum to be a General Practitioner (GP) or 3 – 6 years for specializing.
How are the years broken down?
First 3 years is Bachelor degree: physics, biology, chemistry, bio-chemics, immunology, embryology and some basic clinical skills like history taking and basic physical exam.
Next 4 years is the Master degree.
  •  First year is still pure theory, but more clinical: pathology, nephrology, cardiology, pharmacology, etc.
  • Second year is theory and internships. Again: theory is more clinical like ob/gyn, gastro-enterology, etc. and courses are given in the afternoon. In the morning we go to our internship, which rotates every month.
  • Third year is also theory and internships but the last 4 months of this year we do our end-exams. This is one exam of Surgery, Medical, Ob/Gyn and Pediatrics. The scores earned on these exams are critical to be approved for a specialization.
  • Fourth year is basically a preparation for your specialty or GP career.

Describe your typical day.

As I’m in my second Master, I go to the clinic in the morning for my internship of that month (this month anesthesiology, previous month pediatrics, next month neurosurgery). In the afternoon I go to class (2 pm ‘till 6 pm). When I come home in the evening I study or relax. There also has to be a student on call at the ER every day. So, 2 to 3 times a month it’s my turn to do the on call and that’s from 8 am ‘til 11 pm.
If you choose a specialty, when do you have to decide by?  
At the end of your 6th year (3rd Master) you should decide what specialty you want to do. Students apply after 6th year and get approved in the first months of the 7th year.
What are you called at this stage of training?
A med student, most people call me by my first name.

Getting Out:
What exams do you have to take?
At the end of the 6th year you have to pass the “end-exams” where you do an internship of one month on Surgery, Meds, Ob/Gyn and Pediatrics then do a theoretical exam of the respective subject.
Do most people graduate?
Since the entrance exam is pretty hard, most people that begin med school graduate. I think 95% graduates. However, not every one get’s approved for a specialty, so they will work as General Practitioners instead. Only the best 50% of each class can specialize, so it’s very competitive in the 5th and 6th year.
When are you finally considered a “doctor?”
The title of doctor is given after your 7th year, no matter what specialty you choose.
Do you have additional training or do you start working immediately?
After 7th year you go for an additional training of 2 years if you choose GP or 3 – 6 years if you choose to specialize. Neurosurgery is 6 years of additional training after the 7th year.
What’s the average debt for attendance?
This is the good part of med school in Belgium: none. Med school is not expensive, as it is highly subsidized by the government. We only pay € 550 ($782.87 USD) for a year of med school (excluding books, stethoscope, etc.) and our entire living is paid for by our parents (housing, car, food, etc.).
What are you called at this stage of training?
After graduating the 7th year you are an assistant. Patients call you doctor during your additional training.

Being Out:
What’s the average salary?
This is a tough one – it depends on specialty, academic or private clinic. It varies from
€ 80.000 ($113,872 USD) to € 350.000 ($498,190 USD) annually, with an average for a specialty doctor of € 200.000 ($284,680 USD).
Is the job security good?
Yes, almost everyone graduating as a doctor finds a job.
Can you switch specialties?
It’s possible, but then you have to start from where you were after the 7th year. Some do this after the first year of additional training.
What are you called at this stage of training?
Patients still call you a doctor, but the degree in clinic varies from resident à head of clinic à head of department.