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?
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: