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  • Introduction

  • Disruptors in Healthcare

  • Overview of Medical Education in the United States

  • Choosing a Residency Program

  • Applying to a U.S. Residency Program (Specialty Training)

  • The Components of the Residency Selection Process

  • The Match

  • Useful Resources

The landscape of healthcare has undergone tremendous changes over the past several decades, especially with the explosion of medical information and discovery, innovative solutions, and technologic advances, which, in turn, have improved the health outcomes and safety of our patients and their communities. The physician remains the steward of the healthcare team who must encompass the necessary knowledge base and skills to not only deliver high quality medical care, but also respond to the disruptors facing the evolving healthcare environment. Medical schools have been modifying their curriculum to keep pace with the ever-changing clinical environment. In fact, 84% of the 124 medical schools surveyed in 2017–18 were either planning for or were implementing change, or had completed implementation of a new curriculum in the last three years.1

Original chapter by Charles A. Pohl, MD


  1. Patient individuality. Beliefs and superstitions, access to care, economic status, family interactions and pressures, environmental stressors, and the political climate.

  2. Shared governance of care. Shift toward shared decisions between the patient, their family, if the patient so chooses, and the medical team.

  3. Patient trust. Patients are satisfied with their physician but not with the health system.

  4. Patient safety. Reports note that medical error accounts for a significant number of deaths daily.

  5. Fragmented care and limited resources.

  6. Competing information on care. Multiple unregulated sources of information on the Internet.

  7. Exponential expansion of medical knowledge and scientific discovery. Clinicians are challenged to assimilate and apply the ever-expanding amount of medical information. By 2020–21, the amount of medical-related knowledge will double in less than 100 days.

  8. Rapid explosion of technology and innovation in the delivery of care. Digital health is now augmenting care by assisting in decision-making, patient engagement, altering health behaviors, scientific discovery, and reengineering of the healthcare system.

  9. Physician wellness. Provider wellness is now linked to quality of care, patient safety, and overall satisfaction by both clinicians and their patients.

  10. Steady state of change in medicine.


The intent of medical education is to provide future physicians with the core knowledge and skills to be competent specialists in a chosen field and the ability to adapt to the ever-evolving healthcare environment. The goal of every medical student is to become a competent physician who practices safe and effective medicine. To reach this goal, aspiring clinicians must be licensed to practice medicine by one of the 71 state medical and osteopathic boards in the United States and its territories. The requirements for medical licensure vary from medical board to medical board.

One licensure requirement for every ...

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