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Doctor of Medicine(MD)

Doctor of Medicine (M.D. or MD, from the Latin Medicinæ Doctor meaning “Teacher of Medicine,”) is a doctoral degree for physicians.
How the term MD is applied varies among countries — it is a first professional degree in some countries (e.g., USA, Canada), while in others it is a higher doctoral academic research degree resembling a PhD (e.g., the United Kingdom, Australia).^[1] In the UK and many former British colonies, 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, Syed Farid Alatas, and S. M. Imamuddin, the first medical schools to issue academic degrees and diplomas were the teaching Bimaristan (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][4]
According to Douglas Guthrie,^[5] who bases his account on L Thorndike,^[6] 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.”

Academic degrees for physicians by country

United States and Canada

The MB or Bachelor of Medicine was also 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 Scotland. University medical education in England culminated with the MB qualification, and in Scotland the MD, until from the mid-19th century the public bodies who regulated medical practice at the time required practitioners in Scotland as well as England to hold the two the dual Bachelor of Medicine and Bachelor of Surgery degrees (MB BS/MBChB/MB BChir/BM BCh etc). North American Medical schools switched to the tradition of the Ancient universities of Scotland and began granting the MD title rather than the MB mostly throughout the 1800s. The Columbia University College of Physicians and Surgeons in New York (which at the time was referred to as King’s College of Medicine) was the first American University to grant the MD degree instead of the MB.^[7]
Within the United States, MDs are awarded by LCME-accredited medical schools.^[8][9][10]. 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 is highly competitive, with 17,800 of the approximately 47,000 applicants matriculating to any 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. Medical Scientist Training Programs (MSTPs) are offered at many universities which are a combined medical degree and PhD. 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.^[11]

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.^[12]
At some other universities (especially older institutions such as Oxford and Cambridge) the MD is a higher doctorate (similar to a DSc) 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.^[13]
The University of Buckingham,^[14] 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.

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 {MBBS degree course has a duration of five and a half years}, 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). DNB(Diplomate of the National Board))is considered equivalent to MD and MS.This can be obtained by passing an exam conducted by national board of examinations after completing 3 years post MBBS training in hospitals recognised by the board.After obtaining the first post graduate degree, that is MD/MS/DNB, 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 (Doctorate in 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.The DM or MCh degrees are equivalent to the Fellowship training in the US and are considered “post-doctoral” degrees in India, similar to the PhD.
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^[15] 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.

Equivalent degrees in other countries

• The Bachelor of Medicine and Bachelor of Surgery degrees (MB BS or MB ChB, and several variants) are equivalent to the North American MD degree.
• The American osteopathic medical degree (DO) has identical training requirements and practice rights as the MD degree.^[16] (See Comparison of allopathic and osteopathic medicine.)
• In Germany medical students have to complete twelve semesters of study and pass two state examinations (the first one after two years) to become physicians. A research doctorate (PhD) can only be obtained at some universities after three to five years of additional studies and research. Physicians can obtain the degree “Dr. med., Doktor der Medizin” 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 the North American 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 the Polish medical schools, which run English-taught units of the medical degree, translate this title as “MD” and not “MBBS”. However, the Polish School of Medicine (Polish Medical Faculty) at the University of Edinburgh, which operated from 1941 to 1949, awarded both British degrees of Bachelor of Medicine and Bachelor of Surgery (MB ChB) and a Polish Dyplom Lekarza on the same bilingual Latin-Polish certificate to 227 students. Of these, 19 progressed later to Doctor of Medicine (MD). ^{[17] [18] [19]}
• The Danish and 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 (some Mexican universities award the “Titulo” after 7 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.
• In the Netherlands finishing a medical university training does not automatically qualify to treat patients, or for that fact, to use the internationally recognised MD title. Finishing an university medical study results in a MSc or doctorandus title, locally noted as Drs. or drs. (e.g. drs. Jansen). A minimum of 2 years internship/ specialisation are required, the length in years varying with the discipline. Only after specialisation (e.g. GP medicine, cardiology), the MD title can be used. A PhD title can only be obtained after presenting a large body of original academic research, defending a resulting dissertation successfully before “a gathering of peers”, and a substantial number of peer-reviewed international publications. In the Dutch language, titles can be confusing; the Dutch “dokter” stands for a MD and literally means “physician”, while “doctor” signifies a PhD. The earlier mentioned abbreviation Drs. can also be obtained in other academic disciplines if completed succesfully, and is not medicine specific.^{[20] [21]}
• 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.

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).

Bachelor of Medicine and Surgery(MBBS)

Bachelor of Medicine and Bachelor of Surgery, or in Latin Medicinæ Baccalaureus et Baccalaureus Chirurgiæ (abbreviated MB BChir, MB BCh, MB ChB, BM BS, MB BS etc.), are the two degrees awarded after a course of study in medicine and surgery at a university in the United Kingdom and other places following its usage, such as medical schools in Australia, Hong Kong, Malaysia, Singapore, New Zealand, Jamaica, South Africa, Pakistan and India. The naming suggests that they are two separate degrees; however in practice they are usually treated as one. (At Oxford and Cambridge it is/was possible to be awarded the two degrees on different dates.)
The degrees are the Commonwealth equivalent of what is known elsewhere as the degree of Doctor of Medicine (MD). In countries that award bachelors’ degrees in medicine, however, the MD refers to a Higher Doctorate, and is reserved for medical practitioners who do research and submit a thesis in the field of medicine.

Naming

The Latin names for these degrees are variously Medicinae Baccalaureus, Chirugiae Baccalaureus or Baccalaureus in Medicina et in Chirurgia, abbreviated as MB ChB, MB BCh or in other ways depending on the individual institution; the English versions are Bachelor of Medicine, Bachelor of Surgery, usually abbreviated as MB BS. The different Latin and English abbreviations may occasionally be combined by certain institutions such that BM BCh and BM BS are also seen. The specific names and abbreviations of the degrees vary with each awarding body and from region to region; this is mostly for reasons of tradition, rather than to indicate any significant difference of level or between the degrees.
The degrees are not offered in the United States, Canada and other countries. The equivalent degree in the United States is the MD or DO. In Canada the MD or MD CM are awarded.

Australia

MB BS are conferred by most Australian medical schools (undergraduate and graduate-entry).
The graduate-entry Flinders medical school confers BM BS.
The University of Newcastle offers the five-year undergraduate degree BMed. Although no degree in surgery is formally awarded by Newcastle, this degree is equivalent to the MB BS, and students may go on to a career in surgery the same as any other graduates in medicine and sugery.

Bangladesh

All medical schools in Bangladesh award MB BS.

England

Several variants of these degrees are awarded in England:

• MB ChB are used at the universities of Birmingham, Bristol, Leeds, Leicester, Liverpool, Keele, Manchester, Sheffield, and Warwick.
• MB BS are used at the University of East Anglia, Hull York Medical School, the University of London, and University of Newcastle-upon-Tyne.
• BM BCh are used at Oxford.
• BM BS are used at University of Nottingham, Peninsula Medical School and Brighton Sussex Medical School
• BM is awarded at the University of Southampton. Although no degree in surgery is formally awarded by Southampton, this degree is equivalent to the MB ChB, and students may go on to a career in surgery the same as any other graduates in medicine and surgery.
• MB BChir are awarded by the University of Cambridge.

At Oxford and Cambridge universities the preclinical course leads to a BA degree (upgradable after 3 tor 4 years to MA), after which most students used to go elsewhere to complete clinical training. They could take the degrees of their new university or return to their old university to take clinical examinations.
The English Triple Conjoint Diploma of LRCP, LRCS, LMSSA was a non-university qualifying examinations in medicine and surgery awarded jointly by the Royal College of Physicians of London, Royal College of Surgeons of England and Society of Apothecaries through the United Examining Board. These qualifications were registrable with the GMC until 1999. Prior to 1994, the English Conjoint diploma of LRCP, MRCS was awarded for over a century, and the LMSSA was a distinct and sometimes less-esteemed qualification.

Hong Kong

The awarding of qualifications in Hong Kong has continued to follow the British tradition despite the handover of the territory’s sovereignty from the hands of the United Kingdom to the People’s Republic of China on 30 June 1997. The dual degree is awarded as:

• MB BS at University of Hong Kong; and
• MB ChB at Chinese University of Hong Kong.

India

All medical schools in India award the MB BS degree under the Medical Council of India and State Medical councils’ regulations. An MB BS is an undergraduate degree, usually lasting 5½ years or more. It includes one year of a compulsory rotating internship. Completion of an MB BS degree is required in order to apply for, and join, a specialised program offering the MD / MS degree. Subsequently further specialisation can lead to DM or MCh degrees.
There used also to be Licentiate qualifications in Medicine and Surgery (LMS) in India, awarded after a shorter course, originally at a “medical school” rather than a “medical college.”
The College of Physicians and Surgeons of Bombay awarded a Licentiate at LMS level, a Membership (MCPS) at MB BS level and a Fellowship (FCPS) at MD level. The State Medical Faculty of West Bengal (previously of Bengal) also gave Licentiates and Memberships.

Ireland

The three degrees of MB BCh BAO are awarded by all medical schools in both the Republic of Ireland and Northern Ireland - namely Queen’s University Belfast, University of Dublin (Trinity College) and some constituent institutions of the National University of Ireland (Royal College of Surgeons in Ireland, University College Dublin, University College Cork and National University of Ireland, Galway).
BAO is Baccalaureus in Arte Obstetricia (Bachelor of the Obstetric Art), which the Irish Universities began to award in the 19th century after legislation insisted on a final examination in obstetrics: however this third degree was not registrable with the GMC.
LRCPI LRCSI, or simply LRCP&SI, denotes a holder of the historical non-university qualifying licenciates awarded jointly by the Royal College of Physicians of Ireland and the Royal College of Surgeons in Ireland to students of the RCSI’s medical school. Unlike the corresponding licentiates awarded by the Royal Colleges in Scotland and England (which were external qualifications), these qualifications are still registrable with the Irish Medical Council. Students at RCSI still receive these licenciates but now also receive the degrees MB BCh BAO, due to RCSI’s status as a recognised college of the National University of Ireland.
The RCSI students also received a Licence in Midwifery (LM) from each college, in the same way that the Irish Universities granted BAO degrees, so their qualifications were sometimes expressed as L & LM,RCPI, L & LM, RCSI or more misleadingly as LLM, RCP&SI.
LAH formerly denoted a licentiate of the now-defunct Apothecaries’ Hall, Dublin, and is no longer awarded.

Kenya

The two National Universities(the University of Nairobi and Moi University) with Medical Faculties in Kenya offer the ‘MBChB’ degree.

Myanmar

All medicine schools in Myanmar award the M.B.,B.S. degree.

New Zealand

The two New Zealand Medical Schools, Auckland and Otago, style their degrees as MB ChB. The New Zealand MB ChB degrees take at least 6 years after commencing university study depending upon graduate or undergraduate entry.

Pakistan

All medical schools in Pakistan award MB BS. as per the Medical and dental council of Pakistan. An MBBS is an undergraduate degree, usually lasting 5 years.

Scotland

All medical schools in Scotland award MB ChB. The University of St Andrews awarded MB ChB until the early 1970s, but since the incorporation of the medical school in the new University of Dundee, the University of St Andrews now only awards a pre-clinical BSc or BSc (Hons), and students go elsewhere to finish their training, usually to the University of Manchester for an MB ChB.
The Scottish Triple Conjoint Diploma of LRCPE, LRCSE, LRCPSG (earlier LRCPE, LRCSE, LRFPSG) is an old non-university qualifying examination in medicine and surgery awarded jointly by the Royal College of Physicians of Edinburgh, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, previously through a Conjoint Board and from 1994 through the United Examining Board. These qualifications were registrable with the GMC until 1999.

South Africa

The University of Pretoria, University of Cape Town, University of the Free State, University of Stellenbosch and MEDUNSA all award MB ChB, whereas the University of the Witwatersrand styles its degree as MB BCh. All South African medical degrees are awarded under the auspices of the Health Professions Council of South Africa and take at least 6 years to complete.

Singapore

The only medical school in Singapore, the Yong Loo Lin School of Medicine, confers the MBBS degree.

Wales

All medical schools in Wales award MB BCh.

West Indies

All constituent countries of the University of the West Indies confer the MBBS degree due to the historical affiliation of the University of the West Indies to the University of London.

Classification of degrees

The degrees of MB BS are rather difficult to classify. They can be received both after an undergraduate course, which lasts five or six years in addition to one year of practice as a pre-registration house officer (PRHO), or after a graduate course which lasts 4 years in addition to one year of practice as a PRHO (which now, in the UK, incorporates the first year of Foundation Training following the initiative “Modernising Medical Careers“), having previously obtained an undergraduate degree of a good class.
The degrees differ from other undergraduate degrees in that they are professional qualifications which entitle bearers to a guaranteed position upon receipt. This is not the case with other undergraduate degrees, so whilst the MB ChB are undergraduate/graduate degrees, they are perhaps more accurately conceptualised as a so-called ‘First Professional’ degree.
It is a general/ordinary degree (not an honours degree), and as such one is not awarded 1st class, 2:1 etc. as one does for honours degrees. At some institutions (for example the University of Manchester) it is possible for the degrees to be awarded with Honours, i.e. MB ChB (Hons) etc., if the board of examiners recognises exceptional performance throughout the degree course. Very few of these are awarded.
More often, it is possible to study one subject for an extra year for an honours BSc, BMedSci, BMedBiol or similar: as with the Oxford and Cambridge BAs. At a few universities most medical students obtain an ordinary degree in science as well: when the University of Edinburgh had a six year course, the third year was followed by award of an ordinary BSc (Med Sci).

Progression

Graduates of these degrees are entitled to use the title Doctor, and are eligible for membership of professional institutions (such as the Royal College of Physicians after sitting further postgraduate examinations, as well as being eligible to submit research for the awarding of the degree of MD or DM.
At some institutions it is possible to study for the degree of Master of Surgery (ChM, MCh, MChir or MS), and the possession of a medical degree is normally a prerequisite for this. There is also a similar Masters degree in Obstetrics (MAO) in Ireland.

Stylisation

The degrees of Medicine and Surgery are sometimes stylised more formally, when abbreviated as M.B., Ch.B. / M.B., B.S.

Lipoabdominoplasty: A New and Improved Tummy Tuck

Lipoabdominoplasty provides an alternative to patients weighing their options between liposuction and abdominoplasty. It combines traditional tummy tuck with aggressive liposuction for a more sculpted, sleek and defined look.

Author:
A Aaronson
For patients weighting their options between a tummy tuck or liposuction in the abdominal area, new technology exists to provide the best of both worlds using lipoabdominoplasty.
Lipoabdominoplasty is a revolutionary procedure which combines the traditional abdominoplasty (tummy tuck) procedure with aggressive liposuction to achieve a more sculpted, sleek and defined look in the abdominal area. There are a variety of benefits in choosing lipoabdominoplasty over stand alone liposuction or abdominoplasty procedures.
Lipoabdominoplasty surgery has considerably less complications than traditional liposuction or abdominoplasty alone, including a lower rate of seroma, less postoperative numbness, a shorter scar and quicker recovery due to reduced swelling, bruising and pain. Best of all, the recovery time can be as short as ten days for patients concerned with an absence from work or sitter issues.
This procedure is ideal for those looking to lose weight and tighten the stomach area at the same time. With liposuction alone, fat deposits are permanently removed, but the procedure does not address the issue of loose or hanging skin following dramatic weight loss. Stretch marks may also cover the surgical area, leaving a slimmer, but aesthetically unappealing look to the abs.
The tummy tuck, however, does address the issue of loose skin, but does nothing to remove the layers of fat below the surface. Loose or unappealing skin is simply removed to create a tighter and sleeker look in the stomach area.
Alternatively, lipoabdominoplasty combines the two procedures to remove excess fat using liposuction while tucking and sculpting the abs for a more sleek and toned look. The patient is able to achieve the best of both procedures with minimal complications as detailed above.
The procedure itself is relatively straight forward and starts with aggressive liposuction of the entire abdominal area. The patient will be sedated intravenously and given a local anesthetic solution near the area of incision. Typically two small cuts will be made in the abdominal area to create minimal scarring following lipoabdominoplasty surgery.
After the liposuction is complete, the skin below the umbilicus is removed (similar to a traditional tummy tuck); however, the lymphatic vessels will remain intact to reduce postoperative swelling and pain during the healing process. Next the upper abdominal skin flap is undermined and the rectus muscles are placated. Finally, the surgical site is closed with multiple layers of dissolvable sutures to reduce the occurrence of postoperative scar spreading.
As previously noted, the recovery time can be as little as ten days, as pain and swelling are less dramatic than what accompanies a traditional tummy tuck or liposuction procedure.
Lipoabdominoplasty can also be combined with other procedures such as the liposuction of hips, back and extremities, breast augmentation or facial surgery for those considering a more “complete makeover”.
To find out if lipoabdominoplasty is right for you, consult with a well respected plastic surgeon that has significant experience and training in this area. Future plans and goals (such as anticipated pregnancies, dietary and exercise concerns) should be addressed during the initial consultation to provide the most accurate assessment of your plastic surgery needs.

About Author

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Article Source:
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