Question:  I’m writing a paper for my careers class and I would like to know what training is required to become a transplant surgeon.

Answer: Becoming a doctor in the U.S. generally implies graduating from a 4-year college followed by 4 years of medical school. During the third year of college students take a standardized test called the "MCAT" (Medical College Admission Test) and apply to medical schools. After graduating from college, usually with a bachelor’s degree, medical school begins.

Medical school is 4 years long and generally begins with classroom teaching in the "basic sciences": anatomy, physiology (how the body works), biochemistry, microbiology (the study of infectious diseases), pharmacology (the study of medicines and drugs), neuroscience, and pathology (the study of human disease).

The later years in medical school involve clinical rotations where the student observes doctors taking care of patients and learns physical examination and basic procedures. These rotations include internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, neurology, and may include specialties like radiology, emergency medicine, ophthalmology, etc.

After graduation from medical school the student is granted an MD degree and the title "doctor." The training is not over yet, though.

After medical school comes internship, which last for one year. Internship may be an integrated part of a training program in a particular discipline like general surgery or internal medicine, or it may be a "rotating internship" which includes training in several areas of medicine like pediatrics, obstetrics, internal medicine, emergency medicine, etc. Rotating internships are usually required before training programs in anesthesiology, radiology, pathology, ophthalmology, and other specialties.

Internal medicine is a residency that is 3 years long and usually includes an integrated first year internship. To become a specialist in a field of internal medicine, such as cardiology (heart disease), nephrology (kidney disease), Gastroenterology (diseases of the gut), etc., one does a fellowship that is 2-3 years long after completion of a residency in internal medicine. Some specialists also become "subspecialists" by doing additional training in specific areas such as "transplant cardiology," (the care of heart transplant patients), or hepatology (the care of patients with liver diseases or liver transplants).

Pediatrics is similar to internal medicine in that the residency takes 3 years. Specialists in pediatrics also do additional training in pediatric cardiology, pediatric nephrology, etc.

Surgical training begins with a residency that is 5-6 years long and usually includes an integrated internship the first year. Surgical residencies include neurosurgery (brain and nerve surgery), orthopedics (bone surgery), ophthalmology (surgery on the eyes), otolaryngology (surgery on the ears, nose, and throat) and general surgery (all other parts of the body not covered by the surgical specialties listed above).

Some surgical specialties require a full 5 year training in general surgery prior to their 2-3 year long fellowship training. Examples of this kind of training include plastic surgery, transplantation (usually kidney, liver, and pancreas), thoracic surgery (surgery on the chest, heart and lungs, including transplants), pediatric surgery, and trauma surgery.

Dr. Punch is a transplant surgeon at the University of Michigan and a member of the C.L.A.S.S. Scientific Advisory Committee.