An Interview with Dr. Joshua Cohen
We overestimate what we can do in a day,
and underestimate what we can do in a year.
Does medicine interest you, or perhaps all the research that goes into helping those in need? What does it actually take to become a licensed anesthesiologist or psychiatrist?
I asked Dr. Joshua Cohen, who earned his MD and PhD in neuroscience at the University of Alabama at Birmingham. Now a resident in psychiatry at the University of California, San Francisco, Dr. Cohen's schedule is packed with days at five different clinics, meeting with both young and old patients, as well as days where he focuses solely on research and more classes to supplement his residential program.
When asked what he did as a high school student, Dr. Cohen explained how he had been interested in biology in high school, which spurred him to get his CPR certification. Following this, Cohen was qualified to intern as an EMT, and while visiting homes with the ambulance squad, grabbing materials, and helping patients, Dr. Cohen explained to me how he was especially interested in the psychiatric patients, how while "with patients who had a heart attack, you would fix them up and you might not see them for the next couple years, you might see psychiatric patients every couple of weeks with the same symptoms and behaviors."
As Cohen puts it, "I was incredibly interested in how the brain worked and what made these patients act the way they did."
After college, Dr. Cohen enrolled in a dual program where he simultaneously researched both the genetics of anxiety (among other papers) and graduated medical school. Keeping up with such a busy schedule, Dr. Cohen explains how he did it and all the roads he took in order to arrive today, a training psychiatrist at UCSF.
This article will be focusing only on obtaining one's Doctor of Medicine, or MD, degree in allopathic medicine, not your Doctor of Osteopathic Medicine, or DO, degree. While most do not have recognize a distinction in knowledge in either degrees, it can be noted that the MD degree is the more traditional degree, adhering to the Hippocratic Oath, after the Greek physician Hippocrates, named the "father of medicine" for establishing the first medical schools recorded in history.
Before getting your MD degree, you must go to medical school. To do so, all applicants must have an undergraduate degree and a passing score on the Medical College Admission Test, or MCAT. Now given to students in more than 19 countries, the MCAT was first administered in 1928.
The MCAT is a four-section test scored out of 528, three in scientific knowledge -- Chemical and Physical Foundations of Biological Systems (59 questions, 95 minutes), , Biological and Biochemical Foundations of Living Systems (59 questions, 95 minutes), and Psychological, Social and Biological Foundations of Behavior (59 questions, 95 minutes) -- and finally one in reasoning skills, called the Critical Analysis and Reasoning Skills portion (53 questions, 90 minutes). In total, including breaks, the test is a day of 7 and a half hours of testing, and in 2021, there were only 31 testing locations around the entire United States.
After taking the MCAT, students must apply for medical school. While no score is considered "pass" or "fail," it is ultimately a college's decision to accept students based on their MCAT score, which is usually a score of 500. This momentous day, called Match Day, was on March 19 this year.
From medical school, there are different parts that students must complete, even after graduating from the program and earning their MD degree. At the Duke University School of Medicine, first-year medical students take courses on the basic sciences, first with the 23-week Human Structure and Function course that runs from August to January. This course includes classes on histology (different types of cells and their functions), gross anatomy (visible structures of tissues and organs), neuroscience, and physiology. After a 2-week winter break, classes resume with the Body and Disease course, another 21 weeks in microbiology, immunology, pathology, and pharmacology. Simultaneously, students also take other courses about how to apply their knowledge in a clinical setting, from using computer human simulations, hypothetical situations, speaking with medical practitioners, and learning about health disparities. By June, first year students get a 6-8 long week break until August when they come back for their second year.
In the second year of medical school, students prepare for Step 1 of the USMLE. In order to earn your Doctor of Medicine (MD) degree, you must pass the multi-step United States Medical Licensing Examination (USMLE), also known as the board exam. Step 1 is mostly on the topics learned in the first year of medical school, a day-long multiple choice test on basic scientific principles. Additionally, second year students have the opportunity to participate in clerkship rotations, in general medicine (8 weeks), surgery (8 weeks), obstetrics (childbirth) and gynecology (diseases in females) (6 weeks), pediatrics (6 weeks), family medicine (4 weeks), psychiatry (4 weeks), neurology (4 weeks), and radiology (4 weeks). During this year, students also get to pick around 2 subspecialties to observe.
By third year, there are no more two-month long summer breaks, as third and fourth year medical students must study for Step 2 of the USMLE, which is a two-day test on both knowledge and application of scientific facts. Day 1 consists of the Clinical Knowledge, or CK, test which is a 318-question multiple choice test, and Day 2 is the Clinical Skills, or CS, test which consists of diagnosing human simulations. By passing the Step 2 portion of the test, medical students may graduate medical school with their Doctor of Medicine degree.
But alas! These doctors still are unable to independently practice medicine without passing the final portion of the USMLE, Step 3. In order to become medical practitioners, doctors must complete what is called a residency in a clinical setting where they shadow medical practitioners and take additional classes. Step 3 is also two days, one in clinical knowledge and another with clinical skills. Only upon passing Step 3, doctors can finally complete their residencies and become independent medical professionals. And for Dr. Cohen, each day is packed with appointments with patients, meetings with other professionals in different subfields (such as social workers, neurologists, primary care physicians, etc), and classes.
Finally, some doctors continue to take on additional training, called fellowships, in order to go into subspecialties, such as neurophysiology or emergency medicine. For doctors, each part of school is tiring and complex, and each day, they work toward a world better cared for, putting other people's needs in front of their own.
I'd like to thank Dr. Cohen for collaborating in this project on medical school and sharing his own experience as a resident at UCSF. Thank you all to the hardworking medical heroes working throughout the COVID-19 pandemic, and please stay safe!
For more information, this article was based on information from the Duke University School of Medicine, United States Medical Licensing Examination, and the Association of American Medical Colleges (AAMC) websites for students and residents.
