Matter, Energy, and Life of Michael A. Castello.

How I’m Spending the Next Decade

I am still somewhat dumbfounded and incredibly grateful that I got into the MD/PhD program at Loma Linda University. Now that classes have actually started, I’ve noticed the people around me becoming increasingly confused about what MD/PhD actually means in terms of my daily activities. Indeed, the overall plan for how I’ll be spending the next decade of my life gets a little involved. My attempts thus far at summarizing have done little to mitigate the eye-glazing, so I’ve tried to give a full explanation of how all this craziness works.

Medical School

By itself, medical school takes four years to complete, a course of study that can be roughly divided into two sections: preclinical and clinical. Preclinical corresponds to the first two years, where the student completes classroom and hands-on laboratory training in core subjects like anatomy and pathology. The second year culminates in the first of a number of standardized tests: Step 1 of the United States Medical Licensing Examination (USMLE Step 1).

In the second two years, the student receives clinical training in the actual hospital, rotating through each of the medical specialties: Internal Medicine, Surgery, Pediatrics, Family Medicine, Obstetrics/Gynecology, Neurology, and Psychiatry. They are also required to complete some additional elective rotations and, as the fourth year comes to an end , a sub-internship where the student, closely supervised, takes a more active role in patient care. At the end of the third year, the student takes the USMLE Step 2 exam; at the end of the fourth year, they graduate with their M.D.

Despite having an M.D., they’re still not a “real” doctor and can’t independently practice medicine until they’ve completed a residency (the process of getting assigned to a residency program is what is known as “the Match“). In the first year of residency, Post-Graduate Year (PGY) 1, they complete a full internship and take the USMLE Step 3 (This internship year is where the main characters in Grey’s Anatomy and Scrubs start in Season 1). If you stop here, you can practice general medicine, but most people continue their residency to train in a specialty. This ranges from two additional PGYs for internal medicine to seven years for neurosurgery. Finally, a resident who wants to subspecialize will do a fellowship. At this point, you can practice medicine completely on your own.

Graduate School

Graduate school is a little different, consisting of two years of classwork and two or more years of doctoral research. Unlike med school, graduate students are usually provided with a living stipend while in training – once the student selects a lab, this comes out of their mentor’s funding.

In the first year, the student takes classes and completes research rotations in different laboratories with the goal of selecting a doctoral mentor. In the second year, the student continues to take classes and chooses their mentor – this is the lab they will be doing their doctoral research in. At the end of this year, they take a qualifying exam, after which the student is a PhD candidate.

The following years vary depending on how long it takes to complete the research project. PhD candidates must form a thesis committee of established researchers, one of which must be from outside the candidate’s university. This committee acts as the gatekeeper for the next steps, and will ultimately decide when the candidate is ready to receive their doctorate. The candidate will publicly propose their research project, work on it for a number of years, and ultimately give a public defense of their work. Upon receiving their doctorate, the student can go on to employment, or do post-doctoral (post-doc) work underneath another established researcher, continuing to gain experience until they can fill a faculty position at a university.

An MD/PhD program combines the requirements of medical and graduate school, taking approximately twice as much time to complete as either alone. The years can be split up in a number of ways, the most common being to do two years of med school, all of graduate school, and the last two years of med school. LLU starts their students in graduate school, so I am thinking of doing the two schools consecutively: all of graduate school followed by all of med school. After graduating with both degrees, an MD/PhD student can go on to complete a residency, a post-doc, or both.

Hopefully this helps explain some things, but if you still have questions feel free to ask. Here’s a summarized list of everything I have to do to graduate (please excuse the lousy list formatting):

MD/PhD from Start to Finish

Graduate School (PhD)

  • First Year (classes and research rotations) (I am here)
  • Second Year (classes, choose a lab)
  • Qualifying Exam
  • Following Years (doctoral research)
    • Select a project
    • Propose
    • Defend

Medical School (MD)

  • First Year (classes)
  • Second Year (classes)
  • USMLE Step 1
  • Third Year (clinical rotations)
  • USMLE Step 2
  • Fourth Year (clinical rotations, sub-internship)


  • Residency
  • USMLE Step 3
  • Post-Doc

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4 responses to “How I’m Spending the Next Decade”

  1. Andrew Avatar

    Man I’m so glad I just went with a Masters Degree.

    Good luck, my friend.

    1. SteelWolf Avatar

      Thanks, I’ll need it. 😛

  2. […] over the long road ahead of me, one might consider asking, incredulously, why somebody would want to do an MD/PhD […]

  3. tsanko Avatar

    Wonderful ..thanks a lot for posting a good informitive blog

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