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How to Correctly Prescribe the Duration of Antibiotic Treatments

Just this week the World Health Organisation WHO has issued a warning that resistance of organisms to antibiotics will become one of the biggest challenges of the upcoming decade. Indeed, the correct prescription of antibiotics is crucial for successful treatment and the WHO states that completing the full length of the treatment is just as important.

But what is actually the correct length of treatment for all the different antibiotics and diseases? How many ward rounds on ICU’s have I spent with microbiologists (the maybe most important specialists on our sides!) wondering on how they always had a straight answer on the correct length of treatment. 7 days, 10 days or sometimes 21 days… a little mystery to most intensivists, until now!

Hitchhiking though the the wide space of the internet I finally found secret to this question. Back in the year 2010 Paul E. Sax, a Professor of Medicine at Harvard Medical School him self, posted an excellent blog for the NEJM Journal Watch website. Inspired by a New York Time article by Harvard Professor Daniel Gilbert he finally gave insight into one of the great mysteries of medicine:

To figure out how long antibiotics need to be given, use the following rules:

  1. Choose a multiple of 5 (fingers of the hand) or 7 (days of the week).
  2. Is it an outpatient problem that is relatively mild?  If so, choose something less than 10 days.  After application of our multiples rule, this should be 5 or 7 days.
  3. Is it really mild, so much so that antibiotics probably aren’t needed at all but clinician or patient are insistent?  Break the 5/7 rule and go with 3 days.  Ditto uncomplicated cystitis in young women.
  4. Is it a serious problem that occurs in the hospital or could end up leading to hospitalization?  With the exception of community-acquired pneumonia (5 or 7 days), 10 days is the minimum.
  5. Patient not doing better at the end of some course of therapy?  Extend treatment, again using a multiple of 5 or 7 days.
  6. Does the infection involve a bone or a heart valve?  Four weeks (28 days) at least, often 6 weeks (42 days).  Note that 5 weeks (35 days) is not an option — here the 5′s and 7′s cancel each other out, and chaos ensues.
  7. The following lengths of therapy are inherently weird, and should generally be avoided:  2, 4, 6, 8, 9, 11, 12, 13 days.  Also, 3.14159265 days.

In this highly data-driven exercise, it is imporant also to note the number of rules — seven, as in days of the week.

That did not occur by chance

Wow, not much more I can add!

Source 

A Guide to taking a Psychiatric History

A good history is a fundamental part of any diagnosis. There are some areas like Psychiatry however, where taking a good and thorough history can be more of a challenge for a medical student. The purpose of taking a Psychiatric History can split into three main things;

  • Diagnostic
  • To gain a biopsychosocial understanding of the patient’s problem
  • Therapeutic & psycho-educational

Although while taking a history the structure may appear disjointed, the end result is usually under a set of headings which have a worldwide similarity.

The basic components of a Psychiatric History that I’ll use here are;

  • Identification
  • History of Presenting Complaint
  • Systems Review
  • Past Psychiatric History
  • Past Medical History
  • Family History
  • Personal History
    • Childhood
    • Occupational
    • Psycho-sexual
    • Drug & Alcohol
    • Forensic
  • Pre-morbid Personality

The key to psychiatric assessment is a comprehensive history & mental state examination.
A Primer of Clinical Psychiatry.

Please note this guide does not include everything that you should ask in a  Psychiatric History, but rather some components that I feel are key. It is also assumed that you are familiar with taking history’s in general, and this post just highlights the salient features of a Psychiatric History. A typical psychiatric interview can take 40 minutes or more.

Identification
Name, age, occupation, marital status, etc
Refereral: By Who, Why, When

HPC – History of Presenting Complaint
(in patients own words – including duration)

  • How are you? How long have you been here?
  • Why are you here? Why did you seek help?
  • Current Symptoms: onset, stressors, duration & course
  • Sleep: currently, changes over time?
  • Appetite: normal / increased / decreased?
  • Memory & concentration changes?
  • Current Mood:
    • Rate from 1-10.
    • Classify: Anxious? Depressed? Obsessional? Psychotic?
  • Screen for relevant events: e.g. recent death of a loved one, back from a war, etc
  • Details of any help-seeking behaviour.

SR – Other Psychiatric Symptoms
Much like doing a Systems Review for organic causes of disease, it is important to go through a check-list of other Psychiatric Symptoms, noting the positive & negative findings.

For example, a patient with an exacerbation of psychotic symptoms could also have depression in conjunction, and possibly suicidal ideologies.

It can also be useful to ask your standard Systems Review questions to rule out any organic causes of the patient’s presentation.

PΨHx – Past Psychiatric History
Full details are required of past psychiatric illnesses (e.g. depression, anxiety, etc)
Things to particularly ask about;

  • Admissions: How many? What for? How long?
  • Self-harm/Suicide attempts
  • Treatments: medication, psychotherapy, etc
  • Adverse reactions or events due to treatments
  • Support:  regular GP/Psychologist

PMHx – Past Medical History
Past medical history is useful to ascertain the general health of the patient. In particular, chronic medical conditions can often cause a decrease in the quality of life for that individual, which can manifest as psychiatric symptoms. Other points of interest;

  • Hospitalisations
  • Surgeries
  • Allergies, medication sensitivities and current medication (note those with psychiatric side-effects)

FHx – Family History
Many psychiatric disorders have a genetic component and the biological family history is thus relevant. It can also be useful in guiding treatment and management. It can be useful to draw a genogram with the patient.

Collecting information from other family members can sometimes allow you to develop a clearer picture.

Personal History
When taking a personal history it helps to map out the patient’s life in a longitudinal manner.

Childhood: Birth, development (e.g. motor, verbal & social milestones), family atmosphere? Happy or Sad childhood?

School: Enjoyed? Got on well with others? Other schooling? Truancy? Academic/sporting endeavours?
Drug & alcohol use during these years?

Occupation: Level of education completed? Jobs? How long? Why did they leave? Unemployment?

Psychosexual: Puberty (attitude towards & onset)? Sexual orientation? First experience? Relationships (past & current)? Marriage? Pregnancies?

It is also important to get a good grasp of the individual’s current life situation.

Drug & Alcohol History
Although Drug and Alcohol history can be considered part of Personal History, it requires special consideration as patients will often avoid discussing this topic. It is important to ask about alcohol, tobacco and common recreational drugs (e.g. marijuana).

Investigate: first exposure, patterns of use, effects, withdrawal symptoms, impacts on life, failed treatments or quitting attempts.

A common non-threatening screening tool for assessing alcohol abuse is the CAGE Questionnaire. It can also be adapted for other drugs.

Two “yes” responses indicate that the respondent should be investigated further. The questionnaire asks the following questions:

  • Have you ever felt you needed to Cut down on your drinking?
  • Have people Annoyed you by criticizing your drinking?
  • Have you ever felt Guilty about drinking?
  • Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

Forensic History
Forensic history should be obtained in a non-threatening way (e.g. have you ever been in trouble with the law?). A history of any misdemeanours and any consequences (e.g. prison) should be attained.

Premorbid Personality
Premorbid Personality may assist in diagnostic clarification and provides insight into what strengths/reserves the person may have. A good lead into this is, “What sort of person were you before you developed X?”

Other aspects to investigate:

  • Attitudes to others (social, family, etc) and to self.
  • Predominant mood
  • Hobbies & interests
  • Reactions to stress

References

  • A Primer of Clinical Psychiartry (2010) by David Castle & Darryl Bassett
  • Oxford handbook of Psychiatry (2005) by David Semple, Roger Smyth & Jonathan Burns
  • Ewing, John A. “Detecting Alcoholism: The CAGE Questionnaire” JAMA 252: 1905-1907, 1984

Top Online Resources for Medical Students

As medical students we are constantly bombarded by information at university. We are then expected to go home revise and further extend our knowledge. One strategy towards our self directed learning is to whip out our textbooks and delve into the lines and line of text and static imagery. Online resources are the alternative, they provide interactive and dynamic content and allow us to access information in a much greater variety of ways. The problems of information overload then really start to begin.

Using a selection of quality and informative online resources we can reduce this load, and I hope too today  share some of the resources I and others find particularly valuable in our education toolkit. Please note the list of resources are all freely available, however some more comprehensive options do exist that require payment/subscription. I recommending checking what online resources are provided by your Medical School.

Top 5 Search Engines
Search Engines play an important role in accessing information, but each come with their own strengths and weaknesses. While Google, Bing & Yahoo are fine for general search, they do not always return information that is relevant to the health profession. Consequently, utilising health specific search engines yield better results. These are the Top 5 Search for Health Professionals according toLifeinthefastLane.com. For a more comprehensive overview of each click here.

Alternative

Scirus is the Google for scientific information, currently covering over 480 million science-related Web pages. It’s is not only for medicine but covers a large portion of the science field. Searches can be broken down into Journal sources, preferred web (patent offices, universities, MD Consult and so on) and other web. You can integrate Scirus into your browser by either their Search Toolbar orFirefox extension.

 

Social Media Resources

Medpedia is best described as  a sibling of Wikipedia. A sibling that just happens to know a bit more about medicine and provides the correct information. Medical professionals collaborate to provide accurate information , however only Medical Doctors or researchers with a Ph.D in a biomedical field can edit. This allows everyone to contribute, but ensures the validity of the information.
The feature that is particularly useful for medical students and professionals is that for each entry there is an option for the ‘plain english’ and clinical version. Aside from the wiki, there are also various groups and communities in which you can interact.

Webicina is an aggregator of medical resources, including the best web 2.0 resources. This includes blogs, community sites, podcasts or search engines, among others, that focus on one specific issue. (e.g. cardiology).

Meducation is a community site for Doctors and medical students. At this it is primarily UK-based but contains a wide spectrum of useful medical resources (videos, powerpoints, notes and so on) and practice exam questions. You join by a simple registration process or you can connect via your Facebook account.

Doc2doc is another online community run by the BMJ that allows you to discuss aspects of medicine and puzzling cases. Doc2doc is more suitable for later level medical students as opposed to Meducation.

StudentDoctorNetwork (SDN) is both a community and information site. It covers a wide range of the medical field from audiology through to veterinary. In addition, it has a number of useful tips about coping with student life and career development.

PagingDr is an Aussie medical community.  While it was more of a pre-med community initially, as more of those members have passed through medical education the variety of members has increased (premeds, medical students, interns, and doctors). For a medical student, this community is more about discussing medical student life rather than in-depth case analysis and so on. So for example if you’re worried about getting an intern place or affording medical school, this a good place to look.

Medical Resources
General

  • Medical Dictionary – Not sure what a word means? Check out online medical dictionary for a concise answer.
  • Medical Mnemonics – Struggle to remember the cranial nerves or want an alternative way of learning. Medical mnemonics is a catalogue of mnemonic tools submitted by students and professionals for remembering components of medicine (from Anatomy through to Urology)
  • NCBI Books – A collection of freely available quality books.
  • Lab Tests online –  Want to know what test you need to order, what the results mean or what happens behind the scenes in a pathology lab, Lab tests online answers some of those questions.
  • LearnersTV –  A rich resource of medical video lectures ranging from anatomy, the sciences, heaps of physical examination videos, neurological examinations etc

Clinical

  • Medscape is free resource for students and physicians and provides medical journal articles, drug references news and much more. A useful feature is to sign-up to their MedscapeCME Case Studies. Each week they will send you an email with a Case study to test and challenge your current medical knowledge. An iphone app is also available.
  • LifeinthefastLane Clincal Images & Cases – Provide a wide range of clinical cases per week, and have a great summary of clinical images.
  • MDCalc – Performs common medical calculations used in diagnosis.

Cardiology & Respiratory

Nephrology

Genetics

  • Learn Genetics – Learn.Genetics provided by the University of Utah delivers educational materials on genetics, bioscience and health topics.

Immunology

Histology

  • Shotgun Histology – A selection of videos investigating the histology of different tissues. A highly valuable resource for those who have had no experience in histology.

Microbiology

Pharmacology

Anatomy

  • Grays Anatomy – A timeless resource which features 1,247 vibrant engravings—many in color—from the classic 1918 publication.
  • InnerBody – Covers all body systems from Cardiovascular to Urinary anatomy. Each topic has animations, 100’s of anatomy graphics, and thousands of descriptive links.
  • Instant Anatomy

Surgery

  • Surgical Exam – An online resource for those interested in surgery. Has cases, MCQs, an endoscopy library and much more.
  • The AO Surgery Reference is a huge online repository of surgical knowledge, consisting of more than 7’000 pages. It overviews surgical procedures, surgical decision making, and has an abundance of images and videos.

Embryology

  • Human Embryology – A comprehensive resource developed by a collaboration between a number of Swiss Universities. Would highly recommend.
  • UNSW Embryology – A resource by Dr Mark Hill which contains animations, images, text and links to help you understand how the body develops.

Radiology

Other

  • Anaesthesia MCQ – An interactive resource of tutorials, a forum, exam questions and links pertaining to anaesthesia. Useful for understanding of pharmacology, acid-base system and for GAMSAT or MCAT type questions.
  • Neuromuscular Disease Center (Washington University) – http://neuromuscular.wustl.edu/index.html

Mobile Content

This rounds up the current list of useful medical resources. I will be adding some more as time goes on to the resources section. Feel free to share resources that you find useful.

How to take an Obstetric History

Obstetrics is the field of medicine which encompasses the care of a woman during pregnancy and childbirth. In that way it is very unique, as when assessing these patients, your actually also assessing another the child. Consequently, the approach to history taking in Obstetrics whilst similar to other fields of medicine, includes a number of additional components.

The following is a guide to taking an Obstetric History, that will ensure you miss none of the key components.

Presenting Complaint
What is the problem that brought you to the hospital/clinic?

Some common presenting complaints include;

  1. ◘   Bleeding
  2. ◘   Abdominal Pain
  3. ◘   Hypertension
  4. ◘   Physiological complaints due to pregnancy
The patient may also be presenting as part of standard antenatal care (as per your local guidelines).

History of Presenting Complaint
Often there will be overlap between the history of the presenting complaint and the history of the current pregnancy.

History of Current Pregnancy
The history of current pregnancy should ideally be considered by the different trimesters to date. This will be useful for understanding common issues that arise at each stage, and also determining appropriate antenatal care and management.

General Questions

  1. ◘   Last menstrual Period (LMP)
  2. ◘   Estimated delivery date and approximate Gestational Age.
  3. ◘   Any concerns about your pregnancy
  4. ◘   What are your expectations regarding your pregnancy

First Trimester

  1. ◘   Further details regarding menstrual history (as below)
  2. ◘   Was the Pregnancy planned?
  3. ◘   How was the pregnancy confirmed?
  4. ◘   Signs and symptoms of pregnancy.
  5. ◘   How/has the pregnancy been dated (e.g. dating Ultrasound Scan)?
  6. ◘   What tests and scans have you had to date?
  7. ◘   Current medical illnesses and medications.

Second Trimester

  1. ◘   Any problems during second 3 months?
    1. Bleeding, vaginal discharge, urinary problems and so on.
  2. ◘   Last visit to the doctor?
    1. Has an Ultrasound scan (e.g. morphology scan) been done?
    2. Blood tests to date?
    3. Blood pressure?
    4. Growth of foetus, placenta location.

Third Trimester

  1. ◘   Any issues after the first 6 months of your pregnancy?
    1. Bleeding, vaginal discharge, urinary problems, labour pain.
    2. Blood pressure
    3. Glucose
    4. Test results
  2. ◘   Any plans or ideas about method of delivery.

Past Obstetric History
Gravidity: the number of times a woman has been pregnant, regardless of the outcome.
Parity: the number of times a female has given birth to a baby.

There are many different methods and protocols by which Gravidity and Parity are denoted, please be aware of your local policy and documentation guidelines.

A simple system commonly used in the UK is;

GPx+y
where
G= Gravidity, P = Parity: X = (any live or still birth after 24 weeks);
Y = (number lost before 24 weeks)

A woman who has never given birth is a nullipara, a nullip, or para 0.
A woman who has given birth two or more times is multiparous and is called a multip.
A woman in her first pregnancy and who has therefore not yet given birth is a nullipara or nullip. After she gives birth she becomes a primip.

A woman who has given birth once before is primiparous, and would be referred to as a primipara or primip.

Details of each pregnancy

  1. ◘   Dates of deliveries
  2. ◘   Length of pregnancies
  3. ◘   Singleton/twin and so on
  4. ◘   Induction of labour/Spontaneous
  5. ◘   Mode of Delivery
  6. ◘   Weight of babies
  7. ◘   Gender of babies
  8. ◘   Complications before, during and after delivery

Number of miscarriages, terminations and/or ectopics – with appropriate details.

  1. ◘   This question should be asked as some patients will not consider the above situations as pregnancy.

Any difficulties conceiving and any treatment/management to date for sub-fertility.

Past Gynaecological History
If it hasn’t been so already, you should first gain a Menstrual History as appropriate.

  1. ◘   1st day of last menstrual period
  2. ◘   Duration and regularity of normal cycle
  3. ◘   Flow: heavy/light, clots, number of tampons/pads used
  4. ◘   Pain
Last Cervical Smear (Pap Smear): when and results.
Any Gynaecology Surgery?
  1. ◘   D&C
  2. ◘   Loop excision of transitional zone (LETZ)
  3. ◘   Previous C-Sections
Treatment or investigations for; ectopic pregnancy, pelvic inflammatory disease, infertility
This may be an appropriate place to take a Sexual History (see sexual history for further details).

Past Medical & Surgical History
Current or past illnesses

  1. ◘   Hypertension
  2. ◘   Diabetes
  3. ◘   Epilepsy
  4. ◘   Thyroid (hypo or hyper)
  5. ◘   Thromboembolic disease
  6. ◘   Asthma
Hospital Admissions: when, where and why.
Surgical procedures
  1. ◘   when, where, why and details concerning procedure
  2. ◘   abdominal or gynaecological procedures
  3. ◘   problems with anaesthesia
  4. ◘   problems with bleeding (requiring transfusion) or clotting
Vaccinations/immunisations up to date?

Current Medications & Allergies
Medications can be divided into prescribed medications and non-prescribed medications/herbal remedies. The latter should not be missed, and approached in non-judgemental way.
Allergic to any medications?

Family History

  1. ◘   Medical conditions
  2. ◘   Obstetric complications
  3. ◘   Genetic conditions

Social History

  1. ◘   Occupation
  2. ◘   Relationship Status
  3. ◘   Diet/physical activity
  4. ◘   Smoking
  5. ◘   Alcohol
  6. ◘   Drug use
  7. ◘   Living Situation
  8. ◘   Travel History
References

  1. ◘   ABC of labour care – Obstetric emergencies http://www.bmj.com.ezproxy.library.uq.edu.au/content/318/7194/1342
  2. ◘   Borton, Chloe (November 12, 2009). “Gravidity and Parity Definitions (and their Implications in Risk Assessment)”.
  3. ◘   The Medical Significance of the Obstetric H… [Am Fam Physician. 1983] – PubMed – NCBI.

Free CME Online-Continuing Medical Education

Free CME Online

Free online CME courses are usually sponsored by pharmaceutical companies or device manufacturers. In our listings, we try to identify the sponsoring organization or any affiliation the CME providers may have. As you would imaging, these courses usually deal with the specific pharmaceutical or medical device industry sold by the sponsoring company, but does not specifically identify brands. These courses generally meet the qualifying standards for Category 1 CME courses and therefore qualify for medical CME credits.

PRA Category 1 free online continuing medical education courses are offered by PRIME which are categorized into specialty practice and are augmented with free monthly case studies for physicians. Many of these meet relicensure requirements and are provided free without commercial support. Another major provider of free CME online courses is Medscape. These courses often take the form of “reports” and “highlights” from major medical meetings. The programs are generally of high quality and qualify for Category 1 CME credits. A wide variety of medical specialties (everything fromInternal Medicine CME to Psychiatry CME and Surgery CME) are covered.

There are also a small number of free CME courses provided by medical schools and training hospitals that can be accessed from anywhere. More often, though, CME courses provided by these institutions cost about $25/credit hour. For example, Harvard provides several online CME courses and charges between $20 and $50 per credit hour.

Free CME Course Lists

MedPix: Category 1 CME for physicians and CE for nursing professionals from the Uniformed Services University. One hour of category 1 CME credit is awarded for every 4 “case of the week” completed and after filling out an online survey.

Free Ultrasound CME – this is a catalog of online courses provided by GE and Siemens

Johns Hopkins CME – Hopkins provides online CME courses in a wide range of specialties. Each course is reviewed regularly.

CME courses – the Netdoc database is one of the most comprehensive and easily searched databases of both online CME courses and live or mail CME.

Emergency medicine CME – LLSA: The emergency medicine specialty has shifted to the Lifelong Learning Self Assessment (LLSA) model of recertification. This resource provides links to the LLSA reading list and requirements.

Medicine Board Review – Board review options including courses that offer Category 1 CME credits.

Please note, the editors of studentdoc.com have not reviewed the listed CME courses for completeness or accuracy.

The essential guide to studying medicine at university

Congratulations! You’re going to be a doctor. You will put your hands in places you never thought possible or legal. But first there’s a little learning to be done. A medical degree is an often brilliant and occasionally terrifying experience.

Yes, you will become a hypochondriac. In the first term you will diagnose yourself with cancer and tropical sprue. But If I can get through it, so can you. Here is what I wish I’d known in those first few weeks.

Don’t be Hermione Granger and buy all the books

It is pointless spending £100 on that laminated encyclopedia of functional histology. It will become a doorstop. Massive expensive books are what libraries are for. Spend your student loan on something better, like a hangover. Do get a library card though, those places are open 24 hours and have amazing wifi.

Medicine is a foreign language

Don’t expect to be fluent from day one, the best you can hope for is knowing how to ask for directions. Doctors like to speak in mumbled acronyms and Victorian surgeons’ surnames. But they can do English too. So if you don’t know what something means, ask. All the other clever looking medical students around you will be extremely pleased you did.

Don’t worry too much about the gore

Some medical schools still use cadavers to teach anatomy. The formaldehyde will make you smell of death. But it is the best way to learn, and you will get used to it. I skipped the odd dissection class and it took days of pouring over textbooks to come close to getting the same knowledge. Try to be there even if it makes you feel a bit queasy.

If it’s all making sense you are doing it wrong

The learning curve is the steepest at the very start, so do not be surprised if you are overwhelmed. Everyone is, some are just better at faking it than others.

Don’t pretend you’re a doctor

You are a medical student, not a junior doctor. You will have plenty of time to be terrified by the responsibility once you qualify. Enjoy your access all areas pass to hospitals. If you’re feeling lost, find the special dark den where radiologists live. It’s calm and quiet, and you can pester them for extra x-ray teaching.

Remember that people who are ill are still people

They are not just lung cancer, appendicitis, or schizophrenia. They are exactly like you. It is often only luck and blind chance that is the difference.

Treat nurses with the utmost respect

A wise registrar told me when I first qualified that it would be years before I know more than someone who has worked on the wards for 30 years. Nurses will save you, feed you, and teach you what it really means to work in the NHS. Our healthcare service could not survive without its nursing staff. Show them the respect they deserve.

Get to know people who are studying something else

Medics are lovely, engaging, obsessive, type A personality know it alls, and sometimes you need a break from intense all night discussions about the phrenic nerve.

Do something that isn’t medicine

Your course will get more and more intense as the years go by. Whether you play ultimate frisbee or chess boxing, find something you can pick up and put down that totally distracts you and is completely different from your degree.

Have fun

Study hard, but not too hard. University is about learning all the things, but it is wasted if you don’t enjoy yourself. Good luck! You’ll be great.

Medical study requirements abroad

Studying medicine abroad in Europe is a very competitive, requiring high grades particularly in science subjects as well as a high standard of English. The grade requirements can vary from one university to the other and from one country to other. The minimum requirement for admission to study medicine in UK is three full A Levels, or equivalent. Chemistry is nearly always essential and biology is often a specific requirement. In Bulgaria, the minimum requirement is two A-levels (biology, chemistry or physics).

European medical universities accept International Baccalaureate and European Baccalaureate qualifications. A few medical universities require additional tests such as the UK Clinical Aptitude (UKCAT), the Biomediacal Admissions Test (BMAT) and the Graduate Medical School Admissions Test GAMSAT.

For the admission to study medicine in Europe, some universities requires entrance test in chemistry and biology or of scientific English. For other universities, the personal experience and achievements in the files of medicine is an advantage.

Entry requirements for medical University:  the requirements to get into university of medicine (medicine, dentistry, pharmacy etc.) vary between medical universities, countries and the course applied for. They are Admission requirements, Entry regulations, Language requirements, medical requirements, etc.

General requirements

The following general requirements must be met by all applicants:

Admission requirements: High school diploma (certificate)
Applicants presenting secondary school, Advanced Level of the General Certificate of Education, the International Baccalaureate, or university/college undergraduate credentials will be assessed individually and will be considered for appropriate entry into the medical program. The high school leaving diploma is a mandatory to apply to medical university.  This means that you must have completed 12th Grade in the US/Canada and elsewhere.
UK:  A-level or Advanced Level;  England – General Certificate of Secondary Education ; Ireland –  Leaving Certificate   (School Leaving Certificates ); Scotland –  Scottish Higher/Advanced Higher ; France : Baccalauréat (lycée); American or Canadian – General Education Diploma, General Equivalency Diploma, or Graduate Equivalency Degree; Germany : Abitur; Spain: Baccalaureate (Bachillerato)

Language requirements: To speak English, French, or Romanian or Bulgarian
Medical study guide work only with prospective students who have a decent understanding of the English, French or are ready to follow one year Romanian/ Bulgaria course. In fact, prospective students who do not have enough commend of English or French language can follow one year preparatory year of medicine  in English  or national language(Romanian/Bulgarian )organized by some medical universities. At the completion of the   medical preparatory year the student can start medical university studies.
For post university (Master or specialization) studies, you must be ready first to follow one year course of national language (Romanian/ Bulgarian language course before you start and get Romanian/Bulgarian language certificate. In fact all those courses are conduced in Romanian/Bulgarian language.

Entry regulations: A valid passport
Even if some universities can accept ID card for those students from European union(EU), European union area (EEA) and Switzerland, we recommend all candidate students to have a valid  passport (travelling document) before you apply.

Age limits for university
You must be at least 17 years old at the time of applying to medical university.There are no formal set age limits for entry to medical school and selection and admission policies are matters for individual institutions to determine. However, medical schools will take account of the length of undergraduate course and postgraduate training (at least 9 years) in relation to the length of service the candidate could provide.

Biology, Chemistry, physicas and Maths:
For admission to medical school, the average mark in Biology, Chemistry and/or physics and Maths must be at least 62% for more universities.  But those with less marks can be also admitted taking in account supplementary documents such us recommendation.

Medical requirements (Health state):
The prospective student must be in good health mentally, physically and without daisies incompatible with medical career.

Self finance
You must have your own source of financing your medical studies by student loans, wonderful parents or generous sponsors or other sources.

Additional requirements:

  • University course (if applicable),
  • Letters of Recommendation,
  • Letter of motivation (reasons for wanting to become a doctor),
  • Academic achievements,
  • hobbies and personal interests,
  • Relevant  to health care paid or voluntary work experience e.g. work as a hospital auxiliary, in nursing or residential care, Red cross etc.
  • Computer literacy
  • Communication skills
  • Teamwork skills

The prospective students meeting the above requirements have the chance to succeed getting into medical university on condition of following our guidelines.

Medical study in Europe requires not only academic ability is a pre-requisite for a career in medicine but also a commitment, perseverance, initiative, originality, personal integrity, concern for others, and the ability to communicate are all-essential.  Good academic qualifications are normally required because study medicine is long and intellectually demanding.

The competition to enter a faculty of medicine is very keen so it is important that applicants ensure that they fully meet the entry requirements of each faculty of medicine to which they apply. The applicant’s high school certificate and eventually the type of pre-medical undergraduate degree and institution of study should not deter to apply to any medical school, provided that all academic prerequisites of a given university are met. Not only should applicants plan to meet all academic prerequisites, it is also important to respect all deadline dates. In general, an application or documentation is ignored when received after deadline dates. The incomplete application files are evaluated and rejected.

Assistance and more info:

Earn a Medical Degree (Medicine, Veterinary Medicine, Dentistry, Pharmacy, Physiotherapy, etc.) in English, from leading Medical universities abroad in Europe, low tuition fee and living cost, student loans available for EU/EEA students: Bulgaria, Hungary, Cyprus, Spain, Poland, Czech Republic, Russia, etc.

Medical speciation and training: in Romania, Bulgaria, Poland, Hungary, etc. on condition you follow one year national language of respective country.

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