Medical education in the Philippines primarily offers a four-year Doctor of Medicine (M.D.) degree, qualifying graduates for the national licensure exam. Formal medical training was first established on May 28, 1871, by the Spaniards at the University of Santo Tomas, with the curriculum later evolving to follow an American system. Prospective students must hold a bachelor's degree and pass the National Medical Admission Test (NMAT); foreign applicants are also welcome, though some may require an additional two-year pre-medical program. The M.D. curriculum progressively covers basic sciences in the first year, pathophysiology and early clinical exposure in the second, extensive inpatient/outpatient rotations in the third, and subspecialty rotations in the fourth year. Health professionals educated through this system are a major Philippine export and a significant source of government revenue, with medical schools regulated by the Commission on Higher Education (CHED).