New York Times: Should Medical School Last Just 3 Years?:
Sandwiched between three mind-numbing years of basic science courses and hospital rotations and the lockdown years of residency training, the fourth year of medical school has long been a welcome respite for future doctors. It is the only time in their medical education when students have few requirements and a plethora of elective course offerings – and the time to go on vacation and spend time with friends and family.
I read two perspective pieces in The New England Journal of Medicine on eliminating the fourth year of medical school.
For several years, medical educators have been engaged in an increasingly heated, and occasionally cantankerous, debate about streamlining medical education and training. Many experts have suggested lopping years off the residency training process, but surprisingly few have argued for similarly dramatic changes in the medical school curriculum.
Established over a century ago as part of a sweeping change
to a chaotic collection of schools, apprenticeships and fly-by-night
training programs, the four-year medical school curriculum is the sacred
cow of medical education. Like soldiers in lockstep, nearly all medical
students over the last 100 years have spent their first two years in
lecture halls learning the theory and basic science of medicine and
their third and fourth years on the wards learning the practical
clinical applications. Apart from a few short-lived experiments
during World War II and in the 1970s to shorten the curriculum to three
years, not even the most radical of educational reformers have dared
stray from the norm, carefully integrating their changes well within the
venerated four-year framework.
But now it appears that the convergence of physician shortages,
rising health care costs and student debt has begun to tip this hallowed
heifer. In 2010, responding to the physician shortage, Texas Tech
University Health Sciences Center School of Medicine began offering a
three-year medical school track for select students interested in
primary care. Soon thereafter Mercer University School of Medicine’s
campus in Savannah, Ga., followed suit; and this fall, New York University School of Medicine welcomed, in addition to its traditional four-year students, its first group of students to pursue a three-year option.
Proponents believe that the three-year programs will help address
several pressing issues. By producing doctors faster, three-year M.D.
degree programs help to address the critical doctor deficits projected over the next 15 years. And with almost two-thirds of medical students graduating with $150,000 or more of educational debt and more students entering medical school at an older age, the three-year option allows students to begin practicing sooner and with as much as 25 percent less debt. ...
But critics are quick to point out the failures of past attempts to
do the same. In the 1970s, for example, with support from the federal
government, as many as 33 medical schools began offering a three-year
M.D. option to address the impending physician shortages of the time.
While the three-year students did as well or better on tests as their
four-year counterparts, the vast majority, if offered a choice, would
have chosen the traditional four-year route instead. Many who completed
their work in three years were exhausted by the pace of accelerated
study; and as many as a quarter asked to extend their studies by a year
or two anyway.
The most vocal critics were the faculty who, under enormous
constraints themselves to compress their lessons, found their students
under too much pressure to understand fully all the requisite materials or to make thoughtful career decisions.
The three-year experiments were quickly abandoned.
(Hat Tip: Ralph Brill.)