Thursday, May 10th 2012

Making Medical School Shorter

There has been somewhat of a recent, increasingly popular, move to promote discussion about the length of medical education. Particularly a discussion of the merits of the fourth year of medical school. Medical school breaks down like this, with some minor variations between schools: You spend the first eighteen months to two years in the classroom and then the third year doing a set of core clinical rotations. The fourth year however is less clearly defined, more amorphous. You do elective clinical rotations. For some students, doing particularly competitive specialties a good chunk of fourth year can be spent doing elective in that specialty, boosting their experience and credentials. And for some students who are not sure, at the start of fourth year, what they want to do the beginning of fourth year provides an opportunity to do electives that help decide what these students want to do for their training. But even in such cases a good chunk of fourth year is essentially spent doing peripheral elective rotations often that are, unwanted by the students themselves, and a waste of time.

It is becoming more than a discussion, but a slow reality, for medical schools to start compressing the education timeline.

In the last five years, at least four schools have initiated or are developing three-year programs:

    • Mercer will begin its three-year track at its Savannah campus in June.
    • Lake Erie College of Osteopathic Medicine in Erie, Pa., started its program in 2007 and launched a second three-year track in July 2011 for certified physician assistants who want to become doctors.
    • Texas Tech University Health Sciences Center School of Medicine in Lubbock began its three-year program with nine students in 2011.
    • Louisiana State University School of Medicine is developing a three-year program at its campus in Lafayette. The first class is projected to start in 2014 or 2015, said Sam McClugage, PhD, the medical school’s associate dean for admissions.

Personally, while I enjoyed the free time during fourth year as I prepared for the rigors of residency, essentially all but three months of that year for me were wasted. I did no particularly memorable rotations outside of my neurosurgery ones. I think compressing medical school is a worthwhile idea. It will make becoming a physician more economically viable by reducing the costs of school and it will also make the decision easier as the time committment to a career will be reduced.

Beyond getting rid of fourth year, the first two years can also readily, in many school’s experience, be compressed into eighteen months. Three years is a reasonable goal for medical school. Ideally, as in countries other than the U.S. and Canada, I would love for medical education to be something to pursue as undergraduate work, indepdendent of a complete college degree. It is true most medical schools require only a set of prerequisites and not a formal degree. However, I think there is some bias against students who apply without completing their undergraduate work. That should change. Two years of college, three years of medical school and into resident by 23 or 24 for a traditional student would be an ideal way of training the next generation of physicians.

I think the trend is certainly towards shorter, which is not worse.