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Monday, October 21st 2013

The Fourth Year of Medical School Is Unnecessary

Several schools around the country are offering trails of doing medical school in three years, instead of four.

In general medical school consists of two years of true lectures (or increasingly didactics) focused on the rote learning of the science – anatomy and biochemistry and physiology and pathology and pharmacology and the like. This is followed by a year of core clinical rotations in hospitals and clinics. And then, finally, a fourth year of largely elective clinical rotations and considerable time off.

It is that fourth year that is the most questionably necessary. There’s some benefit to considerable elective time to be sure. It is difficult to get a feel for all the specialties of medicine in your short medical school career. And yet, based on a limited view you decide what you want to specialize in in residency. Might I have been more interested in internal medicine if I had gotten a feel for cardiology or heme/onc or have been more interested in radiation oncology or in opthalmology or radiology if I had more than the vaguest sense of those specialties?

The answer might be in continuing to allow some elective time by compressing the classroom time at the beginning of medical school. Several schools already do away with break time in the first two years of medical school and compress the basic sciences into 18 months without losing anything I think.

The fourth year of medical school has a limited contribution to training adequate physicians. It is considered an easy year, a break and reward for the past three. But it isn’t like you’re paying less to attend school in that year. Or that you’re getting any younger in your journey to being a physician. As said, there’s some benefit to the electives you get to do early in your fourth year. But those can probably be preserved somewhat by reducing your time in the classroom.

I think these trail programs of cutting medical school to three years are going to be largely successful and you’re going to see three year medical schools grow enormously over the next generation. It might even be the new norm in my lifetime.