I was very happy this morning to come across a new article in The Washington Post discussing the pros and cons of shortening medical school education to three years. This article could not have come at a more timely moment for me, as I just had a discussion about this very topic last week with one of my fourth year medical student colleagues. Sitting in her Chicago condo as she completed modules for an online elective on Disaster Medicine, we thought about what rotations we had left. I have only two months of school left from now until I graduate on June 14th. My friend only had a few remaining as well, and one of those was going to be a self-structured research elective. Thinking about the rest of my classmates, I realized that most of us were finished with medical school rotations by February or March of our last year, and that is considering the fact that Stanford requires us to take December and January off to schedule residency interviews. Point is, if we were smart about scheduling rotations, most of us in our last year of medical school could be done 6-8 months before graduation.
The Washington Post article told the story of an older gentleman who was accepted into a three-year fast track program at NYU Medical School, and guaranteed a spot in the competitive neurosurgery residency program. In a time where median debt for med school grads is $175,000, getting one year’s reprieve from paying tuition is a huge bonus. Not to mention a guaranteed spot in such a competitive residency program! It sounds too good to be true. In actuality, programs have been doing this for years, just not necessarily the guaranteed residency spot. Duke’s model is one year basic science training, one year in clerkships, and then two years devoted to research and clinical electives. UPenn is also 1.5 years basic science preclinical training, followed by research and electives. Their graduates have in no way suffered from this curriculum; they are just as competitive as graduates of 4 year programs.
At Stanford, we are encouraged to take 5 years. I’ve learned on the interview trail that this is definitely not the norm at most other medical schools. The reason why >50% of my class is graduating with me this June after 5 years is simple. Having an extra year of research, an extra degree, or in my case, an adventure in medical journalism, gives us more time to explore what field we want to pursue and to gain a competitive edge. For competitive fields such as plastic surgery, dermatology, or ophthalmology, you are definitely at an advantage with an extra year’s worth of experiences in that field. I can see why having a guaranteed spot in a competitive residency is needed for programs with a three-year medical school track.
I think completing medical school in three years would be very difficult, but not impossible for the right type of student. Dr. Fuchs, a Professor of Economics and Health Research Policy at Stanford, wrote in a JAMA article,
“The important patient care skills can be obtained in less than 2 years of clinical training…It is not difficult to eliminate one year of medical school training (1/2 year of preclinical and 1/2 year of clinical training) without adversely affecting academic performance.”
I partially agree. Preclinical education, in my opinion, can be shortened by 6 months. Easily. But in terms of clinical training, for a younger medical student who does not know what field to go into, having a fourth year allows him or her to explore different options, which is critical. For a medical student applying into a competitive field, having a fourth or even fifth year helps him stand out from the pool (unless he has a guaranteed spot as discussed above). But for an older medical student who already knows what he or she wants to do, there’s no reason to have an extra year with electives and research time. And for students going into primary care, especially ones with a background in health (nurses, PA’s, etc.), training can definitely be accelerated to match the huge need for an increase in the primary care workforce.
I personally loved taking 5 years in medical school, because my additional year helped shape my life perspective and what I want to do in the future. I went straight from college to medical school, and for me, a three year medical program would have resulted in burn out. But for a different type of student, a three year track may be ideal.