Should medical school be shortened to 3 years?

I was very happy 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 programIn 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.

Joyce Ho is a medical student who blogs at Tea with MD.  She can be reached on Twitter @TeawithMD.

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  • Dr. Drake Ramoray

    I have long felt that the undergraduate requirement for medical school could be shortened. I went to the same medical school as undergrad and a good portion of the first year material were the same topics even taught by the same professors.

    I agree as for the clinical years they shouldn’t be shortened. I didn’t decide on my specialty until well into clinical experience and was actually a personality daily life aspect (I chose Endocrinology over Oncology and Radiation Oncology (talk about deciding against your financial interests!!)). Less Kreb’s cycle perhaps (especially or at least of other topics in undergrad), and the same if not more clinical time.

    • NPPCP

      That sounds really reasonable. More experience, less repetitive sciences. Experience is the greatest teacher. I know as a physician you know the old saying that I heard from so many med students as an ICU nurse – “see one, do one, teach one.”

  • Allie

    When I compare my 4th year with my parents 4th year 40 years ago, they were working as 4th years at a level expected of me as an intern. I was not prepared to practice medicine in even the most rudimentary way when I graduated (despite AOA, honoring most things, and matching into the holy grail of competitive specialties). Making medical school more like NP/PA schools is not the direction we want to go. There are schools with harder 4th years than mine, and individuals who do more rigorous things; but, overall, strengthen 4th year, don’t take it away.

  • goonerdoc

    Wait, you think that students going into primary care should have LESS education? Are you kidding me?

  • Arbi Khodadadi

    C’mon Joyce, really?
    Maybe things can be shifted around basic science to clinical, but things are getting more complicated and the knowledge base necessary is not shrinking.

    And throw in making things “humane,” in terms of duty hours and work load, I can pretty much guarantee that more, not less, years will be needed in the future.

    You will agree with me once you have practiced a few years.

  • Thomas Luedeke

    Curious what y’all would think about an accelerated program for students interested in primary care? Could it be done without a degradation int he quality of the education and training?

    Obviously (as has been discussed at length on this site), the problems with PCP are related to government policy, insurance company policy, and relatively poor pay (thanks, AMA RUC!!). Given the desperate need for more PCPs, shortening the overall duration by a year would help ameliorate the debt that accumulates so badly for physicians.

    One of the reasons I’m curious about this is that I’m an older non-trad seriously considering a career change into medicine (from nuclear engineering). I would think that non-trads like myself might be inclined to go into FM/IM and provide primary care if the duration were shortened by a year, which improves the overall economics (obviously this would only be one factor, and probably not a dominant one – but $50K is $50K…)

    I agree with the article and the comments that clinical experience should not be short-changed – it is critical. My thought is to provide a mechanism for potential PCP medical school students to enter an accelerated program a year early, take compressed/focused classes that you’d otherwise have to wait around for (e.g. organic chemistry), and start the clinical experience a year early.

    Thoughts??

    • Allie

      Organic chemistry are premed courses, required before you go to medical school, not medical school courses. One year programs to get the premed requirements done exist at several schools. I think non-traditional students are the least served by shortening the pre-clinical years. Places like Duke with 1 year pre-clinical are fine for people who were very driven in college to take as many of the medical school or medical school like classes as they could. But, for people who have broader interests or more diverse backgrounds, who are often better suited to primary care, those classes are essential because haven’t seen it all before.

      • Thomas Luedeke

        Hmmm. I guess I hadn’t considered the existing accelerated pre-med programs when writing my comment. It seems like from my perspective an increasing number that are interested.

        I’m certainly not suggesting that classes like organic chemistry should be skipped, but rather it should be provided sooner by an accelerated program that would get PHP candidates into medical school a year sooner.

        • Allie

          Getting into medical school faster is a totally different discussion to me than shortening med school itself. i think the current problem with the accelerated programs is they are usually offered by expensive private schools.

  • Matthew Mintz

    The major problem is the interview/match process. Pre-clinical can be done in a year and a half. Core clerkships plus electives can also be done in a year and a half. However, because residency has become so competitive, students spend a 2 months (sometimes more) for interviews. In addition, many students do away electives as a way to audition for potential programs. The student doing orthopedic surgery doesn’t really need 3-4 months of orthopedic surgery electives during medical school, but most will do this because they feel they need to in order to match. Until you change the match process and/or increase the number of residency slots, it will be difficult from a practical standpoint to shorten medical school.

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