Why the Flexner model is outdated for today’s medical schools

During my first year of medical school, I attended a “speed dating” event, where medical students met attendings from various specialties to get a better sense of what we could do with our lives once we graduated. Older physicians consistently remarked that they decided their future during their intern year. One even said that he waited until the end of his internship to decide on otolaryngology.

I, along with my fellow third years, no longer have this luxury of time.

Across the nation, thousands of medical students are planning out their fourth year just two and a half years into medical school, setting up auditions and electives, and hoping we can land a residency in the specialty we want. But just how many medical students have the time to explore specialties they receive no exposure to?

For instance, planning a career in ophthalmology today requires gunning and networking from day one of medical school. Yet, my school provides only a scant week’s worth of ophthalmology three semesters in. How am I supposed to know what I like or dislike if I only see a small sliver of it?

One may argue that there are shadowing options available, but who is to say that these are available at every medical school in every state? And who is to say a student can find a specialty they want to shadow that fits into their core rotation schedule? We have little control over when we have our rotations, and not all of us are at liberty to rearrange them in our favor.

Part of the problem lies with how the “2+2” Flexner model operates: two years of preclerkship are dedicated to the sciences that will be applied during third and fourth year. And that’s assuming that clerkship is entirely dedicated to rotations, just as preclerkship is to the basic sciences.

In reality, an air of impatience permeates the latter. The first half of third year is spent trying to figure out what specialty to try and match in; the second half is spent planning out fourth year relative to said specialty. Then, the first half of fourth year is spent auditioning and interviewing, while the second half is spent waiting for good (or bad) news.

That said, preclerkship exposure to many specialties remains highly limited, barely enough to pique any sort of interest until it’s too late. Even during third year, each school has different core requirements, which further hinder exposure to fields like pathology or orthopedics. Mine, for instance, requires 12 weeks of internal medicine while a neighboring school requires 8.

The Flexner model is in need of evolution; or more radically, complete dismantlement if it is to keep up with continuously changing medical knowledge and practice. Medical education cannot watch as a bystander. On top of this, medical students today face challenging obstacles — high rates of burnout, a growing elderly population with an impending physician shortage, relatively fewer residency spots due to lack of graduate medical education funding, and staggering debt upon graduation, to name a few.

Would you do medicine again if you had the chance to start over? My class president once asked me that, and both of our answers to that question was a quick “no.” On my journey to a medical degree thus far, I have asked many the same, and I have yet to hear an answer different from mine. Maybe my sample size is too small, but I haven’t the time to find out more. I’m spending every last minute dealing with student coordinators.

The author is an anonymous medical student.

Image credit: Shutterstock.com

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