A Modest Proposal: College to Pediatric Subspecialist in 10 years! Emanuel EJ et al. Shortening Medical Training by 30%. JAMA 2012;307(11): 1143-1144. Letters to the Editor commenting on the above article: JAMA 2012:308(2):133-136.
Reviewed by Christopher B. White
What was the study question?
Can medical training from college through fellowship be shortened without compromising physician competence or quality of care?
How was the study done?
This was not a study but a commentary by two authors from Stanford University and the University of Pennsylvania. Using examples from successful U.S. undergraduate and graduate medical education programs, they argue that the typical journey from high school graduation through fellowship could take just 10 years:
These are minimum requirements, chiefly designed for trainees who aspire to be full--
time clinicians. Those who desire to do research or pursue more electives would
require more training.
What were the results?
Lots of letters to the editor!
What are the implications of this study?
Shortening college and medical school would result in a substantial cost savings to students (a growing problem internationally). The shortened time required for physicians in the "pipeline" to complete their training would result in younger physicians and a more rapid impact on the national physician shortage. Shortening residency and fellowship training might result in more coverage gaps at night in teaching hospitals. It might also decrease the number of subspecialists and physicians choosing a career in academic medicine.
The authors make a good case, but so do those responding with letters. The authors have done a great job of putting out a bold proposal for national discussion. Given the current costs of medical training and medical care in the U.S., the ideas in this short paper will hopefully spark serious discussions by the LCME, ACGME and AAMC.
Editor's note: The article, and the subsequent letters to the Editor, will hopefully spark a conversation about admission criteria, the strategic goals of a medical education (What exactly are we trying to accomplish during medical school and residency? What sort of physician are we trying to create?), and the role of individualized learning in UG and PG settings (SLB).