Are three-year MD programs the way to go?
A 3-Year M.D. - Accelerating Careers, Diminishing Debt. Abamson, SB et al. NEJM 2013; 369(12), 1085-1087 The 3-Year Medical School - Change or Shortage? Goldfarb S et al. NEJM 2013; 369(12), 1087-1089
Reviewed by Jack Lazerson and Miriam Bar-on
What are these articles about?
As the physician shortage becomes more critical, there is debate as to the feasibility of shortening the educational process for medical students. These articles provide differing opinions on the issue.
What are the implications?
Shortening of time to graduate will impact several concerns; it will decrease the financial burden for students not only by eliminating one year of tuition and expenses, but it will also add a year of money earning potential. In addition, students will become physicians at a potentially younger age and decrease the age of physicians entering practice. To accomplish this task, medical schools will have to redesign their curricula to accommodate students who can complete the required curricular objectives in a shorter time. Advancement will have to be considered based on concrete attainment of objectives rather than time based advancement. Explicit criteria for promotion at every level will need to be redesigned with a focus on outcomes. Progression into residency and the accompanying process will need to be adjusted as to the specific criteria and experience needed. The next step is further integration with residency programs as to how to accommodate new trainees with potentially less hands-on experience and maturity.
Shortening the time to graduate also suggests that individuals coming out of medical school have not had the opportunities to explore the subtle nuances of not only their chosen specialty, but also medicine as a whole. Although the fourth year is frequently described as “wasted time”, if requirements are imposed, the year has the potential to be an outstanding learning experience.
The fundamentals of any educational process are to facilitate learning in which knowledge, skills and attitudes are developed or enhanced. In the formation of a physician, the medical education system has determined that there is a finite time line from undergraduate medical education through residency and/or fellowship training programs. Over the course of time criteria and preparation for entrance to medical school has varied from requiring multiple types of science courses to emphasis on humanities and some combination thereof.
Editor's note: As the graduate of - and now a faculty member at - one of two Canadian medical schools with a three-year medical degree, I can attest that it is possible to achieve the educational objectives in three years. What is missing, though, is significant time in the summers to earn money, engage in additional electives, and explore various areas of medicine. Anecdotally, the first year pediatric residents from University of Calgary and McMaster University (schools with three-year MD programs) fare just as well as the residents from four-year schools (SLB).