✚ Shorten med school, but not overall training

This past week, the Washington Post published an article detailing some recent efforts to shorten med school to 3 years. The illustrious Dr Cranquis weighed in with his usual acerbic, dead-on commentary.

Pauline Chen MD took on this issue back in October in the NY Times, primarily in response to point-counterpoint essays in the NEJM. As with this most recent article, it generated quite a bit of commentary. One of the most thoughtful and informative pieces I read in response to Dr Chen’s article was from Josh Freeman MD, a professor of Family Medicine at my own institution and graduate of a 3 year med school program.

One lesson I’ve taken to heart in medical school is that good education takes time. In order to truly learn something, you have to read and think about it, breathe it in and live it [1]. Doing so takes time. The implication of this is that appreciably shortening the time to train a doctor will likely be difficult.

However, just because shortening total training length seems unwise or difficult does not mean we still can’t reform the structure of medical training. Ideally, I think we should shorten medical school to 3 years but lengthen residency training to 4 years (which would maintain 7 total years of training for most specialties). A greater emphasis needs to be placed on premed education so that basic science education can be completed in the first year of medical school. Some of this can spill over into the clinical training in second and third year. For example, intense anatomy education with time in the cadaver lab seems better suited to occur during a surgery rotation rather than 1–2 years prior. Basic clinical training—which now occurs solely in the 3rd—could be spread over two years.

In terms of residency, such a schedule could help cope with the increased focus on limiting work hours and patient safety. Residencies would have an additional class to help with patient care. The interns would gain more active patient care experience while the senior residents will have additional time supervising trainees.

Our current training paradigm poorly allocates time. Nearly everyone in medical education will agree that active patient care is where the most useful and longest-lasting education occurs. Instead of blindly trimming a year off of training, let’s reallocate that time to more useful education and contribute to taking care of our ever-increasing patient population. [2]

  1. This is why the bulk of medical education (3rd &4th year of med school + a minimum of 3 years in residency; 5 of 7 years) is hands-on, seeing and learning from real patients.  ↩

  2. Will such a restructuring ever happen? Almost certainly not; it would disrupt the current economics of medical education too much. Medical schools would get one less year of tuition and residency programs would have to find ways to support an additional class. Residency programs can’t even find money to expand their classes to cope with the increased number of med students. How are they ever going to deal with a seismic shift like adding a full residency class?  ↩