Yes, medical school could definitely be shorter

Two articles this week—one from the Atlantic and the other from the NYT—deal with a couple of rare modern pilot programs to condense medical school into three instead of four years for a small number of students. The Atlantic article in particular is pretty bad and clearly written by someone who has no meaningful familiarity with medical education in this country. The concern is that shortening medical school will hinder the quality of the education. Of course, this presupposes that the length of training equals the quality of training, which is a fallacy based on nothing so far as I can tell. Of note, most countries in the world do not have an eight-year total premedical and medical school system (ours is an exception).

There are also other programs across the country (and the number is increasing) that are condensing the basic sciences (first two years of medical school) from 2 years to 1.5 years to give more time for clinical exposure. Hell, one of the years at Duke medical school is completely unrelated to the traditional medical school curriculum (you can use it to get another degree or do research). Therefore, even though it’s a four-year degree, only three of those years are used for a traditional medical curriculum. Last I checked, that is not news.

But there’s more than one way to make medical education more efficient. Here are several:

  1. The AAMC premed requirements are currently: one year of biology, physics, English, and two years of chemistry. Many schools tack on additional biology and math requirements. Physics is low-yield. Two years of chemistry is overkill. What if the pre-med requirements that are broad and largely inapplicable to medicine were trimmed, and instead premedical students took basic science courses, say…physiology and microbiology. In fact, some students take these courses already and actually repeat this coursework for a second time during medical school. The premed requirements have not been changed in eons, and they’re a wasted opportunity. You can make any class hard enough to scare people away, it doesn’t have to be a year of “orgo.”
  2. Combine the first and second years of basic science into one cohesive 12-18 month experience as above. A significant portion of second year is spent re-teaching what it taught during first year. Additionally, a lot of school curricula are inefficient and actually teach the same thing across multiple classes because curricula are often insufficiently integrated. In some ways, there is too much material to learn for the Step 1 (the most critical portion of the licensing exam series) and too much information to take in for basic sciences; however, more time just means more time to forget more things. Preparing for the boards is largely a function of a 4-8 week marathon prior to the test.
  3. The fourth year is extremely variable. The minimum requirements that a school must offer to suffice are miniscule, and many students spend very little of this time meaningfully. The fourth year exists essentially for students to make final choices about their residency choice, obtain recommendation letters and do audition rotations, and then interview for jobs. While some students may develop meaningfully during fourth year, many many do not, especially during the second semester.

Ultimately, there are one-to-two wasted years in college that could be used to better effect (and I don’t mean letting people go to medical school after sophomore year of college, which is a separate but reasonable idea; I personally believe a slightly more diverse liberal arts education has value in making well-rounded students). If a portion of the basic sciences were part of college instead of in medical school, the total basic science time could be drastically trimmed. Honestly, most of it could even be a correspondence course. But even keeping the content the same, many schools are moving from a 2-year to 18-month curriculum. If the nation wanted to be extreme, then it would even be possible to begin the residency selection process early, have match day in the fall, graduate in the winter, and start residency after the new year instead of July 1st!

And, let’s say four years is a good length. Fine, fine. But then let’s not fool ourselves and say that the programs shortening the system are likely going to provide worse training. To the contrary, they’re taking advantage of waste inherent in the modern American medical education model: we can simply do more (and less) in four years than we are doing now.

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