Academic medical centers can help adapt to dramatic changes in health care by offering accelerated study to selected students so that they receive a doctor of medicine degree (MD) in three years rather than the traditional four, according to educational leaders at NYU School of Medicine.
In a Perspective essay in this week's New England Journal of Medicine (NEJM), the educators describe how a three-year medical degree, a radical rethinking of medical education, can increase the number of productive years clinicians and physician scientists spend in the workforce, as well as reduce student debt.
The educators argue that for highly qualified applicants, the three-year degree can be an effective counterbalance to ever more extensive training periods, which now average 10 years for some sub-specialties, without sacrificing quality. NYU School of Medicine began offering a three-year medical degree pathway for selected students this year.
"This article presents a compelling argument that a more effective medical education process is needed," said lead author Steven B. Abramson, MD, vice dean for education, faculty, and academic affairs and chair of the Department of Medicine at NYU School of Medicine. "We are hopeful that this article will encourage continued discussions focused on restructuring medical education to meet the changing health care needs of the population." In addition to Dr. Abramson, authors include Robert I. Grossman, MD, dean and CEO, NYU Langone Medical Center, and Dianna Jacob, RPA, MBA, vice president, Faculty and Academic Affairs.
"A four-year program for all graduates made sense when postgraduate training lasted two or three years. Now, residencies and fellowships routinely extend the postgraduate period to six years or more, which means that many physicians don't enter practice until their early or mid-30s," says Dr. Abramson. "Indeed, data from the American Medical Association show that since 1975, the percentage of physicians under the age of 35 has decreased from 28 percent to 15 percent."
The essay describes how it has been more than 100 years since Abraham Flexner proposed the current model for medical education in North America -- two years of basic science instruction followed by two years of clinical experience. Cutting the average duration of medical training, they note, by approximately 30 percent -- partly by eliminating one year of medical school -- can be accomplished without compromising physicians' competence or the quality of care provided. While the three-year pathway can also reduce student debt by 25 percent, the educators acknowledge the challenges that a three-year pathway poses and say that shortening medical school education is "just one approach to address the need for change in the Post-Flexnerian era."
"We are at a point of inflection whereby alignment of training across the levels of medical education with regulatory standards and our health care delivery system is critical to train physicians and physician scientists who are passionate care providers across specialties," said Robert I. Grossman, MD, dean and CEO at NYU Langone. "In the years ahead, developing a uniform set of milestones and competencies that assess physicians throughout medical school, residency, fellowship and ultimately clinical practice will be a major task for medical educators."
- Steven B. Abramson, Dianna Jacob, Melvin Rosenfeld, Lynn Buckvar-Keltz, Victoria Harnik, Fritz Francois, Rafael Rivera, Mary Ann Hopkins, Marc Triola, Robert I. Grossman. A 3-Year M.D. — Accelerating Careers, Diminishing Debt. New England Journal of Medicine, 2013; 369 (12): 1085 DOI: 10.1056/NEJMp1304681
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