Should we shorten medical school?

We have been training physicians the same way for a century, ever since the famous Flexner Report of 1910. That report was commissioned by the Carnegie Foundation in an attempt to improve medical education. Up until then many medical schools were simply terrible. Many were proprietary schools, owned by doctors and run for profit rather than education. Many doctors met their first actual patient after they graduated.

During the decade following Flexner report these proprietary schools either closed or merged with universities, becoming the institution’s medical school. Within a fairly short time the model of medical school as a four year course divided into two preclinical years (studying basic medical science) and two clinical years (learning to treat patients) was the standard. We’ve been doing it that way ever since.

There have long been calls to change this. Various schemes have shortened the usual eight year process of four years of college followed by four years of medical school, usually by shortening the college part. A recent op-ed in the New England Journal of Medicine renews the call for shortening the process, this time by making medical school three years instead of four. A counter-point essay follows, arguing to keep medical school at four years.

What do I think? I think the arguments for shortening medical school are beside the point. Two of the main reasons the advocates give are to reduce student debt and lengthen the useful practice careers (by one year!) of doctors. The latter, they write, would improve the doctor shortage. But really, if the problem is student debt, there are many direct ways to address that. Likewise, if one thinks we need more doctors, then train more.

I think we should keep medical school at four years. There is already far more to learn than can be learned in that period, so shortening things would only make it worse. There is also the maturation factor; to function as a doctor you need how to think like one and act like one. That takes time — I’m still learning at age 61. Lopping a crucial year of the process is not the answer.


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