The Merits and Challenges of Three-Year Medical School Curricula

Within the context of major medical education curricular reform ongoing in the United States, a subset of schools has re-initiated accelerated (3-year) medical education. It would be helpful for education leaders to pause and consider historical reasons such accelerated medical schools were started, and then abandoned, over the last century to proactively address important issues. As no comprehensive historical review of 3-year medical education exists, we examined all articles published on this topic since 1900. In general, US medical educational curricula began standardizing into 4-year programs in the early 1900s through contributions from William Osler, Abraham Flexner, and establishment of the American Medical Association (AMA) Council of Medical Education (CME). During WWII (1939–1945), accelerated 3-year medical school programs were initiated as a novel approach to address physician shortages; government incentives were used to boost the number of 3-year medical schools along with changed laws aiding licensure for graduates. However, this quick solution generated questions regarding physician competency, resulting in rallying cries for oversight of 3-year programs. Expansion of 3-year MD programs slowed from 1950s to 1960s until federal legislation was passed between the 1960s and the 1970s to support training healthcare workers. With renewed government financial incentives and stated desire to increase physician numbers and reduce student debt, a second rapid expansion of 3-year medical programs occurred in the 1970s. Later that decade, a second decline occurred in these programs, reportedly due to discontinuation of government funding, declining physician shortage, and dissatisfaction expressed by students and faculty. The current wave of 3-year MD programs, beginning in 2010, represents a ‘third wave’ for these programs. In this article, we identify common societal and pedagogical themes from historical experiences with accelerated medical education. These findings should provide today’s medical education leaders a historical context from which to design and optimize accelerated medical education curricula.

Section: Detailed Historymentioning

confidence: 99%

Comprehensive history of 3-year and accelerated US medical school programs: a century in review

Schwartz

Ajjarapu

Stamy

et al. 2018

“…Some institutions have decreased the entire curriculum from four to three years on the basis of prior training or scholastic achievement/preparedness or in exchange for a commitment to enter a primary care residency [14]. The Family Medicine Accelerated Track (FMAT) at Texas Tech University not only removes the fourth year but provides scholarship funding equivalent to one year of tuition and fees [15].…”

Section: Modern Adaptations To the Traditional Modelmentioning

confidence: 99%

A progressive three-phase innovation to medical education in the United States

Pfeifer

2018

The practice of medicine has changed greatly over the past 100 years, yet the structure of undergraduate medical education has evolved very little. Many schools have modified their curricula to incorporate problem-based learning and organ systems-based curricula, but few schools have adequately addressed rising tuition costs. Undergraduate medical education has become cost-prohibitive for students interested in primary care. In the meanwhile, the concept of a separate dedicated intern year is outdated and mired in waste despite remaining a requirement for several hospital-based and surgical specialties. Described here is an innovative approach to medical education which reduces tuition costs and maximizes efficiency, based on principals already employed by several schools. This integrated curriculum, first suggested by the author in 2010, keeps the current USMLE system in place, exposes medical students to patient care earlier, expands and incorporates the ‘intern’ year into a four-year medical training program, provides more time for students to decide on a specialty, and allows residency programs to acquire fully-licensed practitioners with greater clinical experience than the status quo. Abbreviations: MCAT: Medical college admission test; USMLE: US medical licensing examination

“…Other missions include developing a workforce plan that improves physician geographic distribution through community engagement and collaboration [6]; addressing physician specialty shortages such as primary care and psychiatry; targeting/streamlining training for subspecialties [7]; and focusing on care for specific populations such as Native American or inner city urban poor [8]. The mission may also specifically target the cost of medical training by reducing the overall tuition [3].…”

Section: Align the Accelerated Pathway With The Intended Missionmentioning

confidence: 99%

“…There are two primary models for student admission: direct admission at matriculation or delayed admission, usually within the first months of medical school [5,7]. These models offer unique advantages and disadvantages to both the applicant and the institution.…”

Section: Develop the Admission Modelmentioning

confidence: 99%

“…An administrative assistant to manage logistics, scheduling complexities, and non-traditional deadlines is required for bigger programs; while a smaller, less complex program may get by with less support. Programs that include multiple residency partnerships should identify department specific faculty mentors to ensure that their students are well integrated into the department [7]. …”

Section: Ensure That Sufficient Resources (Personnel Infrastructurementioning

confidence: 99%

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Roadmap for creating an accelerated three-year medical education program

Leong

Cangiarella

Fancher

et al. 2017

Medical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development – meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring – and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public. Abbreviations: CAMPP: Consortium of accelerated medical pathway programs; GME: Graduate medical education; LCME: Liaison committee on medical education; NRMP: National residency matching program; UME: Undergraduate medical education