Time-variable medical education innovation in context

Abstract

Background: Medical education is undergoing robust curricular reform with several innovative models emerging. In this study, we examined current trends in 3-year Doctor of Medicine (MD) education and place these programs in context.

Methods: A survey was conducted among Deans of U.S. allopathic medical schools using structured phone interview regarding current availability of a 3-year MD pathway, and/or other variations in curricular innovation, within their institution. Those with 3-year programs answered additional questions.

Results: Data from 107 institutions were obtained (75% survey response rate). The most common variation in length of medical education today is the accelerated 3-year pathway. Since 2010, 9 medical schools have introduced parallel 3-year MD programs and another 4 are actively developing such programs. However, the total number of students in 3-year MD tracks remains small (n=199 students, or 0.2% total medical students). Family medicine and general internal medicine are the most common residency programs selected. Benefits of 3-year MD programs generally include reduction in student debt, stability of guaranteed residency positions, and potential for increasing physician numbers in rural/underserved areas. Drawbacks include concern about fatigue/burnout, difficulty in providing guaranteed residency positions, and additional expense in teaching 2 parallel curricula. Four vignettes of alternative innovative and relevant curricular initiatives are also presented in order to place 3-year MD programs in a broader context of medical education reform in the U.S.

Conclusion: Three-year MD pathways are the most common accelerated alternative available at a small number of medical schools for highly selected students. Long-term evaluation of these programs will be essential to determine if these programs are meeting their goals (e.g., increasing the number of physicians in rural/underserved areas). Benefits and shortcomings of such programs should be carefully examined when considering this approach, or others described, as part of MD curricular options designed to individualize medical education.

Keywords: 3-year MD; curriculum; medical school; medical students; pedagogy; reform.

Figure 1

Number of residency programs offered to 3-year MD program graduates. Notes: *There are 4 additional medical schools (University of California at San Francisco, University of Colorado at Denver, University of Minnesota, and University of Utah) that participate in EPAC as another form of accelerated MD/residency programs for pediatrics (see text). **Other residency specialties offered by 3-year MD programs include the following: anesthesiology, dermatology, emergency medicine, neurology, neurosurgery, ophthalmology, otolaryngology, pathology, physical medicine and rehabilitation, plastic surgery, podiatry, radiation oncology, radiology (diagnostic and interventional), thoracic surgery, urology, and vascular surgery., Abbreviation: EPAC, Education in Pediatrics Across the Continuum; Ob-Gyn, Obstetrics and Gynecology.

Figure 2

Alternative accelerated and decelerated medical education programs by medical school.* Notes: *Numbers shown represent years for undergraduate degree + MD degree. Two medical schools have both 2+4 and 3+4 programs and are counted twice. Medical schools with multiple 3+4 programs were only counted once. Abbreviation: EPAC, Education in Pediatrics Across the Continuum.

Figure 3

Reason given by Deans for their medical schools focusing on 4-year curriculum.