3 year M.D./D.O. degrees with fewer rotations - good/bad idea?

[calimeds]

There are a couple threads on the pre-med forums about programs at LECOM and now Texas Tech being launched that are granting D.O.'s and M.D.'s in 36 months.

We pre-meds can debate about it all we like - but I'd REALLY like to hear from some residents about your opinions. Especially if you are in primary care and could do it over again - would you choose a 36 month program? If so, why? Do you feel that eliminating some rotations to bang out the degree faster would be a worthwhile trade-off? Do you find value in your work today from the time you spent on rotations not related directly to your work?

Do you feel this will water down the medical degrees?

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[Substance]

There are a couple threads on the pre-med forums about programs at LECOM and now Texas Tech being launched that are granting D.O.'s and M.D.'s in 36 months.

We pre-meds can debate about it all we like - but I'd REALLY like to hear from some residents about your opinions. Especially if you are in primary care and could do it over again - would you choose a 36 month program? If so, why? Do you feel that eliminating some rotations to bang out the degree faster would be a worthwhile trade-off? Do you find value in your work today from the time you spent on rotations not related directly to your work?

Do you feel this will water down the medical degrees?

The current medical school framework is severely obsolete. It is operating on recommendations made a CENTURY ago, with very little variation since then.

Three years is enough. The density of the instruction has to increase, and the useless touchy-feely bits need to decrease. Hospital rotations should be more instructive and less scutty for medical students(since residents and doctors should not be doing the scut at all). Diagnostics and anesthesia need to be considered "core" curriculum as much as psychiatry and obstetrics. The past model of instruction is based on the assumption that students will go into primary care, which is outright false in today's world. In fact, more would be gained from a radiology or anesthesia rotation than an obstetrics rotation for most medical students.

 

[lowbudget]

Agree that diagnostics & anesthesia should be core but I don't know how you would squeeze that into a 3 year curriculum. For the 4 yr curriculums that squeeze those in already, they're watered down & already integrated many components like ambulatory IM/FM/Peds.

As dense as you want to make it, people's brains don't absorb all that dense information in one sitting. And so you need repetition, practice, & simulation to make it stick. That require volume & you need volume to see nuances. By doing 1 less year (in the face of an already limited 80 hr work week, in a multi-rotating specialty like family med), you, by definition, reduce your volume. The more you see, the better you get, the more efficient you get. That's your advantage over NPs who lack all that.

6 year program is an economic response to a (private school trained) primary care doc's unfavorable debt to income ratio. It has nothing to do with education, training, or medicine. It has all to do about the money.

 

[dragonfly99]

I think it is a bad idea.

Yes, I think it would water down the degree.
I actually think I learned more in 4th year than 3rd year. 3rd year spent getting scutted out and with most students trying to run around kissing a--. In 4th year I felt the attendings and residents paid more attention to us. Instead of just being focused on grading us, they actually tried to teach us. There is actually a LOT to be learned clinically in 4th year, if you try. I don't really think that 4 years is too long for med school.

I could see a 3 year degree being useful for someone like a PA or maybe even a dentist who was career switching, who could perhaps benefit from skipping certain rotations (or maybe some of the 1st year classes).

I may be in the minority on here r.e. this opinion.

 

[J1515]

Exactly what dragonfly said. 4th year is absolutely required as that is when you learn most of the management skills and reasoning you will use intern year. During 3rd year you are exposed to all this stuff for the first time and you partially forget it or it becomes fuzzy. You see it again 4th year and it becomes permanently engraved in your brain. 4th year is where things actually become fun, as you start to make all the connections and finally begin to have a little confidence in your patient management decisions. If medical students graduated after 3rd year you'd have a bunch of clueless interns who need to have their hand held for the first 8 months of intern year.

Why is everyone trying to dumb down our medical training? Whether it's less resident work hours or less schooling, you need to learn from experience and repetition. If you don't want to go to school for 4 years then become a PA.

 

[Saga1]

McMaster Medical School in Canada is a 3 year program. Their doctors seem to be as proficient as any other. They don't have any sumer holidays and only get 2 weeks off a year I think.

 

[exPCM]

This is a no brainer. You really learn how to be a physician in residency and in practice as an attending so the sooner you can get to residency the better. Some posters here would like to keep the training wheels on the bike longer which ends up just wasting more time.

 

[thedrjojo]

What really needs to change is time spent in undergrad... I think the model in other countries with 6 total years of schooling, undergrad and medical school, is more appropriate. I know some schools have 7 year programs, and almost all of those students are stellar students and have no signs of problems in their medical schooling. I have heard/read about undergrads also looking/going into 3 year programs instead of 4 years...

As for Medical School going to 3 years, it depends on where the cuts come from. It it becomes 1-1.5yrs basic science with no summer vacation (which is 2.5months at my school) and 1.5-2yrs clinical, eliminating some elective time but not all of your advanced clerkships like subinternships, then I think the model could work (I have essentially be taking filler clerkships since November that, while intersting and will help me in residency/future slightly, isn't worth the half of year away from my field).... why are all the posters here assuming that the cut down to 3 years will come from clinical rotations?

Why have pre-med prerequisits if they are just going to reteach the information? Why not make some of the basic science information part of the undergraduate education? In undergrad, I took Molecular Bio, Cell Bio, Physiology, Immunology... all of these overlaps very much with the classes I repeated in medical school... Streamline the whole process and make students only take those courses once.. you can make the MCAT more topical and more consistant with what knowledge is needed for medicine (make it like a Step 0 test instead of a comprehension test... don't test on abnormalities, but on what is normal function, structure, development, etc) and start medical school with Micro, Pathology, Pharmacology instead of Anatomy, etc...

Some cuts can be made clinical years: At my school, our 4th year includes a mandatory 4 week SubI, 4 weeks EM, 2weeks PM&R, and 2 weeks Public Health (3rd year has Ob, Psych, Neuro, FM, IM, Surg, Peds plus 4 weeks elective), and then gives you 26 weeks of electives (10 weeks vacation or time to make up failed clerkships/electives). Cut out the redundancy of requiring FM (since we do outpatient IM, or eliminate outpatient IM) , decrease some elective time and remove any caps from electives (we can only do 16 weeks in any 1 field), and remove some vacation time, and that would cut half a year off the clinical rotations.

 

[peppy]

I think it is a bad idea.
Yes, I think it would water down the degree.
I actually think I learned more in 4th year than 3rd year. 3rd year spent getting scutted out and with most students trying to run around kissing a--. In 4th year I felt the attendings and residents paid more attention to us. Instead of just being focused on grading us, they actually tried to teach us. There is actually a LOT to be learned clinically in 4th year, if you try. I don't really think that 4 years is too long for med school.

I could see a 3 year degree being useful for someone like a PA or maybe even a dentist who was career switching, who could perhaps benefit from skipping certain rotations (or maybe some of the 1st year classes).

I agree with you. I think that it is unfortunate that Family Medicine is being watered down like this. Family medicine is one field where you never know what is going to come through the door, and you can never say for sure what knowledge might come in handy. FM docs who get this abbreviated rotation schedule are missing out on possibly important experiences that could be part of their foundation for what kind of doc they'll be. If you aren't comfortable in a field as a med student, you're less likely to seek out experiences in it as a resident IMO (since the pressure to not look stupid is higher in residency)

 

[ygree001]

Why have pre-med prerequisits if they are just going to reteach the information? Why not make some of the basic science information part of the undergraduate education? In undergrad, I took Molecular Bio, Cell Bio, Physiology, Immunology... all of these overlaps very much with the classes I repeated in medical school... Streamline the whole process and make students only take those courses once.. you can make the MCAT more topical and more consistant with what knowledge is needed for medicine (make it like a Step 0 test instead of a comprehension test... don't test on abnormalities, but on what is normal function, structure, development, etc) and start medical school with Micro, Pathology, Pharmacology instead of Anatomy, etc...

Those classes you took aren't prerequisites. Even biochemistry is only recommended at most schools.
The biggest issue with this is the huge differences in quality of undergraduate schools.

 

[NotAProgDirector]

There is no question that medical school can be compressed into three years. Duke has been doing this for many years -- they do all of the basic science in the first year, and take Step 1 after the first year. Year 2 is clinical cores. Year 3 is pure research. Year 4 is electives, SubI, etc.

Obviously, you could skip the research year and have a three year curriculum which is reasonable. Question is, could everyone handle the workload of all of the basic science in a single year?

The LECOM program looks like they compress basic sci to 20 months, then shave off some from 4th year to make a 3 year program. However they've basically said that the three year program is designed only for primary care.

 

[medsRus]

There is no question that medical school can be compressed into three years. Duke has been doing this for many years -- they do all of the basic science in the first year, and take Step 1 after the first year. Year 2 is clinical cores. Year 3 is pure research. Year 4 is electives, SubI, etc.

Obviously, you could skip the research year and have a three year curriculum which is reasonable. Question is, could everyone handle the workload of all of the basic science in a single year?

The LECOM program looks like they compress basic sci to 20 months, then shave off some from 4th year to make a 3 year program. However they've basically said that the three year program is designed only for primary care.

Don't see why non-primary care won't work. Have to do internship anyways for most specialties...

 

[bleeker10]

Yea the graduates of the program can only go into FP, general peds or general IM. They cannot subspecialize in anything other than geriatrics or OMM for a certain amount of time after residency.

Here is a site showing the breakdown of basic science and clinical rotations for PCSP students.
http://www.mutualgravity.com/dld/djpordioy/pscp-flyer.pdf

If you wanna read about the program, here is an article I found on it

http://www.physiciansnews.com/2009/...curriculum-to-encourage-primary-care-careers/

 

[ccfccp]

The biggest problem I see with this is the lack of elective time. I was pretty fortunate in that I knew what specialty I wanted by second year of med school. I spent the rest of my school time directed towards that goal. Many (I would venture to say most) people weren't that sure of what they want to do. Even if you know what you want, it would still decrease the number of months available to do away rotations (I did two) and get letters of recommendation. This would hurt people interested in anything outside of primary care unless the whole country went to this system en masse.

 

[NotAProgDirector]

.. unless the entire compression is in the 1st year. If you compress the first 2 years into 1, then the clinical years remain 2, and electives are unchanged.

Whether compressing the two basic science years into one is a good idea is a whole other discussion.

 

[lowbudget]

Whether compressing the two basic science years into one is a good idea is a whole other discussion.

If it's systems-based, problem-oriented, no way unless you're recruiting sharp sharp, well-trained kids with really high MCATs. (The shortest I've seen is 1.5 years, but those kids are sharp). If you're discipline-based, maybe, since you can push many of the stuff down to undergrad prereqs as stated above. No way you can recruit non-science majors if you compress basic science. And non-engineering, non-science majors are usually the ones interested in primary care.

1st 2 years are your foundation years. If it's not strong, you may not be able to think independently or solve problems creatively in your clinical training years.

Agree with above that if you don't see it in med school, you're going to try to avoid it in residency.