2 years undergrad-6 years medical school?

[Bigredmed]

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–Undergrad doesn’t need to become a professional program. 4 years with broad liberal arts is still an excellent idea.

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<p>Agreed.</p>

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–But it does need to have more extensive premedical requirements. Condense organic chemistry to a single semester and add biochemistry. Skip over introductory biology (phylogeny? really?) and add animal physiology. Anatomy and embryology might also be a good idea.

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<p>Absolutely.</p>

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–Condense medical school to two years. The first year is unnecessary with more extensive prerequisites and the fourth year is not worth the time, period. The only difficulty here will be that fourth year is largely taken up with the residency application process, but streamlining that should be a pretty trivial challenge. (You could, for example, have a single designated two-week period for candidates to visit everywhere. It’d be a hellacious travel schedule, but saving the year would be worth it.)

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<p>I think there’s room for streamlining the process, particularly if you consolidate the preclinical years. I feel though that in some ways the opposite is happening, as there’s a movement towards increased clinical experience while pre-clinical and also an increased importance on research, evidence based medicine as well as growing implications in genetics. </p>

<p>However, the idea of removing the 4th year is entirely unfeasible - in particular anything that significantly alters the interview season. While a 2-3 week interview window would work for for fields like Ortho, urology, or many of the other specialties, for Peds and Medicine this is absolutely impossible. You have programs that take 35, 40 even 50 interns a year. With most of the match statistics saying that peds and IM programs tend to need rank 7-9 applicants on their match lists per residency spot, you cannot have 21 days worth of 15 applicants. Most peds programs have 3-4 interview days a week starting from the first week of November through to the end of January. You’d also have a hell of a fuss from anyone doing couples match, where 20 interviews for both partners is not the least bit uncommon.</p>

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–Residencies need to streamline faster. Put everybody through a single “intern” year in either medicine or surgery, but after that the specialization needs to speed up. Putting eventual trauma surgeons through seven years of general surgery residency first is excessive, for example. Putting cardiologists, nephrologists, and all of the other internal medicine specialties through the same three-year track is similarly excessive. Branch them off earlier.

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<p>I think this probably is feasible, but only in the surgical specialties - and you are seeing some of this happening like in the integrated vascular and colorectal programs that are cropping up. In medicine and peds though, I’m not so sure…and I think that there are quite a large number of residents who would absolutely protest a more rapid specialization, as they enter residency with no idea if they wish to specialize or not. The fact that some specialties are involved in the spring match during the 2nd year of residency is already another point of contention. Perhaps it’s because of my future career plans, and because peds intensive care, unlike adult intensive care, is less consultant dependent, I absolutely feel like I NEED to be a great general pediatrician before moving on. However there are opportunities to affect the pediatric training model as peds fellowships are uniformly 3 years in length (required by the American Board of Pediatrics) and are at least 50% dedicated to research activities…there are certainly some fields within peds (developmental, adolescent) where this needs to be changed.</p>

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–In addition to work-hours requirements, Medicare needs to impose work-content requirements. Because residents are free labor for hospitals, they’re often relegated to grunt work. I remember seeing a team of residents poring over a Babelfish translation of foreign medical records – this is not a useful way for them to spend their time. If they’re not learning and they’re not taking care of patients, residents should be at home. Obviously there’s going to be some controversy in terms of where exactly the line is drawn, but a line does have to be drawn somewhere. The current system is unacceptable.

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<p>Absolutely. I don’t know what the trend is for IM programs, but in pediatrics, the development of hospitalist teams is gaining traction. It’s easier for peds though as it’s so much more seasonal in nature. It’s easy to tack on an extra set of faculty during RSV season to take care of the straightforward bronchiolitis cases. </p>

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–Here’s an idea I haven’t thought too much about. Residents need to be paid more. A lot more. That much is true, but I also haven’t really taken the time to look at exactly how much of Medicare’s budget is devoted here – so I don’t have any concrete ideas about how exactly to implement this.

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<p>No argument from me!</p>