<p>So, as for clerkships. I agree they could be streamlined. Some schools out there in addition to requiring the standard five (IM, Surgery, Peds, OB/GYN and Psych) also require neuro, ER, and rural family med rotations. Some schools, I don’t know why, include elective months in the third year, as well as vacation time that can be scheduled as a block (2 or 4 weeks). </p>
<p>If you scrapped all the extra stuff leaving just the big five clerkships that would cut significant amount of time. Then as you said, some clerkships just get ridiculous amounts of time. There’s absolutely no reason why you need to spend 12 weeks on surgery. IM - yeah, I can see that being 12 weeks, but surgery? That being said, I think you could drop all clerkships to 6 weeks and still have a quality educational experience in every field.</p>
<p>IM - 4 weeks inpatient, 2 weeks outpatient</p>
<p>Peds - 3 weeks inpatient, 2 weeks outpatient, 1 week newborn nursery</p>
<p>Surgery - 4 weeks general surgery, 2 weeks surgical subspecialty selective (options could include an “academic general surgery” so that students could make their name known if they were planning on a gen surgery residency)</p>
<p>OB/GYN - 2 weeks Labor and Delivery, 2 weeks outpatient, 1 week GYN Surgery, 1 week GYN Oncology</p>
<p>Psych - 3 weeks inpatient, 3 weeks outpatient (alternatively, 2 weeks Psych Unit, 2 weeks consult, 2 weeks clinic)</p>
<p>Ideally, I’d want every clerkship to have a daily hour long lecture. Use teleconference or whatever to make it happen, but the clerkships where there’s a consistent, defined curriculum work better and are far more educational in my experience.</p>
<p>In terms of call, while med students are covered by work hour limitations, it is a little ridiculous to expect 3rd year students to stay for overnight call. I also question the value of overnight call in most situations, either the student gets ignored, just watches their resident answer their pager, or gets sent to bed at 10pm. Not particularly educational. I had friends who did q4 call for months while medical students, and when it’s for a service you’re not interested in doing, it just makes you end up hating life. So I’d propose that students stay till 10pm or Midnight at the latest. One week of OB/GYN however would be nights because there are way more babies born overnight than during the day (or at least it feels that way). I also think a night of trauma call while on surgery is beneficial. </p>
<p>That would get you down to 30 weeks. If we’d similarly shrunk the first two years to 1.5 (easily doable), throw in 6 weeks for studying/taking Step 1, that would finish all the third year requirements by September of the original third year. </p>
<p>In terms of interview season, there’s plenty of time that could be removed there too. There’s no reason why ERAS opens in August in the present system, but Dean’s Letters go out on November 1st. Especially if some programs out there won’t send out interview invitations until Dean’s Letters are received. Wasted time. Similarly, if the Match Algorithm only takes 6 minutes to run, then there’s no reason why applicants and programs should have to wait 3 weeks to find the results. Run the program, electronically notify everyone, let the med schools print out reports and envelopes and whatever else they want to do for their Match Day Ceremonies and be done with it. Run it on a Thursday, Scramble starts the following Monday, Match Day the Thursday after. </p>
<p>So in our hypothetical restructuring, September - December is for Acting internships/audition rotations/getting LOR’s from clinical faculty. ERAS opens on December 1st, and Dean’s Letters get uploaded that same day. Interviews start first day back in January, run through the end of February, and schools would be allowed to require some sort of rotations during that time, but with the understanding that the time is for interviews. All interviews have to be done by the end of February with Rank Lists due on 11:59pm on February 28th, Match Algorithm runs on first Thursday of March, Match Day is the 2nd Thursday in March. The only thing I might tweak about that is to make it the first Thursday after the first Tuesday of March, so there’s a little breather for Rank Order Lists to be certified/technical issues dealt with. They’d have to upgrade the ROL servers to handle a bigger rush of traffic than what they get even now. </p>
<p>With Match done at the same time it’s always done, the “fourth years” continue their coast out to graduation, and we’ve compressed 4 years into 3. </p>
<p>The only major concern I have with a compacted interview schedule is weather. If there’s only 8 weeks, that really crunches everyone and makes rescheduling harder. However, you could push interview season out farther/Match Day to April if you wanted with no fundamental change of being done by “normal” graduation time frame. I don’t think there’s any appreciable disadvantages in terms of relocation/moving if the Match was done a month later than it is currently, but I didn’t have to worry about things like buying a house, finding a daycare or anything like that.</p>
<p>From a residency program stand point, I think there might be initial concerns about intern readiness, but I think with less “fluff” time, and more recently completed “heavy” academics everything would stay relatively level.</p>
<p>Some schools, those that require their students to do multiple sub-I’s, and multiple ICU months as 4th years would probably cry foul, but other med schools (like mine with no major requirements) would probably welcome the change. </p>
<p>That said, while it’s doable…I would lament the loss of the 4th year. Even at 45k + the huge residency/relocation loan I took out, it was a great, great year. I have one attending who says “everyone should get a 4th year of medical school…even people who don’t to medical school”. It’s a unique time and unlike say, the 3rd year of law school, there actually is some purpose to it.</p>