<p>There are programs that exist in which the 4th year of medical school is in effect substituted for an extra year in residency. Students apply for it during their third year of med school, and if accepted, have their tuition for their 4th year of med school paid for, plus receive a regular stipend (though not quite as much as a ‘regular’ resident would). You don’t get your diploma any sooner, as you still graduate with your original class, but you get in to relevant clinical experience that much sooner with the benefit of reducing your overall cost of attendance by 25%.</p>
<p>At my medical school, the program was available to students going into either Internal Medicine or Family Medicine. As mentioned before applications are done as M3’s, so one of the other benefits is that you save the time, expense and hassle of going through the Match as you are guaranteed a spot in the residency program after the M4 year. Thus the program is ideal for students who knew what they wanted to do, knew they wanted to stay in-state/close to home/not force a spouse to relocate/etc, and were looking for a way to reduce their debt. </p>
<p>The resultant 4th year is designed by the program directors to include a mix of Hospital Wards/outpatient clinic, along with exposure to other specialties that might otherwise take up elective time (like radiology) if one were to enter the “standard” residency program. It’s not quite as intense as a true intern year, but certainly more work than the typical 4th year of medical school. My friends and other residents I knew while a med student who did it, were generally very happy they did, and a lot of them ended up doing some really cool things as upper level residents that wouldn’t have been possible in a standard residency. Major, long duration medical mission trips were pretty common, as were some interesting research projects. HOWEVER IT IS VITAL TO POINT OUT THAT THIS DID NOT SHORTEN THE LENGTH OF TIME THEY SPENT AS A RESIDENT. In other words, they didn’t “gain” an extra year. They still had to complete 3 years of “Graduate Medical Educaton” so really, they were putting 3 years of training into 4. If they were, for example in the MD Class of 2009 (like me), they will finish being residents in 2012, just as I will. </p>
<p>The program was certainly not for everybody. Personally, even if they had a Pediatrics version of this, I wouldn’t have touched it with a 10 foot pole. It’s definitely one of those things that you have to be the exact right type of person, and have the right goals for it to be something to even consider.</p>
<p>As for the viability of completing an MD in three years…I find it extremely, extremely, extremely difficult to shortchange the timeline unless, like the Texas Tech program, there was a residency spot waiting for you at the end. The biggest barrier to an accelerated program is the Match as the system is set up for it to take an entire year (from July when the application service opens to mid-March when results are revealed). That takes up such an overwhelming amount of time during the 4th year of med school, that the only answer is to remove it entirely from the process by getting the student into a residency spot before 4th year even approaches.</p>
<p>As for the rest of the curriculum, you can’t shortchange 3rd year clinical clerkships in any way, shape, or form. I suppose, you could limit the length of the standard clerkships (pediatrics, surgery, Psych, OB/GYN and Internal medicine are the Big 5, while other clerkships like Family med, Neuro, and ER depend on the school and not necessarily required every where). Limit it to those 5, make them six weeks a piece, instead of 8 - though many departments would howl, and many MANY students would be upset about the lack of exposure to subspecialty fields - and you’re down to 30 weeks in the 3rd year.</p>
<p>First year, remove the summer break, and that frees up 3 months, so our total “saved time” compared to standard curriculum would rise to 22 weeks, remove any spring breaks or extra time from around the winter holidays, and that saves you another 3-6 weeks depending on the school…And then you’re stuck…I just don’t think it’s possible to shave another 6 months off the time line without deleterious effects. Standard 2nd year curriculum for all intents and purposes includes the standard syllabus timeline plus the at least 3-4 weeks at the end for preparation for Step 1…it’s just impossible. Medical students tend to be a whiny bunch anyways and it’s not like the first two years of med school are walks in the park. They are certainly some of the most intense years of my life (miserable too, I’m not sure you could pay me any amount of money to relive those two years of my life - I’d happily repeat intern year or the third year of med school, but M1/M2…not going to happen). And I have a feeling that a schedule that would make those years any more harried would result in riots or mass suicides.</p>
<p>Further, any school that did attempt this without some sort of guaranteed residency position already in place would be doing a disservice to patients and the students. I think patient care would definitely suffer and graduates of this school would be unprepared for intern year compared to their peers. As for the students, despite putting them through hell, it would prevent a great many from finding the right field of medicine for them, as well as likely result in lower Step 1 scores, thus decreasing their competitiveness for a great many specialties. </p>
<p>Okay, wow, that was long. I guess that’s what happens when I’m in the middle of flipping to a week of Night shifts…middle of the afternoon, can’t sleep, but definitely sleep deprived after having worked 36 of 57 hours since 6am Saturday (one 24 hour shift, then a 12) in the PICU…</p>
<p><strong><em>EDIT</em></strong>
- Maybe, just maybe, if you took the approach that some schools have where the preclinical years are compressed into 3 semesters instead of 4, and you allowed 1 clerkship to slip into the beginning portion of “4th year”, it could work. There are still a lot of issues, but from a timing standpoint it could work while maintaining the integrity of applying for the Match…still would suck A LOT though…</p>