In this month's Canadian Medical Association Journal Flegel et al suggest the possibility of reducing medical school curricula to three years from four. Dr Wes poo poos the idea on his blog and my initial reaction was the same, but after reading the article and a little reflection on my own experience, I'm no longer so sure.
When I went to med school so many years ago, the government introduced a new program whereby students could apply for a five year med school program after CEGEP, which would be the equivalent of grade 13. That is, no undergraduate degree. It seemed crazy at the time and these young, really young, students seemed very immature during their schooling, at least to the older cohort. They did equally well academically, however, and while it's strictly anecdotal, I don't think you can tell the difference once they finish their specialty training. Now, years later, the majority of the new med students in Quebec enter without any undergraduate degree.
Earlier this year I got a visit from a rheumatologist from Brazil who was thinking of moving here to practice. In Brazil, rheumatology can apparently be done after a family medicine residency rather than a medicine residency. It goes to show that there are many different formulas out there. Who knows which is best.
A three year med school may be the same. Medical education has evolved over these many years and perhaps it's time to re-evaluate even our most basic education beliefs. As mentioned in the article, two Canadian schools have already tried out the three year program for many years now, with no obvious detrimental effects. In fact, decreasing med school does not necessarily mean less training over the course of a medical education. We did increase generalist training from a one year internship to a two year family medicine specialty. Maybe other specialties will take advantage of this change and increase their own residency requirements.
The article did bring up the issue of finances. A three year program would obviously save the government a ton in this country where med schools are highly subsidized, but I don't believe anybody in the medical community would really consider this a valid reason in itself. Med students themselves might be interested though, as tuition rates have skyrocketed since my days. (I think I paid about $2000-$3000 per year!)
Another reason I'm willing to listen is because of the author himself. Ken Flegel was an internist at McGill while I went through my own medical residency. He was a bright man, great teacher and devoted to education. If he thinks a three year program is worth a look, I'll take a look.
Lastly, in the article, the authors are not really recommending a three year curricula but simply asking for it to be studied. Good science , right?