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Shortening Medical Education

Shortening Medical Education To the Editor: As physicians-in-training, we support the proposal by Drs Emanuel and Fuchs1 to shorten US medical education by 30%. However, further discussion is needed because their suggestions have far-reaching implications. Emanuel and Fuchs argued that shortening undergraduate medical education is one strategy to reduce the overwhelming debt incurred by most physicians-in-training while also reducing unnecessary repetition of experiences. Although this change may benefit traditional trainees, the average age at medical school matriculation is now 24 years.2 Many US students take nontraditional paths to medical school, pursuing nonscience majors, international experiences, and paid employment. Reducing the length of the premedical experience may compromise recent strides medicine has made in diversifying the physician workforce. Moreover, the impending Medical College Admission Test (MCAT) revisions seek to integrate behavioral and social sciences; thus, preparation for the MCAT is speculated to drive increases in undergraduate coursework. On the other hand, curtailing the length of graduate medical education has been possible for years. The change by the Accreditation Council for Graduate Medical Education to competency-based education, which is far more reflective of adult education principles, has been in effect since 2000.3 However, few programs have capitalized on the opportunity to innovate and incorporate these principles into residency training. Graduate medical education continues to approach resident training from a pedagogical perspective using a stepwise, time-in-training approach. Instead of promoting residents in a linear model based on their attainment of certain milestones, the current system promotes residents based on their fulfillment of a certain amount of time spent in a particular clinical setting regardless of achievement (eg, a certain number of months on service). This system aligns with the way children are educated. However, as adult learners, residents can be expected to progress through different learning milestones at different rates. Some may require more time on a service to become competent, while others may have had prior experiences and require less exposure to the topic. Until programs recognize the value of adhering to effective adult learning and funding models are updated to allow for such flexibility based on competency, we believe it will be difficult to shorten residency significantly. Back to top Article Information Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Stull reported being a nonpaid member of the board of trustees for the American Medical Student Association and was previously employed by the association. Mr Brockman reported being on the board and employed by the American Medical Student Association. Mr Duvivier reported no disclosures. References 1. Emanuel EJ, Fuchs VR. Shortening medical training by 30%. JAMA. 2012;307(11):1143-114422436952PubMedGoogle ScholarCrossref 2. Association of American Medical Colleges. Table 6: age of applicants to US medical schools at anticipated matriculation by sex and race and ethnicity, 2008-2011. https://www.aamc.org/data/facts/applicantmatriculant/. Accessibility verified June 14, 2012 3. Accreditation Council for Graduate Medical Education. History of medical education accreditation. http://www.acgme.org/acWebsite/GME_info/historyGME.pdf. Accessibility verified June 14, 2012 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Shortening Medical Education

JAMA , Volume 308 (2) – Jul 11, 2012

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References (10)

Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2012.7022
Publisher site
See Article on Publisher Site

Abstract

To the Editor: As physicians-in-training, we support the proposal by Drs Emanuel and Fuchs1 to shorten US medical education by 30%. However, further discussion is needed because their suggestions have far-reaching implications. Emanuel and Fuchs argued that shortening undergraduate medical education is one strategy to reduce the overwhelming debt incurred by most physicians-in-training while also reducing unnecessary repetition of experiences. Although this change may benefit traditional trainees, the average age at medical school matriculation is now 24 years.2 Many US students take nontraditional paths to medical school, pursuing nonscience majors, international experiences, and paid employment. Reducing the length of the premedical experience may compromise recent strides medicine has made in diversifying the physician workforce. Moreover, the impending Medical College Admission Test (MCAT) revisions seek to integrate behavioral and social sciences; thus, preparation for the MCAT is speculated to drive increases in undergraduate coursework. On the other hand, curtailing the length of graduate medical education has been possible for years. The change by the Accreditation Council for Graduate Medical Education to competency-based education, which is far more reflective of adult education principles, has been in effect since 2000.3 However, few programs have capitalized on the opportunity to innovate and incorporate these principles into residency training. Graduate medical education continues to approach resident training from a pedagogical perspective using a stepwise, time-in-training approach. Instead of promoting residents in a linear model based on their attainment of certain milestones, the current system promotes residents based on their fulfillment of a certain amount of time spent in a particular clinical setting regardless of achievement (eg, a certain number of months on service). This system aligns with the way children are educated. However, as adult learners, residents can be expected to progress through different learning milestones at different rates. Some may require more time on a service to become competent, while others may have had prior experiences and require less exposure to the topic. Until programs recognize the value of adhering to effective adult learning and funding models are updated to allow for such flexibility based on competency, we believe it will be difficult to shorten residency significantly. Back to top Article Information Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Stull reported being a nonpaid member of the board of trustees for the American Medical Student Association and was previously employed by the association. Mr Brockman reported being on the board and employed by the American Medical Student Association. Mr Duvivier reported no disclosures. References 1. Emanuel EJ, Fuchs VR. Shortening medical training by 30%. JAMA. 2012;307(11):1143-114422436952PubMedGoogle ScholarCrossref 2. Association of American Medical Colleges. Table 6: age of applicants to US medical schools at anticipated matriculation by sex and race and ethnicity, 2008-2011. https://www.aamc.org/data/facts/applicantmatriculant/. Accessibility verified June 14, 2012 3. Accreditation Council for Graduate Medical Education. History of medical education accreditation. http://www.acgme.org/acWebsite/GME_info/historyGME.pdf. Accessibility verified June 14, 2012

Journal

JAMAAmerican Medical Association

Published: Jul 11, 2012

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