The 3-Year Medical School — Change or Shortchange? — NEJM

19 Setembro 2013

Excerpts from a text published in this week's edition of NEJM:
"Shortening medical school to 3 years, some observers argue, would increase the supply of physicians — perhaps particularly primary care physicians — and reduce the cost of medical training, without compromising clinical care. Data from many years of experiments in shortening medical education, however, suggest that doing so is unwise — a conclusion supported by assessments of the readiness of today's medical school graduates to assume increased clinical responsibility as they enter residency programs. There may be exceptional students capable of accelerated learning and small programs that create unusual opportunities for such students, but we believe that for the typical student seeking an M.D. degree, the duration of medical school should not be shortened."
(...)
"In addition, access to global health experiences; instruction in medical ethics, principles of patient safety, and health policy; and advanced clinical experiences are extremely valuable components of the current fourth year. Moreover, there is a recent trend toward students' seeking even longer terms for medical school, with the opportunity to gain additional credentials, including master's degrees, certificates of added competence, and prolonged research-training experiences. All these activities speak to students' sense of an expanding leadership role for physicians on future health care teams."
(...)
"To better prepare students for residency, we believe that more intensive clinical experiences in both outpatient and inpatient settings are needed and that innovative advising and mentoring programs should be created to enhance the transition to residency. Given the growing complexity of medicine, it seems counterproductive to compress the curriculum into 3 years, reducing both preclinical and clinical experiences. The limited opportunity for students to participate meaningfully in patient care during their undergraduate careers is the problem that needs correction; the solution is not to rush students into residency after allowing them even less involvement with patients."
(...)
"Teams of physicians, nurse practitioners, physician assistants, and pharmacists can develop new paradigms for delivering higher-quality clinical care, even with a predicted shortage of primary care physicians. Physicians may need even more advanced education — in health policy, public health needs, clinical research, and medical ethics — in order to lead such teams. (...) That requires enhancement, not shortening, of medical school."
- Interview with Dr. Richard Schwartzstein on the pros and cons of three-year medical school programs.

Copyright © 2013 Massachusetts Medical Society. All rights reserved.

This makes us think about today's Brazil experience. Shortage of primare care providers? Changes in medical education, not all of them very wise? Worries about medical students competence? It's all the same, here and there. The solution is never simple, and should not be pursued or decided unilaterally.