To the Editor:
Re “The Case for Three-Year Medical School,” by Ezekiel J. Emanuel, Emily K. Kim and Vitor B. de Souza (Opinion guest essay, Nov. 12):
The answer to the Trump administration’s move to cap lifetime borrowing for medical and college tuition should not be to reduce the number of years our physicians study, as the authors argue.
It should be to find more creative ways to fund medical education, like using large endowments and philanthropy to make tuition free or affordable (which some medical schools have done), increasing the pay for resident physicians in training and forgiving debt for new doctors who work in underserved areas.
Medical school is intense, and even four years is too short a time needed to learn and understand reams of material, achieve professional identity and acquire complex technical, clinical and communication skills. Doctors need to learn how to help patients deal with illness, loss, ethical dilemmas, end-of-life care, pain, anxiety and despair.
Medical students who wish to become good doctors need robust curriculums, thoughtful mentorship, less worry about debt, real-life experiences and time for development and self-reflection before taking on the enormous responsibility for the welfare of other human beings, their patients.
Nancy R. Angoff New Haven, Conn. The writer is a professor emeritus of internal medicine and a former associate dean for student affairs at Yale University Medical School.
To the Editor:
The authors’ proposal to shorten medical school from four years to three years would certainly cut student tuition and debt. But it would entail another cost: producing undertrained students with insufficient exposure to complicated clinical realities. A mantra we repeat often to our students is, “You need to see a lot of patients to be a good doctor.”
A better way to reduce debt for more students, including those from low-income backgrounds, would be to expand programs that enlist physicians early in their careers to serve in the public sector — in the military, for example, or in federally funded clinics in underserved areas. That service can be used to pay off some or all of their debt.
Rushing students through medical school is not a sound way to respond to the current misguided effort by the Trump administration to reduce federal support of higher education.
Jonathan M. Rosen Stamford, Conn. The writer is an associate dean of medical education at the Larner College of Medicine at the University of Vermont, Connecticut campus.
To the Editor:
Shortening medical school is not the solution.
The final year of medical school is far more than a “costly gap year.” Subinternships, in particular, are crucial parts of medical education, allowing students to acclimate to the tasks of a resident physician. Rotations at other hospitals and elective courses provide crucial depth and experience that are missing in the core curriculums. Cutting electives would disproportionately hurt students who may need more time and exposure to determine their desired specialty.
In addition, doctors have a responsibility to understand medicine outside their chosen specialty. Devaluing these experiences and eliminating the enriching components of the fourth-year curriculum, such as opportunities for research and medical ethics training, are a disservice to students and their eventual patients.
Instead of shortchanging students, we should retain the time needed for a comprehensive education, focus on providing adequate financial aid and forgive student loans for students who choose to pursue primary care. The time invested in producing thoughtful, skilled, kind physicians is time well spent.
Samantha Ratner Philadelphia The writer is a medical student at the Perelman School of Medicine at the University of Pennsylvania.
To the Editor:
I completely agree with the authors’ proposal for three-year medical school programs. I know they can be successful because I am a graduate of the three-year program at Albert Einstein College of Medicine, class of 1977.
Einstein’s program began in 1971, aided by a five-year, $12,157,000 federal grant. Although many of my classmates opted for a fourth year, the majority of us graduated in three years and have gone on to successful careers as clinicians, researchers or both.
We gave up some vacation and had reduced time for electives, but our education in no way suffered. It is time for medical schools to offer this option in their curriculum.
David J. Cohen New York The author is a professor of nephrology at Columbia University’s Irving Medical Center.
To the Editor:
This essay rightly identifies curriculum compression as a solution to rising student debt and physician shortages. As a student at New York University’s Grossman School of Medicine, which has fully adopted a three-year model, I can confirm that this approach works.
A common concern with three-year programs is that they reduce clinical training time. Our students spend the same amount of time in clinical rotations as those in four-year programs. What we’ve condensed is only the preclinical, classroom-based phase to approximately 11 months. The remaining two years provide the same core clerkships, away rotations and electives as most four-year programs.
It makes sense for top schools to pioneer this model. N.Y.U. admits students with the highest grade-point averages and test scores in the country, most scoring above the 99th percentile. Most if not all of these students are capable of mastering preclinical material efficiently. Why require an extra year of instruction when they can demonstrate competency faster?
N.Y.U. is uniquely positioned to lead this reform because our universal full-tuition scholarship eliminates the perverse profit incentive that drives traditional programs. The school can focus purely on what benefits students and the health care system. More medical schools should follow this example and prioritize educational innovation over financial gain.
Joseph Turner New York
To the Editor:
I was surprised that in making their case for shortened medical school programs the authors did not advocate the system used by many countries around the world: a six-year, direct-entry medical program after high school.
Almost all countries in Europe, Asia and South America use this system. While there are a select few so-called accelerated six-year programs in the United States and Canada, they are exceptions to the rule.
A direct-entry, six-year combined undergraduate and medical school system would go even further in addressing the concerns raised by the authors and provide benefits they promote. Simply lopping off one year from a four-year medical school experience is not a solution.
Alexander P. Anthopoulos Elverson, Pa. The author is a physician.
To the Editor:
There is an even older precedent for shortening the length of medical school training to three years, when doctors were urgently needed during World War II. This included my father, who graduated from Johns Hopkins Medical School in 1943. I don’t recall him ever feeling that his education was compromised, although he already had a doctorate in biochemistry at that time.
He went on to have a long and highly successful medical career, including a few years spent as an Army physician.
A. Raechel Hackney Newton, Mass.
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