Three-Year Medical School Has Benefits, Ethicist Says

This transcript has been edited for clarity. 

Hi. I’m Art Caplan. I am at the NYU Grossman School of Medicine in New York City. As it happens, I want to mention some interesting developments at the place where I work, at the NYU School of Medicine. 

Some time ago, as many of you know, NYU was an early entry into the decision to make the school tuition free. That obviously attracted many students; there was great enthusiasm about the idea that maybe medical school could be made tuition free, and other schools have tried to emulate that since that decision some years ago. 

We also have been involved in an interesting experiment, and some information and data have come out that I think are very exciting and important in thinking about how long you should be in medical school, how fast doctors can be created, and even lowering costs further by going to a 3-year medical program as opposed to the current 4-year program.

We have instituted an accelerated 3-year program guaranteeing residency to any of our students who took it, and we now have some data that have been collected on the outcomes comparing our 3-year students with our 4-year students. 

Although some students in the accelerated program didn’t perform quite as well on the Step 1/Step 2 licensing exam, what we have seen is that by the time they got to Step 3, the accelerated students actually did better. 

This comparison also showed that there were comparable clinical reasoning skill outcomes among the 3-year and 4-year students. Nothing showed up that was statistically different about who was selected to be a chief resident between the students that were involved in the two programs over what is probably by now 6 years of looking at this. Clerkship exams, board subject exams, and peer assessment scores were all statistically basically equivalent between the two programs.

If you’re interested, this is all reported in a recent issue of Academic Medicine, where you can see the data. 

What does this really mean? I think it means an accelerated medical school curriculum can be instituted. It’s efficient, it’s cost-effective, it prepares students sufficiently for residency, and it doesn’t cause any compromise in the quality of the education and preparation that the students get.

We need this because, obviously, we’re starting to hit a doctor shortage as many doctors are thinking about retirement or have retired. We’ve got to get more doctors out , and this will accelerate that. 

It lowers the cost, so if you’re not at a tuition-free or heavily tuition-subsidized school, this is a way to get through medical school with less debt, and that’s important in attracting diversity into the pool of those who become physicians.

I think it’s also important because if you wish to add a fourth year to a 3-year program, you can also encourage students to take degrees outside of the medical school for a year before they start residency. There is more time to get that master’s degree in business administration or even maybe a bioethics degree, although I have a self-interest in promoting that. Nonetheless, there are more options for those students who would like a whole year out to pursue a supplement to their medical school education.

I think this is great, interesting news that ought to be discussed and ought to be the subject of whether or not others should follow in the NYU path. The results look great. There was no damage to anybody who did the 3-year program, so it’s really something to think about. 

I’m Art Caplan at the NYU Division of Medical Ethics. Thank you for watching.