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      The Merits and Challenges of Three-Year Medical School Curricula: Time for an Evidence-Based Discussion

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          Abstract

          The debate about three-year medical school curricula has resurfaced recently, driven by rising education debt burden and a predicted physician shortage. In this Perspective, the authors call for an evidence-based discussion of the merits and challenges of three-year curricula. They examine published evidence that suggests that three-year curricula are viable, including studies on three-year curricula in (1) U.S. medical schools in the 1970s and 1980s, (2) two Canadian medical schools with more than four decades of experience with such curricula, and (3) accelerated family medicine and internal medicine programs. They also briefly describe the new three-year programs that are being implemented at eight U.S. medical schools, including their own. Finally, they offer suggestions regarding how to enhance the discussion between the proponents of and those with concerns about three-year curricula.

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          What training is needed in the fourth year of medical school? Views of residency program directors.

          To identify common struggles of interns, determine residency program directors' (PDs') views of the competencies to be gained in the fourth year of medical school, and apply this information to formulate goals of curricular reform and student advising. In 2007, semistructured interviews were conducted with 30 PDs in the 10 most common specialty choices of students at the University of California, San Francisco, School of Medicine to assess the PDs' priorities for knowledge, skills, and attitudes to be acquired in the fourth year. Interviews were coded to identify major themes. Common struggles of interns were lack of self-reflection and improvement, poor organizational skills, underdeveloped professionalism, and lack of medical knowledge. The Accreditation Council for Graduate Medical Education competencies of patient care, practice-based learning and improvement, interpersonal and communication skills, and professionalism were deemed fundamental to fourth-year students' development. Rotations recommended across specialties were a subinternship in a student's future field and in internal medicine (IM), rotations in an IM subspecialty, critical care, and emergency and ambulatory medicine. PDs encouraged minimizing additional time spent in the student's future field. Suggested coursework included an intensively coached transitional subinternship and courses to improve students' medical knowledge. PDs deemed the fourth year to have a critical role in the curriculum. There was consensus about expected fourth-year competencies and the common clinical experiences that best prepare students for residency training. These findings support using the fourth year to transition students to graduate medical training and highlight areas for curricular innovation.
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            Shortening medical training by 30%.

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              Students’ Perspectives on the Fourth Year of Medical School: A Mixed-Methods Analysis

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                Author and article information

                Journal
                Acad Med
                Acad Med
                ACM
                Academic Medicine
                Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins
                1040-2446
                1938-808X
                October 2015
                30 September 2015
                : 90
                : 10
                : 1318-1323
                Affiliations
                [1] J.R. Raymond Sr is professor of medicine, president, and chief executive officer, Medical College of Wisconsin, Milwaukee, Wisconsin.
                [2] J.E. Kerschner is professor of otolaryngology and communication sciences, dean of the medical school, and executive vice president, Medical College of Wisconsin, Milwaukee, Wisconsin.
                [3] W.J. Hueston is professor of family and community medicine and senior associate dean for academic affairs, Medical College of Wisconsin, Milwaukee, Wisconsin.
                [4] C.A. Maurana is professor of population health, vice president for academic outreach, and director, Advancing a Healthier Wisconsin Endowment, Medical College of Wisconsin, Milwaukee, Wisconsin.
                Author notes
                Correspondence should be addressed to Cheryl A. Maurana, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226; telephone: (414) 955-8075; e-mail: cmaurana@ 123456mcw.edu .
                Article
                00017
                10.1097/ACM.0000000000000862
                4585483
                26266464
                45e28b5a-f8b4-4ed1-ba6c-f9809b71fc57
                Copyright © 2015 by the Association of American Medical Colleges

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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