10/02/2013 05:18 pm ET Updated Dec 02, 2013

The Three-Year MD: A Radical Rethinking of Medical Education

It has been more than a century since Abraham Flexner issued his seminal report on medical education, setting in stone four years -- two years of basic science followed by two years of clinical training -- as the time required to earn a medical degree, irrespective of a student's preparation or educational experience. Over the past three decades, however, the required post-graduate training period for a medical student has increased substantially. Meanwhile, the time spent in medical school has remained unchanged.

Today, medical school applicants manifest unprecedented levels of sophistication and quality, along with enormous potential to make significant contributions to society. Yet they enter the workforce older, typically burdened with crushing levels of debt. It is time for the current academic setting to address the training needs of the 21st century student and to recognize that the diversity of their talents and backgrounds will be better served by choice and differentiation in medical education.

In a recent "Perspective" essay published in the New England Journal of Medicine, we argue for the radical rethinking of medical education, and suggest that shortening medical school education is one approach to address the need for change in the post-Flexnerian era. Doing so would offer highly qualified students the opportunity to fulfill their medical school requirements in three years, without compromising the quality of their education. Additionally, earning a medical degree in three years reduces the cost of medical school by an estimated 25 percent, while adding another year of income for students by allowing them to enter the workforce earlier and practice longer.

Knowing that our students come to us better prepared, this fall NYU School of Medicine offered a select group of students the opportunity to enroll in our new three-year medical degree program. Additionally, we guaranteed those students residencies in NYU Langone postgraduate training programs, circumventing the time, money, and angst involved in auditioning for competitive residency programs -- a process that today largely consumes the fourth year of medical school -- and providing these students greater continuity between their undergraduate medical training and their residencies.

Obviously, this is approach is not for everyone, and we do not promote the three-year pathway as the only solution. Even the best students learn and excel at different paces, and some students will opt into masters or doctoral programs, or perform undergraduate research that will extend their training.

To the naysayers, we suggest that Abraham Flexner never envisioned students in the 21st century entering medical school armed with a comprehensive high-school and college educational background, or the dramatic shifts that have occurred in the delivery of health care.
Armed with sophisticated educational opportunities, some with advanced degrees, they arrive to the classroom more committed and better prepared than ever for the rigors and challenges of practicing medicine. It is critical that American medical schools explore effective ways to streamline the education process. Providing choice for students to allow individualized growth and progression is one option -- one we believe will suit students, and the health of our
nation, better.