Three-Year Medical School Catching on Across the US

When it comes to medical education, it appears that history does indeed repeat itself. Take 3-year, accelerated medical school programs, a concept that was first introduced during WWII in response to physician shortages at home and on the battlefield. Today, they’re offered by over 30 schools across the nation.

Accelerated MD programs are part of a movement to offer “different pathways that are available to students interested in becoming physicians,” Dorothy Andriole, MD, senior director of medical education research at the Association of American Medical Colleges (AAMC), told Medscape Medical News. Data have suggested that by providing opportunities for students to enter the workforce a year earlier than traditional 4-year programs, they offer a means to address post-pandemic physician shortages and skyrocketing student debt.

The question is, are they riding a wave of support or are they waves of the future?

Shorter Timeframes, Better Prepared?

The 4-year medical school model emerged in the early 20th century, fueled by the conclusions of a Carnegie Foundation report that a 2-year clinical curriculum (research, clinical medicine, and medical teaching) should be fully integrated into what was then a rigorous, 2-year clinical clerkships.

Accelerated programs have since ebbed and flowed with the times, for example, during the Vietnam War or in response to federal initiatives aimed at increasing diversity in medicine. Critics often questioned if accelerated programs could deliver on competency, student readiness and maturity, and depth of clinical exposure/direct patient care experience.

These concerns appear to be unfounded.

Findings from a preliminary 2022 evaluation that compared the learning and performance of the first three graduating cohorts (2016-2018, n = 53) of 3-year medical students compared with 4-year peers (n = 437) at New York University (NYU) Grossman School of Medicine in New York City found that, aside from age, 3-year students performed as well as 4-year students in both medical school and the first year of residency.

A follow-up was conducted that compared medical school and internship outcomes among seven accelerated 3-year MD graduating classes at NYU Grossman (matriculated 2013-2019, n = 136) and 4-year MD pathways (n = 681). Though they again performed similarly during medical school and internships, 3-year MD students had significantly higher performances on pre-clerkship and comprehensive clinical skills exams.

This is not surprising, said Joan Cangiarella, MD, associate professor, associate dean for education, faculty and academic affairs, and chief of pathology service at Tisch Hospital at NYU Langone Health, New York City. Cangiarella participated in both studies.

“The main difference is that when they take the national exams, they have condensed time to study for them. Aside from that, the curriculum is identical and has the same rigor. The fourth year is really about electives,” she said.

Cangiarella also said that 3-year MD students are often better suited for their residencies.

“The minute they come into this program, they get a department advisor who works with them to provide opportunities within their department,” she said, explaining that they join grand rounds, meet other residents in the same specialty, and are allowed to shadow much earlier.

Matthew Hunsaker, MD, founding dean for the Medical College of Wisconsin (MCW) — Green Bay, agreed, adding that, by and large, 3-year MD students are often better prepared to step into their residencies.

“If you can make it in a 3-year curriculum, you are working at a tempo that approximates residency more than perhaps traditional 4-year programs,” he said. “A student has less free time, they have to be self-regulating, they have to keep a number of priorities front of mind and be ready to address them.”

“If you train at an accelerated level, stepping into an intense environment does not seem foreign to you,” he said.

The Student Perspective

Students in these programs appear to agree with both Cangiarella and Hunsaker.

A 2022 analysis of the 2017 and 2018 Medical School Graduation Questionnaire administered annually by the AAMC compared student perceptions of 3-year accelerated MD programs (n = 90) with perceptions of students who graduated from 4-year programs at accelerated program schools (n = 2573) and schools without accelerated programs (n = 38,116).

Not only did accelerated program students report being more satisfied with the quality of the medical education they had received (97.0% vs 89.5% of non-advanced placement [AP] students/AP schools and at non-AP schools; P = .05), but satisfaction scores with basic clinical coursework, clinical experiences, and personal and professional (physician) development were also as high.

David Rhee, MD, a graduate of one of NYU Grossman’s inaugural 3-year classes and now an associate clinical professor and practicing cardiologist at NYU Langone Health, pointed to another advantage the extra year offered.

“I took an extra year to be a chief resident after 3 years of an internal medicine residency. A lot of my decision-making was based on the fact that saving a year of med school gave me the flexibility of that extra year. It ended up being one of the most formative years in terms of shaping my career,” he said.

The same rings true for Stephanie Fabbro, MD, a board-certified dermatologist in private practice in Columbus, Ohio, and a graduate of Ohio State University’s 3-year accelerated MD program.

“I was able to work at a private practice for several years after training, pay off my debts, and gain clinical experience and expertise to start my own independent physician-owned practice in my early 30s — when most people would be just coming out of training for the first time,” she said.

The Matching Question

Accelerated programs are not one-size-fits-all. Some, like MCW — Green Bay and Wausau campuses, only offer 3-year programs and no direct pathway to residency, and others, both 3- and 4-year programs, add a directed pathway (eg, NYU Grossman). Programs are often limited by the number of candidate spots.

However, prior concerns about lack of preparation appear to be a thing of the past.

“Programs are really just looking for applicants that best align with their mission, culture, and needs,” said Laurie Curtin, PhD, chief operating officer of the National Resident Matching Program.

“Nowadays, a lot of what we talk about is program fit,” said Natasha Chida, MD, MSPH, associate professor of clinical medicine and director of the Osler Medical Residency program at Johns Hopkins School of Medicine in Baltimore. “Our residents have high levels of ownership over their patients and teams and are at the edge of their comfort zones, are self-motivated, and are driven to enhance their skills and attributes,” she said.

“We’re looking at those qualities and characteristics — whether they come from someone applying from an accelerated program or not.”

Numbers don’t lie; in 2023, MCW — Green Bay and Wausau campuses reported 100% match rate percentages for the top three specialties (including family and internal medicine).

“I used to be asked how I knew that my students could compete for residency spots. We’ll put them in the match. We’ll seek to create a graduate who is sought after for leadership, intensity of training, and their ability to manage the fast tempo of medical school. We’ve been successful in that,” he said.

Cangiarella, Hunsaker, Rhee, Fabbro, Curtin, and Chida reported no financial disclosures of interest.

Liz Scherer is an independent health and medical journalist.