Why Should Medical School Take Four Years? [Show Summary]

Dr. Deborah Powell believes that a competency-based medical education can be just as effective if not more so than the traditional four-year model that has been in existence for over 100 years. She has been testing that theory with an innovative program called EPAC (Education Across the Continuum in Pediatrics), where four medical students per year are selected to progress through a competency-based program and move on to residency at the same medical school once they have proven they have acquired those competencies. The program currently has two groups of residents moving through, and once they finish their residency Dr. Powell aims to show that these residents are just as successful as those with the highest board scores.

Interview with Dr. Deborah Powell, Dean Emerita of the University of Minnesota Medical School [Show Notes]

Our guest today is Dr. Deborah Powell, Dean Emerita of the University of Minnesota Medical School and professor in the Department of Laboratory Medicine and Pathology at the University of Minnesota Medical School. At the University of Minnesota, Dr. Powell instituted the medical school’s Flexible M.D. program, an individualized model of medical education designed to be more adaptable to students’ career and learning goals. Dr. Powell served as chair of the AAMC Board of Directors from 2009-10 and was the first female chair of the AAMC Council of Deans in 2004. She is currently working on a pilot study of a new, competency-based model for training medical students who want to go into pediatrics that combines undergrad and medical education. This model is currently being tested in four US medical schools including the University of Minnesota.

Dr. Powell, let’s start with the basics. Why do you want to move away from the 4-year model, which has been in existence for about 100 years? What’s wrong with it? [2:03]

Intrinsically there is nothing wrong with it, but nobody has ever said four years is necessary for a medical school education. It was proposed first by Abraham Flexner after a model in use by many US medical schools at the time which had two years of basic science followed by two years of medical education. No one has ever proven that amount of time is needed to complete a medical education and move to residency training. There have been several examples of three year medical schools. There was a famous one back in the 70s when the fed government felt we didn’t have enough doctors, so the four years was crammed into three years and it didn’t work out very well. The main point is that everybody learns at different paces – some people need more time, and some people need less. I am not a big fan of time-based education, I think it should be more about flexible medical education that is competency-based.

What is a competency-based model? [4:28]

The idea is that you would have a defined set of competencies which could be knowledge, skills, attitude, or all of the above that students would be expected to achieve at a specific level of achievement, at which point they would be deemed ready for the next stage of their education. With that kind of a model you can allow some flexibility, because students will achieve competencies faster or slower than others. The problem is that we currently live in a time-based medical education system, and a competency-based system should be time-variable, moving when you are ready.