For well over a century, becoming a doctor in the US required a minimum four-year medical school commitment. That standard was set in 1910 when Abraham Flexner published a highly influential report that established modern medical practices and, despite no supporting empirical evidence, advocated for four years of training – two years of classroom and book work, followed by two years of immersive, hands-on training.
But what if the time you spent in school could be slashed significantly, potentially saving you tens of thousands of dollars and fast-tracking your career? Deborah Powell, former dean of the University of Minnesota Medical School, believes that should be an option for some students.
“It’s pretty obvious that some people learn things faster than others.” Powell recently told reporters. “It doesn’t intrinsically make sense that everybody has to move at the same rate.”
She’s got a point, experts say. After all, many medical students matriculate having already completed varying degrees of education, including master’s degrees and Ph.D.s. And Powell points to Vanderbilt University’s two tracks of biochemistry courses – one for students who are new to the discipline and another for those who already have a solid background. The more tailored, student-centric approach piqued Powell’s interest. So, when she stepped down as dean in 2009, she began formulating an experiment of sorts.
Thus began the Education in Pediatrics Across the Continuum (EPAC), a pilot project designed to replace time-based medical education with a competency-based program. After all, “We’re used to giving grades on tests but we’re not so good at judging competency,” Powell said.
Under EPAC, students who are quick learners are able to complete medical school and residencies in less than four years, while those who need more time to study and train are afforded that opportunity as well (though thus far, none have needed extra time).
Powell initially encountered a bit of resistance from officials with the Association of American Medical Colleges, which she chaired from 2009-2010. The AAMC is the national organization that administers the entrance exam to medical school; runs the services students use to apply to medical schools and residencies; and sponsors the body that accredits them in the U.S. and Canada. Still, she was able to sign on four schools, including the UM Medical School, the University of Colorado, the University of Utah and the University of California at San Francisco, enrolling the first class of students in 2013. Thus far, results are promising.
Just ask Shane McWhirter. Under EPAC, he began his residency nine months ahead of schedule and saved upward of $50,000 in student debt. Though he admits struggling a bit with the fact that EPAC students must choose a specialty and commit to particular residencies earlier than do students in traditional medical school programs (Normally, medical students apply to scores of residencies before ranking their preferences and matching into a program during their last year of medical school) he believes the payoff is worth it.
First, under EPAC, residencies are more closely melded with classwork, which means a more immersive and immediate learning experience. Students have hands-on training while they’re reading about the same subjects in their textbooks – not months after the fact. This lends to a more thorough and lasting understanding of what they’re learning, participants say. Further, the program affords students completing their residencies much more one-on-one time with patients and more immediate and thorough feedback from instructors.
“We were able to develop relationships and in the end be sort of patient-advocates for them at their other appointments because we knew their history a little bit more,” McWhirter said of the 20-30 patients that EPAC allowed him to work with on a regular basis throughout his training. That experience, he argues, will make him a far better doctor more than a good board exam score or passing a class with honors ever will.
Time will tell whether EPAC will continue. But its success may herald a competency-based revolution that potentially could be tailored for scores of other medical education specialties.
“It’s a huge deal and it’s causing a lot of stir in the medical education world,” said Patty Hobday, an assistant director of pediatrics at the University of Minnesota Medical School and the school’s EPAC’s course director.
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