Mar 252012

"The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care," writes Ezekiel Emanuel, Obama's former health care advisor who's now back at University of Pennsylvania in a big-thinker job spanning ethics, economics and medicine.

In a JAMA essay with co-author Viktor Fuchs, they opine that although medical academicians often romanticize the ideal "triple threat" physician (astute clinician + productive researcher + brilliant teacher), almost none of them actually are one -- we all know there just aren't enough hours in a day, or a lifetime.

Medical education and training programs have expanded to morbid obesity by indulging the fantasy of creating legions of these supposedly ideal doctors, combined with unthinking devotion to past tradition (we have to keep everything in that's been added since the Flexner report). "Years of training have been added without evidence that they enhance clinical skills or the quality of care," in Emanuel's view.

Emanuel calls for compression of medical school to 3 years (or expansion of 5-6 year combined college/med school programs), reduction in general internal medicine residency and surgical residency by one year, and an elimination of mandatory research years for all fellows: "It is wasteful to add years of training for all physicians to ensure the small minority destined to be researchers has the opportunity to engage their interest in research."

Hear, hear.

Emanuel EJ, Fuchs VR. Shortening Medical Training by 30%. JAMA 2012;307:1143-1144.

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Voice of sanity: Reduce medical training by at least 2 years (JAMA)