A wave of change may soon be sweeping
over Canada's medical schools in a bid to meet the ever-growing
demand for new physicians as the baby boom generation
begins retiring.
A committee helmed by the Association
of Faculties of Medicine in Canada (AFMC), which represents
the nation's 17 medical faculties, recently began a
comprehensive review of medical education called The
Future of Medical Education in Canada. Ending in March
2009, the Health Canada-funded project will investigate
how to best confront the imminent challenges facing
tomorrow's med students.
FAST-TRACK
MDs
Among the proposals being considered is the possibility
of changing admissions requirements to get students
into med school faster. For instance, Quebec schools
require just two years of junior college education and
a number of schools in other provinces require completion
of only two or three years of undergraduate study.
The committee will also discuss
reducing the amount of time it takes to complete a medical
degree from four years to three, by asking students
to work year-round — a model already in place at
the University of Calgary and McMaster.
"The founding fathers of McMaster
wanted to create a medical school that was totally different,"
says Dr Alan Neville, assistant dean of the Michael
G DeGroote School of Medicine at McMaster, which has
offered only the fast-track program since its first
students were enrolled in 1969. "They took a gamble
that it would be attractive to graduate physicians faster,
and so far it's paid off."
Though clearly a strong supporter
of his university's strategy, Dr Neville can't offer
any hard evidence of whether a fast-track degree was
better or worse than the norm. "Unfortunately, there's
no good study to show whether a three- or four-year
program is the best way to go," he says. "Consequently,
I foresee there being a lot of push-back from many different
quarters."
The 15 schools with four-year MD
programs may feel it's impossible to manage new and
burgeoning areas of health care — things that Canadians
feel doctors should be educated about — if they
shave a year off their degrees, says Dr Neville. "The
counter-argument is that some things probably shouldn't
be taught in medical school, and some things which should
be taught to MDs shouldn't necessarily be taught to
undergrads. The whole of medical education should be
seen as a continuum, from undergraduate to post-graduate
to CME."
The same points have been raised
in the United States, too. "Many educators in the US
feel that a lot of the fourth year is elective time,
and possibly wasted time," Dr Neville says. "The core
clerkships are mostly covered in the third year, which
advances the argument that the medical schools are not
controlling much of the last year of study."
CUTTING
DEBT
A shorter degree would be economical for students. "There's
anecdotal evidence that shorter training time reduces
MD students' debt," says Shaheed Merani, president of
the Canadian Federation of Medical Students, currently
in his sixth of eight years in an MD-PhD program at
the University of Alberta.
"One year less of tuition means
a savings of about $12,000, not to mention living costs
and other expenses," he says. "It also means that you're
practicing one year earlier — making money rather
than spending it."
Mr Merani argues that since the
total cost of medical training is a large consideration
for students, especially those from low socio-economic
backgrounds, a fast-track option may be a concrete step
towards improving accessibility for students who might
not otherwise be able to afford medical school.
Dr Neville points out that not
all students are up to the challenge of McMaster's or
the University of Calgary's three virtually non-stop
years; regular four-year programs have the usual semester
breaks and summer holidays. "Students are warned at
orientation that, because the program is condensed,
sick time has to be made up. There are always a few
students whom we have to support, sometimes psychologically,
more than others once they realize the commitment that
the program demands," he says.
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