At New York University, one of a handful of medical schools to offer three-year programs, Dr. Betty Chen instructs students on treating drug overdose. | credits: (Credit: Suzanne DeChillo/The New York Times)

Sandwiched between three mind-numbing years of basic science courses and hospital rotations and the lockdown years of residency training, the fourth year of medical school has long been a welcome respite for future doctors. It is the only time in their medical education when students have few requirements and a plethora of elective course offerings and the time to go on vacation and spend time with friends and family.

Do it now, a mentor said as I was about to start my last year, because you may never get the chance again.

I followed that advice wholeheartedly. I spent most of my fourth year away from my medical school, caring for children with hematologic disorders one month, then shadowing cancer surgeons for another, in hopes of figuring out which specialty I liked more. I spent time working in a laboratory, something Id never done before, learning how to culture and freeze cells, care for mice, and critique studies. I attended national medical meetings, hung out with old friends, and slept and ate to my hearts content at my parents home.

For me, it was a pivotal, reassuring year.

But not all of my classmates felt the same. One friend interested in a particularly competitive residency spent much of the year in high-stress audition clerkships, four-week clinical tours at hospitals where she hoped to train; she resented having to pay tuition at our home school while paying travel and living expenses so she could learn at other institutions. Another, older classmate, who had already spent 10 successful years in another profession, was just eager to get on with his training; for him, a fourth year filled with electives and extended vacations was a waste of time and tuition money.

The fourth year is kind of bogus, one friend recently recalled. It might have been fun at the time, but Im not sure it made me a better doctor.

These disparate opinions came to mind recently when I read two perspective pieces in The New England Journal of Medicine on eliminating the fourth year of medical school.

For several years, medical educators have been engaged in an increasingly heated, and occasionally cantankerous, debate about streamlining medical education and training. Many experts have suggested lopping years off the residency training process, but surprisingly few have argued for such similarly dramatic changes in the medical school curriculum.

Established over a century ago as part of a sweeping change to a chaotic collection of schools, apprenticeships and fly-by-night training programs, the four-year medical school curriculum is the sacred cow of medical education. Like soldiers in lockstep, nearly all medical students over the last 100 years have spent their first two years in lecture halls learning the theory and basic science of medicine and their third and fourth years on the wards learning the practical clinical applications. Apart from a fewshort-lived experiments during World War II and in the 1970s to shorten the curriculum to three years, not even the most radical of educational reformers have dared stray from the norm, carefully integrating their changes well within the venerated four-year framework.

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Should medical school last just 3 years?