For the most part, I agree with trent’s assesment. As a “seasoned doctor”, I can now look back on my training and see that a lot of it has little to do with the student but more to do with economics. From a true economic analysis, the student should be able to decide if the marginal benefits of a fourth year a worth the marginal costs. For myself, that was 40K of additional debt plus the lost opportunity to make30-40K as an intern. However, the whole system is set up to prevent the student from making a decision(ie a fourth year is rammed down your throat whether you need it or not). The same can be said or residency also-some residencies in ER medicine are 3 years and some are 4 years. Why do some require a 4th year, to get an additional year of indentured services from a helpless future doc. Is there any evidence that docs taking the additional year of ER residency are any better? NO

In medical school, you practically have to make your decision about what field to go into at the very start of your 4th year so I don’t buy the statement, “it helps some students clarify their career goals.” Maturing takes place with time and the real maturing takes place starting in your internship when you are making real decisions. I find very few interns at the begining of the residency have much true insight into what they are doing. And why should they, they have never been responsible for any decision they have had to make.

True maturity is an evolving concept. I believe I am a better doc now than I was 5 years ago due to good old fashioned experience. I agree with trent that medical shool should be shortened a year to let the real maturity begin.

Thanks for the link.

Responses to your points:

1. I am not sure of the exact number of students who have made up their minds by the first day of 4th year, I’ll wager it is approaching or past 95%.

2. The AI months are improtant I grant you, as I said in my original post, and are the 2-3 months of good experience.

3. I guess I don’t really know what this means outside of the abstract. Every year you spend in medicine after third year is helpful in absorbing the impact of your education. Why does that have to be done as a fourth year student?

As far as my personal experience as a fourth year, I respectfully submit that you may not know exactly how I spent that year. It’s possible, I would argue, that I could have put a lot into the year and still regard ot as a waste of time and money. Saying that 4th year has too little value to justify its many costs and saying it has no value are two different things

Sure, some of that feeling applies to me more than other students. Going into pathology, I had little to no need for my AI’s and other required rotations. Having previous experiene in pathology. I was ready to quit paying tuition and get to work. I don’t think that’s unreasonable and I’m sure 4th year made me negligibly more prepared.

Here is what I propose. 3rd year’s over – your done. Interviews begin immediately, and match by thanksgiving. Residencies begin in the new year, and voila, everyone gets ~6 more onths of training. There may be problems with this (funding come to mind first), but I think it’s a start to thinking (just thinking) about alternatives that might be better than the current situation.

At the very least, Dr. Centor, perhaps my 4th year would not been such a waste had I gone to UAB!

Diasagree.
Perhaps young Trent has poor mentorship in his medical school or very little self initiative. I went out and looked for difficult and interesting rotations my fourth year of medical school. It made an incredible difference between myself and fellow interns when the S*&$ really hit the fan – and it gave me an opportunity to see parts of medicine that I would not be exposed to in my chosen field. All well worth the money looking back. You get what you put into things – if you slack off in the future – you probably won’t be such a great physician.