Are 3 Years of Medical School as Good as 4?

Even in medical school, sometimes less is more.

Three-year medical degree programs are becoming increasingly common, and now new research shows that student outcomes in at least one such program are on par with those at traditional, four-year programs.

“For the great majority of students, with the right mentoring and level of shadowing that can happen earlier, they can easily graduate in three years,” said Dr. Joan Cangiarella, director of the accelerated medical degree pathway program at New York University’s Grossman School of Medicine, which has offered a three-year program since 2013.

“The general medical world has been stuck on the four-year [curriculum] for 100 years,” she said, noting that because three-year programs aren’t the norm, some residency directors may be skeptical of graduates of accelerated programs. “We want to make sure people know that these [three-year] students are just as good.”

Emerging data appears to back that up, according to a study of NYU’s medical program that Cangiarella and a team of other researchers published in the peer-reviewed journal Academic Medicine last month.

In examining seven years of student outcomes, researchers found that graduates of NYU’s three-year medical degree program performed similarly to their four-year peers in medical school and early residency, including on licensing exams.

In fact, the three-year students scored on average about one percentage point higher on their pre-clerkship exams than those in the four-year program, according to the study.

And while accelerated students scored slightly lower on Step 1 and 2 medical licensing exams—which assess basic scientific and clinical knowledge—and on a portion of the comprehensive clinical skills exam, they received comparatively higher scores on the Step 3 exam, which assesses in-depth clinical knowledge.

The study also found that compared to interns in the internal medicine residency who graduated from the four-year program, interns from the three-year pathways performed slightly better on milestones set by the Accreditation Council for Graduate Medical Education, including those related to patient care, medical knowledge and professionalism.

“The clear success of our fast-tracked system has prompted major changes in our overall curriculum,” Dr. Elisabeth Cohen, co-author of the study, said in a news release, noting that as of 2023, NYU enables “all students to graduate in three years if they choose, whether they proceed directly to a residency here or get matched elsewhere.”

Save Money, Start Work Sooner

When NYU’s three-year program first launched more than a decade ago as part of the medical school’s wider effort to expand affordability and revamp the curriculum, it was among just a handful of such programs in the country. Now there are more than 30, including at Texas Tech University, Pennsylvania State University and the University of California, Davis.

Proponents of accelerated medical degree programs say they save students a year of tuition costs and get them working as physicians faster. That’s significant, given that most doctors carry an average of more than $200,000 in student debt and work for relatively low wages during residency programs, which can span anywhere from three to seven years—or more—depending on the specialty.

“Postgraduate education has continually gotten longer. And when you get to your specialty, most of your learning happens in residency,” said Cangiarella, who is also a member of the Consortium of Accelerated Medical Pathway Programs. “How long do we want to take to get people to become doctors? As long as they’ve reached their [core competencies], that next phase of learning is going to happen in residency.”

Dr. Dorothy Andriole, senior director of medical education research at Association of American Medical Colleges, said some students may be a better fit for an accelerated program than others.

“For those students who are fairly sure of their specialty choice early on—and because a large proportion of these programs have direct pathways into their residency programs (including NYU’s) at the same institutions—and know where they want to stay geographically, it’s a great option to consider,” she said, noting that such a setup allows students to become familiar with the department before residency.

While a three-year program may mean less tuition revenue for a medical college, it offers numerous potential institutional advantages. It can help institutions distinguish themselves from other programs, attract a more diverse applicant pool and receive grants or philanthropic donations in support of curriculum innovation.

“The programs build the reputation that the school is innovative and student centric and may create visibility among applicants,” according to a paper published earlier this year in the journal Medical Science Educator. “As a result, the school may be able to recruit higher caliber students to all programs they offer who may otherwise not attend.”

The paper also noted that some three-year programs have exceptionally diverse student bodies; 29 percent of students in Penn State’s accelerated family medicine program come from backgrounds underrepresented in medicine, as do 90 percent of those at UC Davis’s program.

But Andriole pointed out the potential downsides for students who enroll in a compressed program.

“They may just not have the same amount of time to do electives, explore rotations, do research and other enrichment activities they may otherwise want to do during medical school,” she said. “It’s a great program for selected students.”

Not ‘Under the Gun of Time’

For Dr. David Rhee, a clinical instructor at NYU Grossman School of Medicine’s Division of Cardiology, who was part of the inaugural class of NYU’s three-year degree program, enrolling in the accelerated program has been one of the best decisions of his career so far.

NYU’s medical school went tuition-free in 2018, but it was still pricey when Rhee applied years earlier. The possibility of saving on a year of tuition and loans by enrolling in the three-year program immediately appealed to him.

“It also gave me a little bit of flexibility,” he said, adding that he used the year he gained to take a position as chief resident—and pursue his interests in medical education and administration—after he completed his three-year internal medicine residency. “If I had been under the gun of time, worried about finishing my training so I could start making money, I wouldn’t have done that.”

The year Rhee spent as chief resident strengthened his passion for training the next generation of physicians, he said. Now he believes the entire health-care system would benefit from more widespread adoption of the three-year medical school program.

“The problem is, it requires a herculean effort to implement and you need support from the whole village, ” he said. “But once you can design it and run it, the students will benefit, the doctors will benefit and it will ultimately help the patients.”