Nearing the end of his third year at NYU School of Medicine, Devon Ryan, MD, still hadn’t given any thought to the residency match, the angst-ridden process that consumes much of the last year of medical school. In fact, he never bothered with his fourth year. Dr. Ryan didn’t abandon his dream of becoming a physician. Rather, he headed straight into a residency in orthopedic surgery, as part of an accelerated curriculum that allows select students to complete their undergraduate medical studies in just three years.
One of the benefits is a slot in the residency of their choice at NYU Langone, provided they maintain a strong academic performance and apply through the conventional “match” process, by which a nationally standardized algorithm matches residents to residency programs.
“I’m a bit nervous, sure,” says Dr. Ryan, a native of Bedford, Massachusetts. “Residency is daunting. It’s a trial by fire, and the learning curve is steep. But I feel as ready as any fourth-year student.”
If Dr. Ryan sounds confident, he has every reason to be. Before starting his medical studies, he took time off to conduct research in orthopedic surgery at NYU Langone. Since his first days in medical school, he’s been participating in various activities in the Department of Orthopedic Surgery, from rounds to skill sessions to teaching conferences, gradually acculturating to life as a resident.
“I have no doubt that Devon is prepared for the next step in his training,” says his mentor, Kenneth Egol, MD, professor of orthopedic surgery and director of the department’s residency program. “He might be the most prepared intern in the U.S.”
NYU School of Medicine launched its accelerated pathway in 2013 as part of a broader effort to address the changing demands on prospective doctors. Today, the average medical student will graduate with more than $165,000 in educational debt. The three-year option reduces that burden by enabling qualified medical students to graduate with less debt and begin practicing one year earlier than traditional students.
“This program isn’t just a fast track,” says Joan Cangiarella, MD, director of the Three-Year MD Pathway program. “It’s also a unique opportunity to follow and assess learners across the continuum of undergraduate–graduate medical education.”
Not everyone agrees on the perceived merits of accelerated learning, however. Critics point to a series of shaky experiments in the 1970s, when dozens of medical schools began offering three-year MDs. The majority of students and faculty participating in those programs felt overwhelmed by the rapid pace of learning, and schools eventually abandoned them.
NYU School of Medicine, however, has taken a different approach, offering accelerated study only to a select group of students who know which specialty they want to pursue. Three-year graduate Sarah “Rae” Rokosh, MD, for one, knew she wanted to be a surgeon when she was only a high schooler in Winnipeg, Canada. Fellow graduate Danielle Lo, MD, who will pursue a residency in ophthalmology, knew her future specialty at age 15 when she first watched her father, an ophthalmologist, perform cataract surgery.
The accelerated pathway saves a significant chunk of time by simply eliminating the exhaustive process of applying for residency programs. “Most of the fourth year is spent traveling for residency interviews and doing ‘away’ rotations, which are more or less auditions for residency,” explains Dr. Egol. “If you eliminate these activities, you can shorten the curriculum by several months.” Students also forgo their first summer break, using that time for an eight-week elective. In the third year, they waive the 12-week clinical research concentration, 10 weeks of electives, and 4 weeks of concentrated study. Overall, the new pathway features 130 weeks of instruction—18 weeks fewer than the traditional four-year program.
So far, the compressed schedule has not impacted performance. “Third-year students actually outperformed fourth-year students in terms of clinical skills and knowledge on tests conducted in our simulation center last spring,” says Steven B. Abramson, MD, vice dean for education, faculty, and academic affairs and the chair of the Department of Medicine. “I suspect that this is because the former were fresh from their core clerkships, while the latter had been focusing on electives and traveling around doing residency interviews. After some instruction, the fourth-year students recalibrated very quickly. But the point is that, by and large, many students are prepared to begin residency by the end of their third year.”
The potential benefits of accelerated study are substantial. By shortening their stay in medical school, students not only save tens of thousands of dollars in tuition fees and housing costs, but also launch their careers a year earlier—no small advantage considering that the path to practice for some doctors lasts eight years beyond medical school. “People have this mistaken impression that earning the MD degree is the end of your training as a doctor, when it’s essentially a ticket to the next phase of training, which is residency,” says Dr. Abramson. “And the learning should continue after that.”
One big advantage of the accelerated pathway is that it smoothes the stressful transition from medical school to residency, thanks to a special emphasis on mentorship and departmental engagement. “I have a pretty good impression of what to expect as a resident,” says Dr. Rokosh, who begins her residency in general surgery at NYU Langone this July. “I’ve been doing research in the Department of Surgery, going to departmental meetings, and spending my free time in the OR. I’m as ready as I’m ever going to be.”
Elisabeth Cohen, MD, professor of ophthalmology, oversees mentoring for all of the accelerated pathway students, ensuring that their specific progress and concerns are carefully addressed. In a testament to the program and the student selection process, Dr. Cohen says students have come to her not for help with crises, but rather for assistance with everyday practicalities and the occasional pep talk. “In any new venture, it’s a little uncomfortable to be in the vanguard,” says Dr. Cohen. “In most cases, they just needed assurance that when they encountered any problems, we were open to improvements.”
For Dr. Danielle Lo, who’s following in her father’s footsteps to become an ophthalmologist, Dr. Cohen’s mentorship was the cornerstone of her three-year education. “It was the best part of the program,” she says. “Dr. Cohen met with all of us multiple times throughout the year and really got to know us as people.”
Mark Hochberg, MD, professor of surgery, serves as mentor to three accelerated students, including Dr. Rokosh. “Everyone thinks that surgery is just what happens in the operating room,” says Dr. Hochberg. “That’s important. But the major thing we teach our residents is how to evaluate symptoms, lab tests, and imaging studies to determine the diagnosis, and then how to decide whether the patient needs an operation, and when. The three-year students I’ve been mentoring have been getting that experience on a weekly basis.”
Amy Ou, MD, feels similarly prepared. “I received a lot of mentoring and advice about what activities I should be doing to prepare for residency,” says Dr. Ou, who is pursuing a residency in medicine before subspecializing in gastroenterology. “It provided a framework for learning how to think from an internal medicine perspective. And during my subinternship at Bellevue Hospital, where I’m spending a lot of time as a resident, the previous residents were helpful in teaching me how everything functions, all the day-to-day nuances you have to know to facilitate your patients’ care.”
Success in Numbers
The graduation rate for the inaugural class has exceeded expectations—15 of the 16 students enrolled in the accelerated program have stayed with it. “I anticipated that we might lose a third of the original group,” says Dr. Abramson. “But only one student did not remain in the accelerated program, and all those who have done so have done quite well.” Indeed, everyone sailed through the first two years of the curriculum (graded on a pass-fail basis), and all have passed the first two phases of the U.S. Medical Licensing Examination. Two of the 15—Drs. Ryan and Rokosh—were accepted into Alpha Omega Alpha Honor Medical Society, which recognizes the top medical students around the country—a similar ratio seen among students in the conventional pathway.
No substantive changes have been made for students who are following in their footsteps, with one key exception: while the members of the first class had to be accepted into the pathway and a residency on day one, any student can now apply for accelerated study midway through the first year. Being able to “opt in” later is proving popular. In the second class, 12 students were accepted at the start of medical school and 10 more opted in. (Conversely, students in the pathway can “opt out” at any time if they find that accelerated study is not right for them.) Roughly 15 percent of the second and third classes are doing accelerated study. Program administrators expect that enrollment in the new pathway will peak at about one-quarter of the student body.
NYU School of Medicine is also pilot testing a three-year pathway for those who come to medical school with a PhD in hand. “This is especially attractive to students whose ultimate goal is to do research,” says Joan Cangiarella, MD, director of the Three-Year MD Pathway program and associate dean for education and faculty affairs. “Our whole focus is on individualized pathways.”
Shaping the Future of Medical Education
Leaving nothing to chance, NYU School of Medicine will continue to evaluate students in the accelerated program and follow graduates as they move through their residencies. “This program isn’t just a fast track,” says Dr. Cangiarella. “It’s a unique opportunity to follow and assess learners across the continuum of undergraduate–graduate medical education.”
Indeed, the next leg of the journey represents a critical test of the program. If graduates handle their residencies as well as expected, their success will help ease any lingering doubts about the competency and preparedness of three-year graduates and encourage more medical schools to pursue their own accelerated programs. In fact, at least 35 percent of U.S. medical schools have or are considering developing a three-year MD program, according to a 2014 survey of medical school deans. Robert I. Grossman, MD, the Saul J. Farber Dean and CEO of NYU Langone, expects that number to boom in the coming years. During a speech in May honoring the inaugural three-year graduates, Dr. Grossman predicted that the accelerated pathway will become “a tsunami in medical education.”
Inspired by this positive trend, eight medical schools have formed a consortium to identify and share best practices for accelerated pathways to the medical degree. The consortium, funded by a four-year, $250,000 grant from the Josiah Macy Jr. Foundation, includes medical schools that have implemented or plan to implement accelerated pathways. (While NYU School of Medicine was not the first to offer a three-year curriculum, it is the only one to offer residencies in all medical specialties.)
“Our big goal over the next few years is getting the rest of the medical profession to accept the notion of accelerated pathways,” says Dr. Abramson, who is coleading the Macy grant along with Dr. Cangiarella. “Right now, the old guard doesn’t want to think about changing an educational system that has remained largely the same since 1910.”
But a growing number of students see things differently. “I’d recommend this program to others—if they have strong feelings about what they want to do in medicine,” says Dr. Rokosh. “The final six months are pretty jam-packed, but I’ve never questioned my decision.”
Dr. Ryan is similarly positive. “The fourth year is known for being relatively relaxed, with less in the way of clinical obligations,” he says. “At times, I’ve been a little jealous of that. But from what I gather, the match process is brutal, it’s expensive, and there’s tons of uncertainty. I think that most of my peers, if given the opportunity, would like to be done 2 months from now, rather than in 14 months.”