Wednesday, October 24, 2012

Law school revamps final year curriculum. Will med schools ever do the same?

The New York Times reports that NYU Law School is planning to change its third-year curriculum to better prepare its graduates for the realities of legal practice today. In case you don’t know, law school graduates are having a tough time finding work and many require on-the-job training to make up for what they didn’t learn in school.

From the article: “There is a growing disconnect between what law schools are offering and what the marketplace is demanding in the 21st century,” said … the chairman of the panel of alumni recommending the changes.

A revelation from the article is that the third year of law school has been considered a waste of time by many observers.

“One of the well-known facts about law school is it never took three years to do what we are doing; it took maybe two years at most, maybe a year-and-a-half,” Larry Kramer, the former dean of Stanford Law School, said in a 2010 speech.

There has been much debate in the legal academy over the necessity of a third year. Many students take advantage of clinical course work, but the traditional third year of study is largely filled by elective courses. While classes like “Nietzsche and the Law” and “Voting, Game Theory and the Law” might be intellectually broadening, law schools and their students are beginning to question whether, at $51,150 a year, a hodgepodge of electives provides sufficient value.

Although I wasn’t aware of this issue in law schools, it sounds familiar in a way. Copy the above paragraphs, take your word processing program and replace “law school” with “medical school” and “third year’ with “fourth year” and you will have an accurate story about medical education.

The fourth year of medical school has been known to be a waste of time for at least 40 years. Most schools allow some or all of it to be electives of the students’ choosing. This results in anesthesia rotations in Paris and dermatology rotations in New York City. In a previous blog, I have pointed out some of the problems of both the third and fourth years of med school.

A 2011 piece in the New York Times Magazine pointed out that some law firms are providing new associates with intensive training in the nuts and bolts of lawyering that they apparently don’t get in school. For example, although they had studied mergers in law school, graduates had no idea how to make a merger happen.

As an interesting parallel, some surgical residency programs have begun to offer “boot camps” (See links here and here.) as a way to teach incoming first-year trainees some of the material they should have learned in medical school. Apparently, this is necessary in Scotland too, where the boot camp lists such topics as communication skills for surgeons, polytrauma, how to lead a ward round and handling and writing the evidence. These all seem like subjects appropriate for a med school curriculum, but lacking.

I hope that someday medical schools will recognize the problem as NYU Law School has done. Meanwhile, I will keep cranking out the blogs.


SurgeryGirly said...

My school allows electives both 3rd and 4th year, which allowed me to narrow down my surgical interests early in 3rd year. This let me start a research project in the field, and to start making contacts early. If you are self-motivated and have flexibility, you can really give yourself an advantage in the application process.
I don't think they will ever make it shorter just due to the timing of res applications. I think most of the schools are offering counseling services during that time, and want to get paid for it.

Philip said...

Looking at the boot camp curriculum, it seems all the topics listed are covered in medical education. "Big" topics such as sepsis, signs of pulmonary embolism, or hemorrhagic shock, are in fact covered multiple times both in the classroom in years one and two, and on the wards. I suspect that either matched residents aren't retaining any of this material, or that it is a medico-legal CYA tactic for the programs and hospitals. Additionally, as a fourth-year student, I would disagree about the value of the final year. I am "rounding out" my education by taking classes that are related to my chosen specialty, and learning basics that I missed in other rotations, such as starting lines and managing ventilators.

Anonymous said...

4th year can be a blow-off year, but I'm not planning on making it one. I'm deciding between EM and Surgery, but regardless I plan on taking EM (If I go surgery), Anesthesiology, Ortho (If I go EM), and radiology electives post-match. If students are allowed to save 50k, will anyone bother to try and round out their education? But if you force students to spend that extra year, I think quite a few of them try to put it to good use.

Skeptical Scalpel said...

Thanks for the comments. It seems my readers have their acts together (at least these three). Not so for everyone.

I'm not sure that med school should be shorter, but I think the fourth year needs work. SurgeryGirly, should fourth year be about giving yourself an advantage in the application process?

Philip, it's nice to know that they still don't teach critical care in third year. I bet you got a lot of primary care though.

Anon, I wonder how many students really put the fourth year to good use? It would be an interesting thing to study.

SurgeryGirly said...

I don't think it is a bad idea to use it that way. I actually am sad I didn't have more time to take other electives or a research rotation. Over half my 4th yr is required clerkships, like primary care clinics, peds, and psych, and the other half is Sub-Is, time off for interviews, and surg electives. My last rotation is "prep for surgery internship", which is good because I am taking gen surg mid-3rd yr.
Other people I know interested in global health are doing mission work, etc the latter part. This isn't resume padding but instead exploring options for future practice and volunteerism. This would be hard to do if we didn't have flexible scheduling.
I agree that having a static curric is not helping anyone, but I don't think a complete overhaul is necessary. This may be school-dependent, though.

EM Guy said...

Current 4th year here, applying to EM. I'll argue the problems with 4th year cut both ways. Who can blame students applying to 40+ residency programs for competitive specialties if they take reading electives or 'research' months when the expectation is that they will need to interview at 20 different programs to secure a residency spot? That is incompatible with serious clinical duties during interview season (October-January). Now I think some of the residency madness is a bit of a US-Soviet style arms race but it's not changing soon.

For useful months: any ICU time is invaluable along with anesthesia and radiology.

Skeptical Scalpel said...

Thanks for commenting. I agree that the residency application/interview situation is way out of control. The same thing happens with residents looking for fellowships. These are well-known and long-standing problems that no one does anything about.

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