Shortening the medical curriculum
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* Alun Edwards, MB

*   © 2008 Canadian Medical Association or its licensors

The recent *CMAJ* editorial on the medical curriculum1 takes a very narrow economic or mathematic view of professional training, presumably influenced by the current and projected shortages of physicians. *CMAJ*'s editors suggest that medical students “should ask whether a fourth year will make them better and wiser physicians rather than simply older and poorer ones.” I think this question misses the mark. I would ask students instead how they will choose the specialty that will sustain them for their career and whether a reduced time in medical school would make that choice more difficult.

It is fine to suggest that clinical skills and practice style be honed during postgraduate training, but how does someone determine whether they are best suited to family practice, ophthalmology or internal medicine? How do they determine whether their chosen specialty will provide the challenge and stimulation they need in the coming decades? Most reach their decision gradually as they mature and develop an understanding of practice; this process should happen in medical school, before the student commits to specialty training.

If medical education is shortened and students' ability to make appropriate career decisions is affected, the result will not be a year of working life gained but rather a larger number of disaffected physicians unhappy with their careers and closer to burnout and premature retirement. Even among physicians fortunate enough to be content in their specialty, graduation a year earlier may merely result in retirement a year earlier. Physician contentment is most likely to fulfill the economic and societal goal of longevity in practice.

## Footnotes

*   **Competing interests:** None declared.

## REFERENCE

1.  1. Flegel KM, Hébert PC, MacDonald N. Is it time for another medical curriculum revolution? CMAJ 2008;178:11.
    
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