IAMSE Spring 2023 Session 2 Highlights

[The following notes were generated by Tracey A.H. Taylor, Ph.D. and Andrea Belovich, Ph.D.]

Lessons Learned in Developing Accelerated 3-Year MD Programs

In the second session of the series, three experts from the Consortium of Accelerated Medical Pathway Programs (CAMPP) spoke of “Lessons Learned in Developing Accelerated 3-Year MD Programs”. Dr. Joan Cangiarella, M.D. of the NYU Grossman School of Medicine began the session by defining an accelerated medical pathway program as a program that confers the MD degree in less than four years. She said that three-year programs are common in Canadian medical schools and that the first modern program in the United States started in 2010 at Texas Tech University. Interest in these programs is growing, as the group published survey data in 2016 and found that 35% of medical schools (n=127) said they were considering the development of an accelerated pathway program (Cangiarella et al. Med Educ Online, 2016). The general structures of these programs contain a standard MS1 and MS2 year that includes a summer of education in order to meet the LCME (Liaison Committee on Medical Education) accreditation 130-week requirement. The MS3 and MS4 years are usually condensed. Most programs have a directed pathway to an affiliated residency program, but this is not a requirement.

The biggest mission of 3-year accelerated programs is debt reduction where students save a year of tuition and enter the work force one year earlier, to save an estimated $250,000.00. Missions of other programs include serving underserved communities, or focusing on primary care and family medicine. Dr. Cangiarella also described the programs in the CAMPP, which was initiated from a Josiah Macy Jr. Foundation grant in 2014, and include the original seven programs from 2015 (NYU, UC-Davis, Penn State, University of Louisville, MCW-Green Bay Central, Mercer, and McMaster). There has been continued growth every year with new programs joining each year since 2015. One of the core goals of the formation of this group was to identify and disseminate best-practices in the formation of an accelerated pathway program in medical education, addressing diversity, logistical, regulatory, professional development, and competency concerns.

Following this introduction to 3-year accelerated programs, Dr. Cagiarella spoke more specifically about the NYU Grossman accelerated 3-year MD (3YMD) pathway. Developed as part of a major curriculum revision in 2010 that included numerous pathways. The goals were to provide individualized choice, reduce debt, and improve the UME-GME continuum. The medical school is now tuition-free and this was the first step on that path. NYU Grossman was the first medical school in the US to offer a 3YMD pathway to a select group of students with a directed pathway to one of 21 NYU-Langone Medical Center residency programs at the time of admission. This program is highly competitive and was offered as part of the regular admissions process. Students needed to know which specialty they wanted to pursue upon admission, and still participate in the NRMP to be accepted into the residency program following UME graduation after 3 years. The school currently has 40 residency spots available to this program, and the number of slots per specialty is known upon admission. There are various portals of entry to the program: pre-matriculation, during the 4-year MD program (end of year 1 or end of year 2), or through the MD-PhD program. Currently, the 3YMD program is 18 weeks shorter than the traditional four-year pathway at NYU Grossman, and contains a mentoring portion. Between 2013 and 2022, there have been 198 students accepted into the program, representing all residencies available. Of those, 138 have graduated and 43 are current students. A further seventeen students decelerated (either chosen or counseled to do so) and 12 switched specialties. The students overall perform very similarly to their four-year peers with the only differences being performance on step 1 and step 2 (J Graduate Medical Education, February 2022). The program has been so successful that the school has undergone a recent curriculum redesign to expand the 3YMD pathway.

Dr. Catherine Coe, M.D. of the University of North Carolina at Chapel Hill next discussed the FIRST (fully integrated readiness for service training) program. She started by stating “if you’ve seen one 3-year pathway program, you’ve seen one-3-year pathway program”, and then went on to describe the program at the University of North Carolina. A goal of the program was to increase the physician workforce in the state by reducing barriers and educating students at both the UME and GME level, through an accelerated and enhanced 3-year medical school curriculum. Following 3 year of medical school and residency, graduating physicians complete 3 years of service in a rural and/or underserved area within the state of North Carolina. The program began in 2018 and now offers residency options in Family Medicine, General Surgery, Pediatrics, and Psychiatry at all four of the regional sites. The program reduces barriers and harmonizes the transitions from UME to GME to medical practice. The curriculum consists of an 18-month foundation phase curriculum, followed by a 12-month clinical phase, and 12-16 months of individualization or elective time. Students spend one half day per week in the clinic of their chosen specialty starting at the first week of medical school. Summer between the first and second year contains 8-weeks of the clinical phase. In terms of outcomes to date, there have been 37 students matriculate with 19 total graduates. Six students chose to decelerate and three students changed specialties. All graduates perform similarly to graduates of the 4-year program in nearly all metrics, with the exception of slightly lower step 1 scores.

Dr. Gladys Ayala, M.D., Dean of the NYU Long Island School of Medicine next spoke of the exclusively 3-year medical school program at her institution. This program was developed following the success of the 3-year program described by Dr. Cagiarella. The primary aim is to
train physician leaders who are committed to practice in specific primary care disciplines and address the physician work-force shortages in internal medicine, pediatrics, obstetrics & gynecology, and general surgery. Like the other programs described, the three-year accelerated curriculum is followed by a pre-chosen residency program, thereby reducing barriers in the UME to GME transition. The curriculum uses problem-based learning as the core teaching modality, and offers tuition-free scholarships to all students, and a debt-free scholarship to those with the greatest need. The program includes a robust coaching (academic and professional development), diversity mentoring, and specialty advising system. The programs is committed and focused on diversity, equity, and inclusion with a student-run clinic, a pipeline program, and service learning projects. The class-size is small with 24 students and a future maximum size of 40 students. In terms of outcomes, 20 students have graduated (one class) with 90% of students staying in primary care specialties.

Lastly, Dr. Coe summarized the discussion by listing benefits of accelerated 3-year MD pathways as including accelerated and individualized entry to desired specialty, being valuable to those with advanced degrees and career interests, including reduced debt and earlier career earnings, facilitated continuum of training from UME through GME, and including intensive mentorship that begins in the first year. The CAMPP has published a roadmap for creating an accelerated 3-year program (Med Educ Online 2017). Dr. Coe described the consortium and the many benefits of CAMPP, including some of the manuscripts that have been published from the group (Cangiarella et al. 2017 Acad Med; Leong et al. 2017 Med Educ Online; Modrek et al. 2021, Acad Med; Cangiarella et al. 2020 Acad Med), and positive outcomes from these programs in terms of preparedness, student satisfaction, wellness, and reduced debt. These programs provide individualized curricula with close mentorship and support. The webinar closed by sharing an invitation to join CAMPP as a way to collaborate, network, and share best practices (www.acceleratedmdpathways.org).

• Cangiarella J, Gillespie C, O’Shea J, Morrison G, Abramson SB. Accelerating medical education: a survey of deans and program directors. Med Educ Online 2016;21:31794.
• Cangiarella J, K Eliasz, A Kalet, E Cohen, S Abramson, C Gillespie. A Preliminary Evaluation of Students’ Learning and Performance Outcomes in an Accelerated 3-Year MD Pathway Program. J Grad Med Educ 1 February 2022; 14 (1): 99–107. doi: https://doi.org/10.4300/JGME-D-21-00284.1
• Leong SL, J Cangiarella, T Fancher, L Dodson, C Grochowski, V Harnik, C Hustedde, B Jones, C Kelly, A Macerollo, AC Reboli, M Rosenfeld, K Rundell, T Thompson, R Whyte & M Pusic (2017) Roadmap for creating an accelerated three-year medical education program, Medical Education Online, 22:1, DOI: 10.1080/10872981.2017.1396172
• Cangiarella, J; Fancher, T; Jones, B; Dodson, L; Leong, SL; Hunsaker, M; Pallay, R; Whyte, R; Holthouser, A; Abramson, SB. Three-Year MD Programs: Perspectives From the Consortium of Accelerated Medical Pathway Programs (CAMPP). Academic Medicine 92(4):p 483-490, April 2017. | DOI: 10.1097/ACM.0000000000001465
• Cangiarella, J; Cohen, E; Rivera, R; Gillespie, C; Abramson, S. Evolution of an Accelerated 3-Year Pathway to the MD Degree: The Experience of New York University Grossman School of Medicine. Academic Medicine 95(4):p 534-539, April 2020. | DOI: 10.1097/ACM.0000000000003013
• Modrek, AS; Tanese, N; Placantonakis, DG; Sulman, EP; Rivera, R; Du, KL; Gerber, NK; David, G; Chesler, M; Philips, MR; Cangiarella, J. Breaking Tradition to Bridge Bench and Bedside: Accelerating the MD-PhD-Residency Pathway. Academic Medicine 96(4):p 518-521, April 2021. | DOI: 10.1097/ACM.0000000000003920