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  3. Should Medical Schools Turn to Three-year Programs? [A] For Travis Hill,

Should Medical Schools Turn to Three-year Programs? [A] For Travis Hill,

游客2024-04-04  25
问题     Should Medical Schools Turn to Three-year Programs?
    [A] For Travis Hill, it was an offer too good to refuse. Last year when the 30-year-old neuroscientist was admitted to a new program at NYU School of Medicine that would allow him to complete medical school in only three years and guarantee him a spot in its neurosurgery residency, he seized it. Not only would Hill save about $70,000—the cost of tuition and living expenses for the fourth year of medical school—he would also shave a year off the training that will consume the next decade of his life.
    [B] The chance to finish medical school early is attracting increased attention from students burdened with six-figure education loans: The median debt for medical school graduates in 2013 was $175,000, according to the Association of American Medical Colleges. This year, the combined cost of tuition and fees for a first-year medical student range from just over $12,000 to more than $82,000.
    [C] Some medical school administrators and policymakers see three-year programs as a way to produce physicians, particularly primary-care doctors, faster as the new health-care law allows millions of previously uninsured patients into the medical system. Enormous student loans are cited as one reason some newly minted doctors choose profitable specialties such as radiology(放射学)or dermatology(皮肤病学), which pay twice as much as pediatrics(小儿科)or family medicine.
    [D] But debt and the shortage of primary-care doctors are not the only factors fueling interest in accelerated programs. Some influential experts are raising questions about the length of medical school in part because much of the fourth year is devoted to electives and applying for a residency, a process that typically takes months.(Similar questions are being raised about the third year of law school.)
    [E] In a paper published in a journal of the American Medical Association in 2012, University of Pennsylvania Vice Provost Ezekiel Emanuel and Stanford economist Victor Fuchs proposed that a year of medical school could be eliminated " without adversely affecting academic performance". The overall time it takes to train physicians, they wrote, is an example of waste in medical education and could be shortened without affecting patient care or eroding clinical skills: students could be assessed on "core competencies rather than on time served".
    [F] So far, fewer than a dozen of the nation’ s 124 medical schools are offering or actively considering three-year programs, which typically involve the elimination of electives, attendance at summer classes and the temporary guarantee of a residency offered because three-year graduates might be at a disadvantage compared with other applicants.
    [G] NYU launched its program in September with Hill and 15 other students chosen from a pool of 50 applicants—nearly a third of the medical school’ s 160-member class. Texas Tech University Health Sciences Center in Lubbock graduated its first three-year class in 2013: its nine students are training in family medicine. Fifteen more students started this fall. In September, Columbia University’ s College of Physicians and Surgeons launched a " fast track MD" for candidates who already hold doctorates in biology: there were 40 applicants for four quotas.
    [H] Despite the growing popularity of such programs, critics question the wisdom of jettisoning(抛弃，投掷)the fourth year of medical school, which they say plays a crucial role in preparing doctors for residency and subsequent practice. Some note that the three-year track was offered by a few dozen medical schools in the late 1970s but subsequently abandoned, largely because of student burnout from trying to jam too much into three years.
    [I] Supporters of the three-year option say that contemporary medical school programs are different from 1970s curricula, which relied more heavily on rote memorization, and that the new programs have been designed to minimize burnout.
    [J] "This has been tried before, and it was a miserable failure," said Stanley Goldfarb, associate dean for curriculum at the University of Pennsylvania’ s Perelman School of Medicine, who co-authored an essay opposing three-year programs in a recent New England Journal of Medicine. "Since the 1970s things have gotten so much more complex in medicine," he said. The more relaxing fourth year, he said, gives students the chance to pick the field that best suits them and to carefully evaluate residencies. More than three-fourths of students, he said, enter medical school uncertain about their eventual specialty. Goldfarb said he favors enhancing the fourth year, not eliminating it.
    [K] Medical students have mixed feelings about three-year programs, said Nida Degesys, president of the Reston-based American Medical Student Association. While many are eager to reduce their debt, they are also concerned about missing opportunities: fourth-year electives can include ophthalmology(眼科学), critical care and emergency medicine.
    [L] "There have always been some individuals who wondered about the length of medical school," said John Prescott, former dean of the medical school at West Virginia University and chief academic officer at the Association of American Medical Colleges. Prescott calls the current three-year programs "well-designed experiments" that may provide models about how to prepare students "in the most cost-effective way". But he doubts they will substitute the conventional four-year track for most students.
    [M] Steven B. Abramson, vice dean of NYU’s medical school, agrees, but he said he expects three-year programs to multiply over the next five years. NYU’ s accelerated program, he said, is best suited for highly qualified students who are typically older, more mature and certain of their choice of specialty. Because three-year students take the same core courses as their classmates, they will be equally well prepared, he said. And Abramson noted the spread of dual-degree programs: students who earn an MD along with a graduate degree in science, business administration or public health.
    [N] While students at NYU can designate a variety of specialties, the three-year Family Medicine Accelerated Track at Texas Tech is limited to those who intend to pursue that specialty. " There weren’ t enough primary-care doctors before the Affordable Care Act," said Texas Tech medical school dean Steven Berk, who trained as a family physician. "There are lots of towns in Texas with 25,000 people and no doctor. And it’ s the primary-care physicians who find the small breast mass(乳腺肿块)or control patients’ blood pressure. They are essential to the functioning of the health-care system. "
    [O] Texas Tech students are awarded a $15,000 full tuition scholarship to cover the first year.
    When they graduate, their average debt for tuition and living expenses totals about $60,000, Berk said. Like the NYU program, students have the option of switching to the four-year track—none has so far—and are granted a residency spot when they enter med school. Fears that they will not perform as well as their four-year counterparts have not been confirmed, Berk said. Scores on licensing exams are equivalent, and burnout has not been a problem. Charles Willnauer, 30, a graduate of Texas Tech’ s first three-year class, said the accelerated program worked well for him. The promise of a residency in family medicine, a specialty that "fits with my values and goals" , was tempting, as was the lower price tag. "A lot of people have to apply to 30 or more residency programs," said Willnauer, now a first-year resident. "That’ s a very large cost and a lot of time. "
    [P] It was also a bonus in other ways. Married and the father of two toddlers born while he was in medical school, Willnauer, age 30, said, " I bought a house and knew I wouldn’ t have to uproot my family. " [br] The fourth year should be enhanced to allow students to choose the field that suits them and assess residencies.
选项
答案 J
解析 题干大意：应该改进第四年的学习，让学生可以选择适合自己的领域，并评估自己的住院实习表现。根据题干中的关键词fourth year，enhanced，choose the field，assess residencies，将本题定位于[J]段。[J]段后半部分提到，戈德法布认为，时间更为宽松的第四年能给学生机会去选择最适合他们的领域，并且能认真地评估实习表现，他支持改进第四年的学习。故答案为J。
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