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    A progressive three-phase innovation to medical education in the United States

    Medicine practice has transformed significantly over the years. However, the structure of undergraduate medical education has made little progression. Many schools have revised their curricula to include problem-based learning and organ systems-based curricula. However, only some have truly confronted the issue of increasing tuition fee. Undergraduate medical education has become too costly for students interested in primary care. Also, the idea of a separate dedicated intern year is obsolete and unproductive even though it is still a requirement for some hospital-based and surgical specialities.

    With the advancement of technologies leading to the availability of several educational resources, many students today prefer a nationally standardised preclinical curriculum over the present more traditional curriculum.

    With reference to the heightening tuition costs, the average medical student debt today amounts to over $190,000 in 2017. The pursuit of medicine is becoming too expensive and fraught with risk. The growth in hospital-based practices demonstrated a shift in the attitudes of modern doctors, and primary care and rural medicine are not desirable, job establishments for mid-level providers but leading to an absolute maldistribution of physicians. While the time of residency training has not significantly changed overtime, the idea of having a dedicated intern year distinct from the rest of residency is no longer preferred.

    Nuanced curriculum adaptations have been implemented for a few years at competitive medical schools where preclinical sequence is delivered in less than two years. Others have transformed to meet student needs for more self-study by condensing the sequence to allow for a dedicated ‘capstone’ course or similar experience in the spring year to allow self-preparation of USMLE 1. Some institutions have reduced the entire curriculum from four to three years on the basis of prior training or scholastic achievement/preparedness or in exchange for a commitment to enter a primary care residency.

    However, before the increasing adaptation of three-year medical curricula over the past seven years, a four-year, three-phase solution was created to address present challenges which was referred to as the Pfeifer curriculum. This curriculum presents an alternative method to leverage on the success of accelerated preclinical pathways and takes advantage of the benefits of modern three-year medical curriculum plans. By curtailing wasteful elements of the present system, it allows for an updated paradigm in which all three steps of the USMLE can be taken within a four-year framework would become apparent.

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