Fifth year of residency versus fourth year of medical school and residency

Abstract

I have suggested that residency programs in Obstetrics and Gynecology have a number of deficits with a major one being insufficient education in the full spectrum of the specialty. Specifically, there are inadequate ambulatory care, inadequate case volume, inadequate instruction in pelvic surgery, and inadequate instruction in a number of other areas such as practice management, ethics, etc. I proposed a fifth year of residency to provide enough time for each of these areas to be covered. There is an alternative that may be achievable. First, it is unlikely the Accreditation Committee for Graduate Medical Education will agree to an increase in the length of any residencies. Pathology made such a change a few years ago and incurred the attention of all involved. It is equally unlikely that the funding necessary for such an increase will be available. It would probably require that each program cut its annual resident complement by 20% to be able to pay for the 20% increase in years. Even cutting the number of residents will not solve all of the money problems because salary goes up in the fifth year and fringe benefits go up proportionately. Such an increase by reducing numbers per year also impinges on service versus education and, in many programs, would not accomplish the goals desired. It would be difficult to recruit to Obstetrics and Gynecology if we add a year. I have had a number of queries from concerned candidates this year. For many students the senior year of medical school is a hodge-podge of electives. They have no guidance in too many schools and are allowed to take almost anything they want. Some elect for easy rotations; others choose hard ones. The end result is a senior year that is poorly structured for entry into our discipline. I propose that we mandate a change in the senior year of medical school. This is possible even though other