Present: Deowall Chattar Sarita Kaza Alan Liu Yolanda Troublefield Seth Dailey Jason Kornberg John-Paul Mead Diana Yoon Demetre Daskalakis Roland Knoblauch Nayan Sivamurthy Craig Gordon Yince Loh Joe Quaranta Not Present: (* = excused) Melissa Fischer* Mike Henry* Eric Kim* Edie Lederman* Stephen Pool Rich WestreichNew Items:
Clerkship Length (weeks) Required Completion Time Medicine 10 During 3rd yr Surgery 10 During 3rd yr Psychiatry 6 At any time Neurology 4 At any time Pediatrics 1 (inpatient) 4 At any time Pediatrics 2 (outpatient) 4 At any time Obstetrics/Gynecology 6 At any time Advanced Medicine Sub-I 6 During 4th yr Total Required: 50 Electives 24 Misc 14 (Electives, Research, Interviews, Sub-Is) Vacation 8 Total 96 Here is the modified program: Clerkship Length (weeks) Required Completion Time Medicine 10 by Nov of 4th yr Surgery 10 by Nov of 4th yr Psych (6) + Neuro (4) 10 by Nov of 4th yr Peds (6) + Ambulatory Care (4) 10 by Nov of 4th yr Ob/Gyn (6) + Elective (4), 10 by Nov of 4th yr may be restricted type Medicine Sub-I 6 During 4th yr Total Required 52 (minus the 4wk Elective with Ob/Gyn) Electives 18 Misc 14 (Electives, Research, Interviews, Sub-Is) Vacation 8 Total 96
From the time part I of USMLE is over to November of the fourth year is a period of 70 weeks. After 50 weeks of requirements, this leaves two ten week blocks free for electives, vacation time, etc. Currently, students are not required to complete all of their core clerkships before taking part II of USMLE in early March.
The impetus for change arose from the following concerns presented by Dean Abramson:
The questions raised include: Will these changes correct the problems mentioned above? What are the pros and cons of these changes? Finally, what are other possible solutions for the problems mentioned above?
Let's address each of the above mentioned problems:
The new system would resolve this problem by ensuring that the grades for all of the required clerkships would be important to students when applying for residencies. It would force them to attend, and it would minimize the overlap between 3rd and 4th year students in core clerkships.
The principal problem with the new system is that it would dramatically reduce the flexibility of the curriculum. Students applying for early match and competitive residencies, such as some surgical subspecialties and for programs in prestigious hospitals, need the elective time in their third year to build up a competitive application. This will especially affect students who do not decide until late in 3rd year that they want to go into a competitive program. In order to complete the requirements before the November deadline, students may not have time to complete the research and do the sub-Is necessary to build up a strong application. These students may also burn out because they will not feel that they can afford to take any vacation time third year. While some other schools have more rigid systems, flexibility has always been a strength of the NYU curriculum and helps NYU students compete with graduates of other prestigous schools. It is one reason that students choose to come to NYU over other institutions. The new system will diminish the edge NYU students have over students from other schools in highly competitive areas, and not really benefit NYU students going into less competitive areas.
Finally, there is an advantage for 3rd year students in having 4th years in their clerkships. Interacting with senior students can beneficial to 3rd year students in that they can be taught procedures and gain advice in a mentor-type fashion.
The real problem of "senioritis" can be addressed in other ways. Faculty should be supported in efforts to enfore attendance and develop a real grading system. This would make fourth years take their required coursework more seriously and improve the working environment for incoming 3rd years as well. Another possibility would be to block out the interview period as a time when 4th year students can not take core clerkships. This would improve attendance and also open up time for 3rd year students to take courses without 4th years if they prefer.
While this is a current problem, it is not clear to us that the new system will solve the problem.
The new schedule, by being more restrictive, may instead increase pressure on students to compete with each other for prime or "peak" scheduling times. Further, it will make it harder for students to get spots in popular elective rotations, because everyone who wants to do them will have to do them at approximately the same time. The current schedule would force all of the 4th years to fulfill their medicine sub-I between the end of interview season and June. By forcing people to all do the same thing at the same time, there is going to be more strain on accomodating people for peak times and popular sub-internships.
A solution under either system would mean setting limits on the number of students allowed in a given rotation and sticking by the limits. In the current system, if students are locked out of the their most preferred time, at least the remainder of the schedule has enough flexibility to enable them to prepare an alternate time. In a more rigid schedule, it will be harder to satisfy the students once they are locked out, because the number of alternative solutions is diminished.
It is not clear that this is currently a significant problem. Most students do finish in time. The only problem that may have arisen is the unequal filling of core clerkships forcing cancellations, but as mentioned before, the new system may not really solve the problem. A student committed to completing their required clerkships on time will be able to do so under either system equally well.
Other scheduling problems will arise, such as planning of away rotations. Everything would have to fit into neat little 10 week blocks, and other schools don't necessarily work on the same schedule. Ex: if you want to work at USCF for 3 weeks and it overlaps 2 of the ten week blocks in the schedule, you have used up all of the free time allowed in the third year schedule. You can't fill in any of the remaining 17 weeks with required clerkships, because they do not fall into 10 week blocks; and if the required courses fall into the ten week block schedule, so will the NYU elective rotations. For those 17 weeks, you would have to take your vacation time or find an elective at another school.
Under the current system, with everything broken down into smaller periods, you could fill those 17 weeks with at least 2 required clerkships or NYU electives.
There may be small one or two week gaps, but there will be a problem with time gaps under either system. The amount of "unschedulable" or dead time will be smaller under the current system for students who want to take the option of doing away rotations, research, and so on.
On the whole, we believe that most students are highly satisfied with the current system. We will gather data on the student's experience. While the concerns brought up are valid, we believe that there are equally effective ways of addressing them that would not eliminate the flexibility of the NYU clinical years.
Meeting with Dean Abramson is scheduled for the next Student Council meeting. Concerns will be discussed and a letter to the student body drafted. These changes will have the most significant impact on the first and second year students, who have exams right now. Meetings explaining the current and proposed system will be set up in the first week or two of January, with a third and fourth year in attendance to help answer questions. Data and student response is needed before the dialogue with Dean Abramson is re-opened next term.