{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:41:05Z","timestamp":1787755265717,"version":"build-2784847793"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2017,7,5]]},"abstract":"<jats:sec>\n                    <jats:title>Abstract:<\/jats:title>\n                    <jats:p>Most U.S. medical schools follow the 4-year model, consisting of 2 preclinical years, core clinical experience, and a fourth year intended to permit students to increase clinical competency, to explore specialty areas, and to transition to residency. Although the design and delivery of Years 1 through 3 have evolved to meet new challenges and expectations, the structure of Year 4 remains largely unchanged. For most students considering a career in orthopaedics, Year 4 is a series of elective rotations in which educational objectives become secondary to interviewing for residency programs. Most accreditation bodies recognize the importance of attainment of competency over the duration of medical school as the goal of educating physicians, and thus, there is a growing interest in reexamining the traditional medical school curriculum with the goal of integrating the final phases of undergraduate education and the first phases of postgraduate education.<\/jats:p>\n                    <jats:p>A literature search was undertaken to identify publications on the duration of medical education. Pilot approaches to competency-based integration of undergraduate medical school and postgraduate training in orthopaedic surgery were reviewed.<\/jats:p>\n                    <jats:p>There have been few data suggesting that 4 years of medical education is superior to shorter-duration programs. Three approaches to competency-based integration of undergraduate medical school and postgraduate training are presented. Their goal is to use student and faculty time more effectively. Each approach offers the opportunity to lower the cost and to decrease the time required for Board Certification in Orthopaedic Surgery. Two approaches shorten the entire duration of medical school and graduate training by using various proportions of the fourth year to begin residency, and one approach expands the duration of orthopaedic training by starting in the fourth year of medical school and including training equivalent to a fellowship program into the residency experience.<\/jats:p>\n                    <jats:p>The effectiveness of such programs will form the basis for revisions to the current orthopaedic training paradigm, resulting in a more effective, efficient, and integrated orthopaedic training curriculum.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.16.01094","type":"journal-article","created":{"date-parts":[[2017,7,4]],"date-time":"2017-07-04T13:00:01Z","timestamp":1499173201000},"page":"e72","source":"Crossref","is-referenced-by-count":1,"title":["The Fourth Year of Medical School: Time for Reassessment"],"prefix":"10.2106","volume":"99","author":[{"given":"Benjamin A.","family":"Alman","sequence":"first","affiliation":[{"name":"Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"Purtill","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent D.","family":"Pellegrini","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Scoles","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"1","key":"bib2-20230714","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1365-2923.2010.03850.x","article-title":"Revolution or evolution? Putting the Flexner Report in context","volume":"45","author":"Barr","year":"2011","journal-title":"Med Educ."},{"issue":"11","key":"bib3-20230714","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1097\/ACM.0b013e3181f52dc6","article-title":"The fourth year of medical education: a literature review","volume":"85","author":"Walling","year":"2010","journal-title":"Acad Med."},{"issue":"3","key":"bib4-20230714","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.jsurg.2015.11.014","article-title":"Procedural experience and confidence among graduating medical students","volume":"73","author":"Barr","year":"2016","journal-title":"J Surg Educ."},{"issue":"6","key":"bib5-20230714","doi-asserted-by":"crossref","first-page":"e184","DOI":"10.1016\/j.jsurg.2015.07.005","article-title":"Graduating students\u2019 and surgery program directors\u2019 views of the Association of American Medical Colleges core entrustable professional activities for entering residency: where are the gaps?","volume":"72","author":"Lindeman","year":"2015","journal-title":"J Surg Educ."},{"issue":"2","key":"bib6-20230714","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.amjsurg.2013.07.032","article-title":"American College of Surgeons\/Association for Surgical Education medical student simulation-based surgical skills curriculum needs assessment","volume":"207","author":"Glass","year":"2014","journal-title":"Am J Surg."},{"issue":"2","key":"bib7-20230714","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.amjsurg.2013.10.010","article-title":"When surgeons decide to become surgeons: new opportunities for surgical education","volume":"207","author":"Hochberg","year":"2014","journal-title":"Am J Surg."},{"key":"bib8-20230714","doi-asserted-by":"crossref","first-page":"31325","DOI":"10.3402\/meo.v21.31325","article-title":"Do audition electives impact match success?","volume":"21","author":"Higgins","year":"2016","journal-title":"Med Educ Online."},{"issue":"2","key":"bib9-20230714","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1080\/10401334.2015.1011655","article-title":"Length of attending-student and resident-student interactions in the inpatient medicine clerkship","volume":"27","author":"Osman","year":"2015","journal-title":"Teach Learn Med."},{"issue":"5","key":"bib10-20230714","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1097\/ACM.0b013e31828a0cf9","article-title":"Medical students with median debt: an endangered species?","volume":"88","author":"Rogalsky","year":"2013","journal-title":"Acad Med."},{"issue":"4","key":"bib11-20230714","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1097\/ACM.0b013e3181d296da","article-title":"Perspective: PhD scientists completing medical school in two years: looking at the Miami PhD-to-MD program alumni twenty years later","volume":"85","author":"Koniaris","year":"2010","journal-title":"Acad Med."},{"key":"bib12-20230714","doi-asserted-by":"crossref","first-page":"31794","DOI":"10.3402\/meo.v21.31794","article-title":"Accelerating medical education: a survey of deans and program directors","volume":"21","author":"Cangiarella","year":"2016","journal-title":"Med Educ Online."},{"issue":"11","key":"bib13-20230714","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1001\/jama.2012.292","article-title":"Shortening medical training by 30%","volume":"307","author":"Emanuel","year":"2012","journal-title":"JAMA."},{"issue":"4","key":"bib14-20230714","first-page":"294","article-title":"Perspectives of graduates two or five years after graduation from a three-year medical school","volume":"57","author":"Woodward","year":"1982","journal-title":"J Med Educ."},{"issue":"10","key":"bib15-20230714","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1097\/ACM.0000000000000862","article-title":"The merits and challenges of three-year medical school curricula: time for an evidence-based discussion","volume":"90","author":"Raymond","year":"2015","journal-title":"Acad Med."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201707050-00015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:40:21Z","timestamp":1787751621000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201707050-00015"}},"subtitle":["AOA Critical Issues"],"short-title":[],"issued":{"date-parts":[[2017,7,5]]},"references-count":14,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.16.01094","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7,5]]}}}