Curricular reform of the 4th year of medical school: the colleges model.
BACKGROUND
The practice of medicine has changed dramatically over the last 3 decades. Medical education has struggled to keep up with these changes, with only limited success. The 4th year of medical school offers a tremendous opportunity for curricular innovation, but little change has occurred in the past 30 years.


METHODS
This article traces the history of the 4th year, from the Flexnerian era in which the classic preclinical-clinical model for medical education was developed, through the 1970s, when virtually every medical school adopted a largely elective 4th year, to the present. Although the classic 4th-year curriculum has a number of strengths such as flexibility and relative autonomy of scheduling for students, it also has significant weaknesses.


RESULTS
A major educational initiative for the 4th year-the "College Phase"-has been implemented at the David Geffen School of Medicine at UCLA. It is designed to remedy many of the weaknesses of the 4th-year curriculum while preserving the benefits.


CONCLUSIONS
Five colleges have been created: acute care, applied anatomy, medical science, primary care, and urban underserved. Students participate in a number of different college-specific activities that are hoped to produce a more engaging, rigorous, and enriching experience for students and faculty alike
Slavin
Stuart J
SJ
Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. sslavin@mednet.ucla.edu
Wilkes
Michael S
MS
Usatine
Richard P
RP
Hoffman
Jerome R
JR
D002321:Career Choice; D003479:Curriculum / Q000639:trends*; D004504:Education, Medical, Undergraduate / Q000592:standards / Q000639:trends*; D005180:Faculty, Medical; D006801:Humans; D015141:Los Angeles; D017145:Models, Educational; D009936:Organizational Innovation; D012577:Schools, Medical / Q000592:standards / Q000639:trends*; D013337:Students, Medical; D014481:United States; D014830:Vocational Guidance