An editorial in the current issue of CMAJ, the journal of the Canadian Medical Association, asks whether four-year medical schools are really necessary in this age of problem-based learning, a method that encourages students to work cooperatively in small groups on real problems.

The editorial points to the success of two schools, at McMaster University and the University of Calgary, that have for more than 30 years educated doctors with a three-year curriculum.

The articles says that unlike many programs in the United States, “Canada’s two three-year schools have not condensed four years of classes into three by teaching on Saturday and across the summer.” The physician authors say licensing authorities have not expressed concerns over test scores from graduates of the three-year curricula, nor are there increased lawsuits or evidence of problems with those graduates going on for specialty training or into family medicine.

Moving to a three-year model, the authors argue, would save money and end Canada’s shortage of doctors faster.

The CMAJ issue also contains the results of a systemic global study of problem-based medical curricula, carried out by researchers in Singapore on the competencies of graduates. The study found moderate to strong evidence for the problem-based approach, especially in diagnostic and communication skills.

An accompanying commmentary says that it’s time to study why problem-based curricula make such a difference, pointing out that after McMaster pioneered the concept, in the 1960s, it took off in many countries. Still, a debate over its effectiveness continues — one that perhaps can be put to rest, the commentary argues, by finding out “why the method works.” —Karen Birchard