5-year medical school, if realized, would put Korea back to Japanese colonial era

The government has recently mentioned the idea of switching medical colleges to five-year schools.

However, foreign examples show few such cases except for India and Nepal.

Looking back, the only similar instance was the action taken by the Japanese Government-General of Korea during World War II, which forced a reduction in the duration of medical education to expedite the recruitment of military doctors.

In Korea, people can practice medicine after graduating from medical school and passing the national medical examination to obtain a license. Therefore, a five-year curriculum will allow them to practice as a doctor in five years. However, no other country permits doctors to practice in just five years.

On Oct. 6, the Ministry of Education announced the “Emergency Plan for Normalizing Medical School,” saying it would consider flexibly shortening the medical school curriculum from six years to a maximum of five years.

Article 25 Paragraph 1 of the Enforcement Decree of the Higher Education Act states that the bachelor's degree program must be six years for medical, oriental medicine, dental, and veterinary schools. However, Article 26 (Reduction of the number of years of study) states that the number of years of study can be shortened if students earn more than the required number of credits to obtain a degree, and the government said it would use that clause.

In response to protests from the medical community and criticism from lawmakers during the parliamentary audit of the administration, Minister of Education Lee Ju-ho announced, “We will leave it to the autonomy of universities.”

Training a doctor takes more than six to seven years

Medical educational institutions in Korea are divided into medical colleges and graduate medical schools. Many countries operate medical colleges and graduate medical schools together, but they differ in how they train doctors. Like Korea, the United Kingdom, Australia, New Zealand, and other Commonwealth countries adopt a five—to six-year undergraduate medical program.

In the U.K., obtaining a medical license takes at least seven to eight years. Most undergraduate programs at U.K. universities are five years (some are six years). However, it's seven or eight years before people can get a license to practice because they must complete a two-year “foundation” after medical school. Additional time may be required to obtain A-level grades or equivalent education, a prerequisite for medical school.

In the U.K., doctors are licensed to practice after the first year of the foundation year and must complete the second year before they can practice. (There used to be no national exam for doctors in the U.K. other than the PLAB for overseas medical students, but starting with this year's graduates, they will have to pass the UKMLA, a new exam introduced in the final year of medical school.)

In other European countries that train doctors primarily through undergraduate programs, obtaining a medical license also takes six to seven years. Most undergraduate programs are five to six years, but many require a year of internship after medical school to sit for the medical licensing exam and become licensed.

The same is true in Asia.

In China, medical school is five to six years long, followed by a year-long internship, before people can sit for the NMLE (National Medical Licensing Examination). Only after passing this exam can people practice as general practitioners. In Japan, after graduating from a six-year medical school, like in Korea, students can take the Japanese Licensing Medical Examination (JLME) and obtain a medical license if they pass.

On the other hand, in North America, including the United States and Canada, doctors are mainly trained through graduate medical schools. It takes at least eight years to produce a doctor, including undergraduate programs. In the U.S., a bachelor's degree from a four-year university is required to enter medical school, followed by four years of medical school.

It takes 5.5 years in India and Nepal, but they require a one-year internship

So, which country takes the shortest time to get a doctor's license? According to Korea Biomedical Review’s research, becoming a licensed doctor in Nepal and India takes five years and five months. These are rare cases where medical education is shorter than in Korea.

In Nepal, after entering medical school, students spend four years and five months studying basic medicine and clinical theory and the remaining year as interns at a training hospital before graduating. After that, people must pass the National Medical Council Licensing Examination (NMCLE) administered by the Nepal Medical Council (NMC) to become licensed.

India is similar to Nepal. After studying for four years and five months in medical school, doctors can become licensed by interning for a year and registering with the National Medical Council of India (NMC). There has never been a separate exam in India, but starting next year, the country will introduce the National Exit Test (NExT). The idea is to standardize medical education and bring doctors up to international standards.

Shortening the medical school program is not without precedents. In the U.S., some medical schools offer a “three-year accelerated program” alongside the traditional four-year program.

New York University's Grossman School of Medicine is a case in point. The school offers a combination of a four-year pre-med program and a three-year accelerated program. However, if people graduate from the three-year accelerated program, they can choose only among 21 specialty courses. Once they start training in their specialty, they can shave a year off before obtaining their medical license as the education proceeds under the existing system. The three-year program still means a seven-year course, including four years of undergraduate school.

In addition to NYU, 33 other medical schools in the U.S. and Canada have formed a consortium called the “Consortium of Accelerated Medical Pathway Programs (CAMPP).” Some of them, including the University of California, Davis, offer accelerated programs to train doctors to practice primary care in the community.

Japanese colonial rulers reduced the number of education years during WWII

The only example of an artificial and abrupt reduction in the number of years of medical school was the action taken by the Japanese Government-General of Korea. In 1937, the colonial rulers shortened the four-year Severance Medical School curriculum by three months to recruit military doctors. In 1940, they shortened the program by five to six months.

“Just before the Japanese empire collapsed, they shortened the medical curriculum to fill the shortage of military doctors, and it ended up being a failure,” said Ahn Duck-sun, head of the Korean Academy of Medical Sciences under the Korean Medical Association. “This is not wartime, so why are they pushing for a five-year program? How will they change the curriculum, and how will they change the internship system? There are no discussions on these issues.”

Don't mess up medical education with armchair debates: experts

The medical community consensus is that it is not appropriate to introduce a five-year program without any preparation or discussion in Korea, where medical students can practice immediately after graduating from medical school and passing the national medical examination.

“The government’s mentioning the five-year system without any prior discussion is a problem,” said Ahn, who served as the vice president of the World Federation for Medical Education (WFME).

“Are we going to shorten the undergraduate program to five years like the U.K. and implement the foundation period, which will require at least a few years to build the system and a huge budget,” he said. “We shouldn't be cluttering up medical education with armchair debates.”

A medical education expert, who requested anonymity for privacy reasons, also pointed out that medical curriculum reform is possible only after comprehensive discussions, including social demands and medical community consensus.

“It is common for university curriculums to be determined by many factors, including situations facing different countries and social needs,” the expert said. “Even if there is a consensus to reorganize the school system, much preparation is needed before the new system can be applied to the educational fields.”

“A long time ago, there were two- or three-year medical schools in the United States, but they determined that there was not enough training time to train doctors properly, so it was changed to a 4+4 system,” he said. “Whether a five-year medical school is necessary or even possible can only be determined after numerous discussions.”