The Yale System

The Yale System of Medical Education remains unique among medical schools. It has been an important part of life at the Yale School of Medicine since the 1920s. Although it has undergone minor modifications in the intervening years, its essential spirit has remained intact, and it is a major reason why many students choose to come to Yale for their medical education.

The fundamental element of the system is the concept that medical students are mature individuals, strongly motivated to learn, requiring guidance and stimulation rather than compulsion or competition for relative standing in a group. The corollary of this concept is that students must assume more than usual responsibility for their education. Students should be considered adults in a graduate school and be permitted to enjoy as large a degree of freedom as is consistent with the fulfillment of requirements for the degree of Doctor of Medicine. Memorization of facts should be far less important than a well-rounded education in fundamental principles, training in methods of investigation, and the acquisition of the scientific habit of mind.

During the pre-clerkship years, the students acquire knowledge and develop clinical skills. In the integrated basic and clinical science courses, lectures are held to a minimum, and there is a focus on interactive learning in small-group workshops and conferences. Students are evaluated through examinations that they take anonymously. Performance is assessed by the faculty based upon participation in small-group sessions, by anonymous qualifying examinations at the end of each course, and by passing of the United States Medical Licensing Examinations. Competency in performing a complete history and physical examination is assessed at the end of the pre-clerkship period using standardized patients in an observed structured clinical examination (P-OSCE). Student attendance is expected in all skill-building sessions and sessions in which interactive learning, clinical reasoning, or collaboration are necessary for optimal learning.

In the pre-clerkship period (first eighteen months), there are no grades and there is no class ranking throughout medical school. While grades are not given and rank order not established, evaluation of students is an important part of the educational process. The faculty considers small-group teaching with formative feedback interchanges between faculty and students to be the most effective means of teaching and evaluation. Students should expect direct questioning in workshops and labs as an important adjunct to the evaluation process. The final decision of acceptable performance for a given course or clerkship is determined by the course/clerkship director based upon the successful completion of the assessments described above.

Freed from the usual anxieties provoked by high-stakes summative examinations, students tend to learn for their future rather than for tests. Competition for grades is eliminated and students are eager to help one another. Class spirit is remarkably high year after year. Upon completing a course, all students are expected to submit a programmatic evaluation so that course/clerkship directors can make changes based on student feedback.

Students are encouraged to allocate their time to further their own interests, within the framework of the Yale curriculum. Some students pursue elective courses or a joint degree program in another school at Yale University, such as management, public health, divinity, or law.

Finally, the Yale School of Medicine requires each student to design, carry out, and successfully complete a research thesis, intended to foster the development of a lifelong commitment to learning.

A unique aspect of the Yale System is the Flex Year option. This option allows students to extend the four-year MD Program by an additional year for research, clinical experience, or coursework, with no additional tuition charged * by the School of Medicine. This Flex Year occurs between the traditional third- and fourth-years of the MD curriculum and in recent years, about half of our students have engaged in it.

There are four main categories of activities that students pursue during their Flex Year: 1) a one-year research fellowship; 2) a clinical/research year; 3) a joint degree at Yale; or 4) a dual degree at another university.

Most students who choose to take a Flex Year opt for a clinical/research year (69%). Some of the activities that students engage in during this time include funded short-term research, clinical electives, clinical shadowing, sub-internships, global health clinical electives in domestic and international settings, global health research, and volunteering

Students who choose to do a year of fully-funded research will work with the Office of Student Research to help secure a one-year medical student research fellowship.

About one-third of Flex Year students choose to pursue a second degree, either through a joint degree with another professional school at Yale or a dual degree at an outside institution. By far, the most popular dual degree option is the MD/Master of Health Science Degree program (MD/MHS), followed the MD/MBA program.

Students taking part in a One-year Research Fellowship, a clinical/research year, or the MD/MHS dual degree are not charged an additional year’s tuition *, and continue to remain fully registered students at the Yale School of Medicine during their Flex Year. Students completing a joint degree at another Yale school or a dual degree at another institution may be charged tuition by that school/institution, and must arrange financial aid at the other Yale school or away institution. Additional details on fees assessed during a Flex Year can be found here.

* Students must either:

1. Pay full tuition in flex year (fourth chronological year) and a registration fee in 4th year (fifth chronological year); or
2. Pay split tuition in flex year and 4th year. Billed one-half of the current rate of tuition and one-half of the current rate of the registration fee per semester over a two year period.