Medical school curricular reform: fourth-year colleges improve access to career mentoring and overall satisfaction.

Despite the trend toward curricular reform in the preclinical and core clerkship years, the fourth year of medical school is commonly unstructured, allowing students to take multiple "audition electives" in preparation for residency. Students struggle to identify mentors in their intended specialty in time to plan a well-rounded elective schedule and to prepare adequately for residency selection. The authors described the impact that an innovative fourth-year curriculum, the "College Program" at the David Geffen School of Medicine at the University of California-Los Angeles, which focuses on mentoring and required curricular components, has had on student perceptions of access to career mentors and overall satisfaction with the fourth-year experience. Pre- and postintervention cohorts participated in a 25-question telephone survey about their experience with mentors and overall satisfaction with their fourth year in 2001 and 2003. The Association of American Medical Colleges Graduation Questionnaire was analyzed as a secondary outcome measure, and responses were compared with those of national peers. Data were analyzed using two tailed t tests. Students in the intervention group reported a higher degree of satisfaction with accessibility to mentors and the impact they had on their educational experiences and careers than the preintervention cohort. Despite initial concerns that student freedom was going to be compromised, the students who participated in the College curriculum reported increased satisfaction with an intense foundations course, longitudinal experiences in the clinical setting, and scholarly projects during their senior year. Fourth-year students in the College Program were more likely to identify and develop better relationships with faculty mentors than their preintervention counterparts. They indicated excellent residency preparedness, and their overall impression of the fourth year was favorable.