Pilot Clerkships Fly at Affiliates

Photo by Liza Green, HMS Media Services Jules Dienstag says that the reorganization of the clerkship experience for medical students has been an HMS-wide initiative.

Pilot programs within the Medical Education Reform Initiative being conducted at HMS-affiliated hospitals are yielding the benefits of greater continuity during the early clerkship period. The improvements are largely based on consistent mentoring and assessment by faculty and on collaboration between faculty in different departments and disciplines.

Cambridge Hospital is in the second year of an integrated clerkship program (see Focus, June 4, 2004) in which eight students follow a panel of patients throughout their illness, from the onset of symptoms through diagnosis and treatment in a variety of inpatient and ambulatory settings. Developed by David Hirsh, HMS instructor in medicine, and Barbara Ogur, HMS assistant professor of medicine, the program is designed to help students develop clinical skills while gaining a greater understanding of the patient experience.

Ogur said the pilot students “see themselves as well prepared to connect with their patients and understand their culture and background,” and they have not only equaled their traditional student colleagues in tests of content, but have performed particularly well in the areas of cultural competency, communication, and information-gathering. Hirsh added, “We have seen an incredible sense of duty develop among the students as they work to understand their patients, their patients’ illness, and the science underlying it. We believe this educational approach reflects the essence of what it is to be a master care provider and scientist.”

Another model, focused on combining longitudinal and immersion experiences, is being piloted at the large HMS teaching hospitals. At Brigham and Women’s and Beth Israel Deaconess Medical Center, students in the pilot programs rotate through clerkship experiences within the same hospital for a full year. The programs are designed to improve the mentoring of students; enable better skills assessment by the faculty; and promote interdepartmental, cross-disciplinary teaching. Massachusetts General Hospital is currently in the process of developing a similar clerkship experience and is planning to pilot a new clinical experience for students in Harvard’s MD–MBA program. The pilots at BWH (12 students) and BID (eight students) began in July; the MGH pilot is being planned. Children’s Hospital Boston will be the pediatrics site for the BWH and BID programs.

The BWH pilot is led by Erik Alexander, HMS instructor in medicine; Richard Schwartzstein, HMS associate professor of medicine at BID, is leading that hospital’s program. “This model gives us the ability to cover topics that while not fitting into any single clerkship well, apply to many clerkships in different disciplines,” Alexander said.

These integrated clerkships attempt to bridge the basic and clinical sciences and reinforce what is learned in the first two years through a structured, case-based, longitudinal curriculum. “This structure allows the faculty to provide more focused, student-centered teaching and evaluate skills-acquisition over the course of an entire year,” explained Schwartzstein.

Jules Dienstag, HMS dean for medical education, said that the development of the new clerkship experiences has been a School-wide effort. “The faculty at the pilot hospitals have shown tremendous leadership and creativity in planning, implementing, and assessing these programs. Their efforts have received valuable support and cooperation from the departments and department chairs in the major hospitals, fellow faculty members, and in particular, the members of the Principal Clinical Experience design group, who have taken the lead in defining the common principles these programs should incorporate.”

—Chris Railey

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