The Clinical Education of Medical Students

1
The Clinical Education of Medical Students

• What would Osler think about the current
  situation?

2
Curriculum Reform in the 1990sAAMC/Milbank
Memorial Fund

• Ten schools selected to participate in project
• All adopted significant reforms in years 1
  2
• None could implement meaningful reforms in years
  3 4 despite interest in doing so

3
AAMC Project on the Clinical Education of Medical
Students

• Nutter project 22 schools site visited after
  review of resource materials (what is the state
  of the clinical curriculum in schools across the
  country?)
• Millennium Conferences 19 schools participated
  (what to teach, how to teach, who should teach?)
• Corbett project review of materials and site
  visits (evaluation of clinical skills teaching )

4
Project FindingsGeneral Issues

• Learning objectives
• Teaching and assessment of clinical skills
• Integration of contemporary topics
• Sites for clinical experiences
• Faculty commitment to teaching
• Coherence of year-4 experiences
• Oversight and management of curriculum

5
GPEP ReportWorking Group On Fundamental
Skills(1984)

• - clinical clerkships are often little more than
  unstructured apprenticeship experiences that
  contribute little to the overall learning
  objectives of the educational program -

6
Health Professions EducationA Bridge to
Quality(2003)

• Health professions education is in need of a
  major overhaul. Clinical education simply has
  not kept pace with or been responsive enough to
  shifting patient demographics and desires,
  changing health system expectations, evolving
  practice requirements and staffing arrangements,
  new information on improving quality , or new
  technologies.

7
Health Professions EducationA Bridge to Quality

• Interdisciplinary teams
• Patient -centered
• Evidence-based practice
• Quality improvement
• Informatics

8
The Clinical CurriculumWork in Progress

• NYAM/AAMC Project Enhancing Education for the
  Clinical Transaction
• AAMC Clinical Skills Task Force
• Education for Chronic Illness Care

9
Enhancing Education for the Clinical Transaction

• University of Washington
• Harvard University
• Case Western University
• SUNY Upstate (Syracuse)
• Vanderbilt University
• Stony Brook University

10
Enhancing Education for the Clinical Transaction

• Dedicated rounds and conferences
• Portfolios
• Standardized patients
• Master teachers
• College concept
• Modification of clinical curriculum structure and
  individual clerkships

11
Clinical CurriculumMajor ChallengesOrganization
and Structure

• Which disciplines should be required?
• How should clerkships be designed and conducted?
• How can variation in patient encounters across
  sites be managed?
• How should schools ensure that experiences
  contribute to overall programmatic objectives?

12
Evolution of Clinical Curriculum

• Pre-Osler no formal clinical instruction
• Post Flexner - year 3 clinics year 4 wards
• 1950s years 3/4 swap psych added
• 1980s year 4 clinic rotations eliminated
• 1990s pre-clerkship experiences primary care
  (FP) added neuro, EM, critical care
• 2000s integrated blocks/inter-sessions

13
What Would Osler Think?
14
You need to take more seriously your
responsibility to provide medical students a
quality clinical education.
15
Academic Health CentersLeading Change in the
21st Century

• The committee believes that among all the AHC
  roles, education will require the greatest
  changes in the coming decades .
• We regard education as one of the primary
  mechanisms for initiating a cultural shift toward
  an emphasis on the needs of patients and
  populations and a focus on improving health,
  using the best of science and caring.