Harvard med students to follow patient progress

Harvard Medical School is making changes to the way some students learn patient care with a new third-year rotation program designed to focus on patients and their range of care over time.

As of July 2004, eight third-year medical students were introduced to an experimental program that seeks to update the centuries-old way of training medical students.

In the average third-year rotation system, students spend most of their time in a largely inpatient setting, moving after several weeks to another area of the hospital. But students involved in Harvard's integrated clerkship program are able to explore the impact of an illness at diagnosis and throughout treatment in both the inpatient and outpatient settings with the same patient.

"The program is working wonderfully. It has been very successful at the core aspects we had envisioned as most important," said Barbara Ogur MD, director of the program. "Students follow patients longitudinally, pursuing an understanding of an illness."

Through a carefully orchestrated system, students are notified and assigned patients who come to the emergency department with various symptoms that suggest an educational experience. The student then follows that patient through testing, additional visits and any outpatient appointments with specialists.

"They have the opportunity to see how patients evolve," Dr. Ogur said. "Students following psych patients are able to see how that patient can change throughout the year. This is not available to students on a four-week rotation."

Joe Wright, a student in the program, thinks it is an important experiment that re-examines the process of training doctors.

"It remains to be seen that this is the better way of doing things," said Wright. "But what I'm getting that's unquestionably different is long relationships [with attendings and patients] because I'm not moving in and out of different parts of the system.

"All of medicine needs to think about how they will train doctors in a way that reflects this century's way of doing medicine," he said. "I think this is an important experiment, but it's even more important for people to consider that medical care is different than it used to be."