Med students benefit from following patients long-term

Students in a pilot clerkship program cite better patient relationships, more mentoring and greater confidence in the care they provide than students in traditional rotations.

By Carolyne Krupa — Posted April 24, 2012

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Third-year medical students who participated in a program that allowed them to follow the same patients throughout the year performed as well or better than peers who underwent traditional clerkship training, says a study in Academic Medicine.

The program was a pilot of the Harvard Medical School-Cambridge Integrated Clerkship at Cambridge (Mass.) Health Alliance, and it since has been made a full program. Instead of traditional clinical block rotations, integrated clerkship students follow a panel of patients representing a wide spectrum of medical conditions through inpatient and outpatient care. They also work continuously during the year with physicians in each of the core specialties.

Students develop relationships with patients and faculty and witness the natural progression of illness and treatment outcomes, said David Hirsh, MD, lead study author and the program’s director and co-creator. “They really get to know patients in context so that they aren’t known just by their disease.”

Researchers compared 27 students who participated in the integrated clerkship between 2004 and 2007 with 45 students completing traditional clerkships at other Harvard teaching hospitals, according to the study, published online March 28. (link). They found that students in the pilot program performed on par with — and in some cases better than — those in the traditional clerkships on clinical skills and content knowledge, as measured by the National Board of Medical Examiners’ exams in surgery, pediatrics, obstetrics-gynecology and psychiatry.

The integrated clerkship students expressed more satisfaction with their learning environment and more confidence with patient care. Students in the pilot program were nearly twice as likely to say they established meaningful relationships with patients and made a real difference in their well-being.

They also received more mentoring from attending physicians and were more satisfied with the quality of the feedback they received. Fifty-two percent of integrated clerkship students rated the quality of their supervision high, compared with about 18% of students in traditional clerkships.

“[Cambridge Integrated Clerkship] students felt that their clerkship experience was more satisfying, confidence-building, rewarding, humanizing and transformational, and less boring and marginalizing than did the comparison students,” the study said.

Students in the pilot program described their experience as more hectic and stressful than other third-year students, a fact that Dr. Hirsh attributes to integrated clerkship students being responsible for managing their schedules. Students must juggle their relationships with patients and their clinical responsibilities.

“It is more hectic, because they are managing more patients and all the different disciplines at once,” said Dr. Hirsh, assistant professor at Harvard Medical School. “They find it hectic and stressful, yet they are highly satisfied.”

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