Transitions AND the Advanced Clinical Experience

Hofstra North Shore-LIJ School of MedicineCurriculum Committee Presentation

October 22, 2012

Transitions

Spring Break: 3/25 – 4/1/13 Comprehensive Basic Science Test: 4/2 – 4/5 Step 1 Study Time: 4/6– 5/31/13 Deadline to Take Step 1: Friday May 31st

To the best of our knowledge i.e. subject to change Transitions: 6/1 – 6/30/13 3rd Year ACE: 7/8 – 6/29/14

◦ Includes 3 weeks vacation and 9 weeks selective 4th Year ACE: Starts 6/30

Time Frame

Recertify in BLS Acclimate to hospital settings Navigate hospital systems and EMR Refresh basic skills- CXRs, EKGs,

phlebotomy, IV placement, suturing, knot tying

Learn new skills- new procedures, inpatient and outpatient notes, the 1min/3min/15min presentation

Experience new horizons- e.g. anesthesia Pick up some longitudinal patients

Transitions

Preliminary Schedule

The Advanced Clinical Experience

Lack of meaningful responsibility or an authentic role

Insufficient development of clinical reasoning skills

Conflicting interests between learning and getting a good grade

Inadequate information to make an informed career decision

Inadequate assessment data

Unintended Consequences of the Traditional Clerkship Experience

What we can do to improve the Third Year

Experience

Give students authentic responsibility for patients and place them where the thinking occurs

Cultivate “whole illness” relationships with patients and develop longitudinal coaching relationships with faculty

Assess students in a way that drives learning and integrates science into clinical education

Give students better insight into careers in medicine and facilitate “differentiation” through self-directed learning time and electives

We CAN

to be feasible as tracks in leading medical schools (a decade of experience)

to improve long term retention and capacity for learning

to provide students with a superior clinical experience in terms of depth and volume of core diseases (by orders of magnitude)

to create patient-centered doctors

Longitudinal Integrated Clerkships…PROVEN

Feasibility for our class size Considerable multi-tasking for students

Challenges

The Best of Both Worlds

“Hybrid” Model for 3rd Year

Keeps the discipline-specific focus of traditional clerkships while

Integrating cumulative and longitudinal features of a Longitudinal Integrated Clerkship

Discipline-specific focus6-week cycles focused on one discipline

Discipline-specific morning “ACE” rounds

Discipline-specific class time, one full half day per week

Shelf exams (national multiple choice

exam-one for each specialty) every 6 weeks

Cumulative and Longitudinal Features Self-directed time for follow-up of patients Ongoing, cumulative experiences in

Internal Medicine and Surgery Longitudinal continuity clinic experiences

in Internal Medicine Highly select group of longitudinal

patients to follow Week-long “Reflection, Integration, and

Assessment” (RIA) weeks at the end of each trimester

New Model

Sample Schedule: Neurology

ACE Manager – combo course manager and student affairs – at both campuses

ACE Directors – at least one for each discipline – paid to dedicate half of their time to you

Me – office on campus with candy

Infrastructure and Support

Grades will be given for each discipline◦ Honors, High Pass, Pass, Fail◦ Assigned at the end of the year (though will have

tentative grades at the end of each trimester)◦ Will reflect achievement of real milestones

Dean’s letters will not only look familiar but will include more robust data

We will have AOA and Gold Humanism chapters

Our students will be highly sought after!!

And to top it all off….

Fourth Year

Discussion