Integrated clerkship

I’ve recently been selected for a new program that I’ll try to keep you all posted about as I go–an experimental integrated clerkship that will take all of my third year. Rather than going service by service (medicine, surgery, psych, ob/gyn, peds, etc), a small group of us will stay in one hospital; each of us will keep a panel of patients, with diverse conditions, who we’ll follow over the year. We’ll also see other patients for shorter periods of time. The idea is that we’ll end up learning all the content of third year, but in a way that is more patient-centered and more deliberately designed in terms of what we are supposed to learn for the year.
I’m excited about it; I like the chance to be a part of a new experiment, and I like the chance to work with what I think will be a great team of 8 students. And I like the hospital where we’ll be–not one of the big teaching hospitals, it’s the city hospital for the city of Cambridge, with lots of great people there and a commitment to medicine for all that I like better than the “public service”/“private service”/VIP suite hierarchy of two of the big teaching hospitals that are the other alternatives.
Whether we’ll learn to be better doctors–I hope so. Certainly there is a lot of effort going in to trying to make this approach work, and lots of good people involved in it. If it fails, I’m doing a five-year plan anyway, and so I’ll have–worst case–some extra time to make up for any deficiencies that might emerge. But I don’t think they will. I share the optimism of the course directors–I think it’s going to be a great year of learning medicine.
Now to pass the boards–which seems like a far greater hurdle than anything else…

Thanks for sharing. This sounds really interesting. I have never heard of an integrated clerkship before. It seems like there would be a lot of positives. I look forward to hearing how it goes…

Very cool.
Keep us posted as much as possible.

Wow, I love that idea of having a set number of patients who you really get a chance to know and grow with throughout the year. That sounds like an amazing experience. I hope it works out. Let me know how it goes.

Wow Joe, that sounds really interesting. I hope it turns out to be really cool and educational. You’re a real trooper to volunteer to be the guinea pig!
Definitely keep us posted on how it goes!

I was ready to be the guinea pig when I went and saw my sister’s senior art show (she’s going to college in the same place I went, UC Santa Cruz–she’s 13 yrs younger than me). I remembered that what i loved the most about school is what she has now–creative projects. I think that being part of this project will be a really cool process in and of itself, so I’m excited about that part of it. not to mention the medical education benefits, of which i hope there will be some!

that is fantastic, joe! i’ll be really looking foward to hearing about it, esp. since ucla is really working on this new curriculum i’ve been a part of this year as an ms1. the faculty have been very receptive to our suggestions for improvement - they are very into integration as opposed to separate learning of each system - and it sounds as if that’s what you’re doing 3rd year so i’d love to hear what works and what doesn’t! - donna

Joe, you seem to do the coolest things! Keep us all posted on this!

I recently had an amazing experience at med school, in which another student and I went with a doctor to a Wellness Community (a community/support center by/for people with cancer), where two people who have had/have cancer did role plays with us to teach us how to deliver bad news. The morning was extraordinary; I learned a lot and was very moved by the experience for all kinds of reasons.
On the ride back to our hospital, the doctor, said, “Both of you did a great job, as good or better than most doctors out there.” And then after telling a personal story of feeling, in her internship, that she had lost her humanity, she said something sad:
"I see you guys in second year, and you really connect with patients, and you are really good at this kind of thing, and you are really human and present. And then I see you in fourth year, and the change has happened. I don’t know exactly when or why. But that sense of altruism and connection isn’t there in the same way."
In sum: the argument for why third year needs to be designed in a new and different way.

Very cool. Thanks for that.

More on this experiment in medical education can be found in this Boston Globe article:



An even better article about this experimental clerkship can be found at:
I promised updates and I’ve been pretty slow in delivering them… mainly because I’m working my *ss off. But in a good way. The patients are great, the hospital is great, and I’m getting a lot of great teaching.
Today, I spent most of the day in the pediatrics section of the emergency department; but also rounded on a mom whose baby I helped deliver–and who I’d seen in ob clinic for the last two months–and rounded on a guy with COPD who I have seen in my clinic, and admitted from the ED yesterday. So much for my weekend. But I’ve learned a ton. Next weekend, out of town, no pages.
More soon I hope.