Medical students shine during new curriculum’s Clerkship phase
By Lin Lofley
One of the defining elements of the new UT Southwestern Medical School curriculum is that the students now begin clinical work much earlier in the four-year program. Medical students in the inaugural Class of 2019 are now a third of the way through their Clerkship phase, and the valuable benefits of this early clinical exposure are becoming apparent.
This phase of the new curriculum is something like a jewel.
Turn it one way and your eye catches the 12 weeks of scholarly activity afforded to second-year medical students, interwoven with their clinical rotations. View the triggering of this education milestone another way, and you see the time that’s dedicated to Step 1 preparation, with Student Academic Support Services helping every student set up an individual plan for success on the exam.
Consider, too, the core Clerkships in ambulatory medicine, along with the specialized elective offerings, and it becomes clear that few students moving through the medical curriculum’s second phase will have experiences identical to any others, but all will have the opportunity to take away from UT Southwestern the personalized education they need to become a successful clinician or researcher, or in some cases both.
The core Clerkships are the centerpiece for the Medical School’s Class of 2019, who embarked on pre-Clerkship education when they arrived on campus two years ago. The goal was to get medical students out of the classroom and into broader and earlier exposure to clinical fields in which they expressed interest. That experience allows for more opportunities to engage in early exploration of specific fields sooner. The expanded learning opportunities should lead to a greater examination of career options.
But everyone still has the Step exams to contend with, so an integral part of the learning cycle is the six weeks during the first year of the clinical curriculum that are dedicated to preparing for that make-or-break exam.
Dr. Arlene Sachs, Director of Student Academic Support Services and Assistant Professor of Psychiatry, and her team worked with the students on preparation for their USMLE Step 1 exam, the first of two required national board exams taken by all U.S. medical students.
To say it was new territory would be an understatement.
“Previously, all second-year students prepared independently and all took the Step 1 at the same time,” Dr. Sachs said. “But, as part of the new curriculum, we developed a required six-week course to support students in their preparation for Step 1.
“The class was divided into four groups, who took the course between January and June of their second year. To prepare for that, we met individually with students to advise on best practices and to aid each student in developing a personalized study schedule. They reported on their progress with weekly surveys, which allowed us to reach out and help students stay on track for success.”
MS2 Taylor Dess certainly considers the curriculum a success. In her various rotations, Ms. Dess learned anesthesiology procedures, studied infectious disease and advanced anatomy, and participated in an Ambulatory Clerkship that focused on primary care across the age continuum.
Several medical students remarked that while no one got all their first-choice electives, all the electives were designed to pique interest in an unexpected area of medicine.
“Anesthesiology was like that for me,” Ms. Dess said. “The residents and the attendings supervised us closely, and actually taught us the procedures we’ll become second-nature at accomplishing.
“In the infectious disease rotation, we studied cases from all vantage points – getting to know the patients, then seeing and analyzing the data in the pathology lab the following week. We took the cases full circle, and the attendings quizzed us on what we were seeing as we revisited each case.”
Ambulatory Clerkship Directors Dr. Adrian Salazar, Assistant Professor of Internal Medicine, and Dr. Heidi Roman, Assistant Professor of Pediatrics, were tasked with developing the core Clerkship in ambulatory medicine, combining pediatrics with internal medicine experiences. Like all the existing Clerkships, they were challenged to combine learners equipped with varying levels of experience, as novice preclinical Clerkship students work side by side with experienced students completing the Clerkship phase of education.
“We are sure that the broad exposure to ambulatory care will be a great opportunity for students to acquire clinical skills,” Dr. Salazar said. “Another benefit is the opportunity to allow a discussion of wellness skills that can benefit the student, who can then pass those skills along to the patient.”
“We offered a weekly theme for the students to consider, be it burnout prevention or professional resilience,” he said. “If you are cognizant of the importance of your own wellness, then you will learn things that you can teach others.”
Dr. Roman added that, in addition to wellness strategies, the earlier exposure of students to clinical skills and outpatient medicine will be of major benefit, and mixing the MS2s and MS3s, the latter in the Clinical Clerkships phase, turned out to have a profound effect.
“These students are gifted people, be they in their second year or in their third year,” Dr. Roman said. “And we have found another thing: Our MS3s have the relative expertise, so they can help the MS2s; but the MS2s come in with a lot of energy.”
Through it all, the Academic Colleges system provided encouragement and support through mentorship and peer leadership. Small groups that formed at the beginning of the pre-Clerkship phase continued to meet monthly throughout the year with their respective mentors to discuss topics such as ethics, professionalism, health systems, quality improvement, clinical reasoning, and career advising.
Stakeholders in the new curriculum will meet through the summer with plans to shore up facets that might need support and to see the Clerkships fine-tuned for the coming academic year.
Features, timeline of ‘new school’ curriculum
UT Southwestern Medical School initiated a significantly revised curriculum in 2015 to better train students to become knowledgeable, confident, and forward-looking clinicians and scientists in a rapidly changing 21st century.
The curriculum includes:
- An overarching theme is integration: integration of classes such as cell biology and biochemistry; integration of the study of normal and abnormal body processes; and integration of clinical perspectives with basic sciences.
- Pre-Clerkship, Clerkship, and post-Clerkship phases, which lessen cycles of reviewing while propelling students toward experience with patients.
- Emphasis on training students to view themselves as part of a team, fostering relationships between students and experienced clinician mentors, and teaching students how to identify the relevant clinical information and synthesizing that information into problem-solving for patients. Small-group learning enables students to engage in fluid discussions with faculty members and includes more active learning (simulations and clinical scenarios) and less passive learning (lectures).
- Instruction that starts with blocks like Body Structure Functions, which incorporates gross anatomy, embryology, histology, and radiographic imaging; and a Foundations of Biomedical Sciences block, which incorporates biochemistry, genetics, cell biology, physiology, neuroscience, microbiology, immunology, and pathology.
- Core Clerkships that medical students start in January of their second year – half a year earlier than under the prior curriculum. The core Clerkships that medical students take are the same – internal medicine, surgery, pediatrics, etc. – but the Clerkships are spread out over 72 weeks rather than 48 weeks.
- In the post-Clerkship period, among other classes, medical students will take classes that include a Back-to-Basics block that will return their focus to basic science subjects, such as biochemistry and cell biology, but at a level that will be integrated with their newly acquired clinical knowledge.
Milestones for this UTSW educational initiative include:
June 2013 – Work of overhauling the Medical School curriculum begins to take shape under the leadership of Dr. J. Gregory Fitz, Executive Vice President for Academic Affairs, Provost, and Dean of UT Southwestern Medical School, and through the efforts of a five-member faculty committee.
September 2015 – The Class of 2019 began instruction under the new curriculum, initiating the pre-Clerkship phase.
January 2017 – Second-year medical students began the Clerkship phase.
July 2018 – Fourth-year medical students will begin post-Clerkships, which include selection of individual interests. Students can choose one 12-week block for their scholarly work, selecting from a variety of tracks.
June 2019 – The first class of UT Southwestern Medical School students who have gone through the new curriculum will graduate.
Dr. Fitz holds the Nadine and Tom Craddick Distinguished Chair in Medical Science and the Atticus James Gill, M.D. Chair in Medical Science.