Commentary
Linking Medical Education and Patient Care
Early exposure to practicing physicians shows medical students the importance of being lifelong learners.
By Keith Lindor, M.D., and Barbara L. Porter, M.A.
Spending time in a clinical setting is the best way for medical students to learn about patient care. It make the concepts they learn in class more tangible, and thus motivates them to study hard. It’s also the first step in turning students into lifelong learners, as they begin to see that physicians constantly have to educate themselves about emerging evidence regarding treatments, new drugs and devices, and ways to change practice in order improve the quality of the care they deliver.
At Mayo Medical School, we’ve designed our curriculum in a way so that students are exposed to physicians and patients almost immediately after they start medical school. This change took place in the 2006-2007 academic year. Our goal was to make education more relevant to practice and to encourage medical students to see themselves as physicians-in-training rather than college students. Not so long ago, our first-year students might spend eight hours listening to lectures about rare cardiac conditions but very little time learning how the heart and circulatory system function. Weeks might pass before they actually had a chance to follow a cardiologist in the hospital or clinic. Now, they spend no more than 20 hours a week in lectures, and the time they spend in clinical settings is tied to what they are learning in class. We made these changes partially in response to what students had been telling us.
Today, each incoming student is assigned a faculty mentor. Mentors arrange for students to shadow them during the first week of school and introduce them to the vast clinical training environment of Mayo Clinic. Students have a chance to see their mentors in action—talking to patients, working with other providers, and educating themselves as they encounter cases they haven’t seen before or patients who may not be suited for a typical treatment protocol. We have 2,000 physicians and scientists at Mayo Clinic, and each year, our call for new mentors yields more than we can use; we even have volunteers from dentistry. Under the supervision of their mentor, the students do everything from observing to helping with history taking and examinations.
The students’ first two years of medical school are broken into six-week blocks with two-week selective periods in between. During the six-week blocks, students study the basic sciences and organ systems and learn about ethics, professionalism, and the health care system—topics that may not fit into a traditional medical school curriculum but are essential to medical practice. Integrated into these blocks are cases that illustrate the concepts being taught. For example, in the general pathology course, first-year students are required to identify the most likely diagnoses based on the limited clinical information provided. They use a template that they will again use during their third-year family medicine clerkship, and their write-ups are critiqued by teaching assistants. Students then are given a set of autopsy slides. Working in groups of four, they are required to make a presentation to the class that integrates the clinical information, the differential diagnosis, the basic mechanisms of disease, and the public health aspects of the disease process.
Another key construct of our training program is the 19 weeks of selectives that are embedded in the first two years of the curriculum. Early on, students begin using these two-week periods to explore fields they might pursue. During selectives, students might follow a transplant team, observe surgery, or take part in a medical mission to an underserved country. They might conduct research, study health policy, do a local service learning project, work on patient education, do a chaplaincy rotation, have a rural medicine experience, or any number of other things.
We regularly receive feedback that all of these experiences teach students far more than could be gained through a lecture or textbook. Here are some examples of what students have said in their evaluations:
“My mentor has such as positive attitude about her job and her patients.” “Working in the clinic helps me understand how to apply the science I am learning to give the patient the best care possible.”
“While working with my mentor, I am learning about clinical care but also about how to balance medicine with other priorities in my life.”
At the start of their second year, students staff the REACH Clinic in Rochester every three weeks. The REACH Clinic is a student-run free clinic held in collaboration with the Salvation Army’s Good Samaritan Health Center. They participate in history taking, examinations, and debriefings with a faculty preceptor. They also witness the challenges people face when they have no health insurance and very little money. A highlight of this clinical experience is having the chance to work with pharmacy students and residents as they review patient medications and discuss therapeutic options. The idea is to not only give medical students more hands-on experience but also to help them learn how to work as members of a health care team.
We believe these early opportunities to be with practicing physicians and patients inspire students and help direct their learning. Being exposed to the clinical setting early in medical school not only makes what students learn in class more real to them, it also reinforces the importance of learning throughout their career. MM
Keith Lindor is the dean and Barbara Porter is the dean of student and academic affairs at Mayo Medical School.