The Harvard Medical School-Cambridge Integrated Clerkship: An Innovative Model of Clinical Education

Abstract

The Harvard Medical School-Cambridge Integrated Clerkship (HMS-CIC) is a redesign of the principal clinical year to foster students' learning from close and continuous contact with cohorts of patients in the disciplines of internal medicine, neurology, obstetrics-gynecology, pediatrics, and psychiatry. With year-long mentoring, students follow their patients through major venues of care. Surgery and radiology also are taught longitudinally, grounded in the clinical experiences of a cohort of patients and in a brief immersion experience working directly with an attending surgeon. Students participate in weekly, case-based tutorials integrating instruction in the basic sciences with training to address the common and important issues in medicine, as identified by national organizations. In addition, they participate in a social science curriculum that focuses on self-reflection, communication skills, ethics, population sciences, and cultural competence. In the pilot year (July 2004 to July 2005), HMS-CIC students performed at least as well as traditional students in tests of content knowledge and skills, as measured by National Board of Medical Examiners (NBME) Subject Exams and the fourth-year Objective Structured Clinical Exam, and they scored higher on a year-end comprehensive clinical skills self-assessment examination, suggesting that they retained content knowledge better. From surveys, HMS-CIC students were much more likely to see patients before diagnosis and after discharge and to receive feedback and mentoring from experienced faculty than were their traditionally educated peers. HMS-CIC students expressed more satisfaction with their curriculum and felt better prepared to cope with the professional challenges of patient care, such as being truly caring, involving patients in decision making, and understanding how the social context affects their patients.

Impacto da “Disciplina Relação Médico-Paciente” sobre Atitudes Centradas no Paciente

“…The restructuring of the medical education focusing the patient-centredness is a current relevant issue worldwide [5][6][7][8][9][10]21,22 . Operationally, our main goal in offering the "doctor--patient relationship" discipline was to maximize the learning and retention of fundamental humanistic and ethical knowledge and communication skills, particularly based on a reflective practice.…”

“…The medical students must be stimulated to develop a critical own view toward the attitudes and communicative skills linked to the provision of patient care 6,16 . Educational strategies that encourage the examination of these attitudes and behaviours might result in the better understanding of the lapses of the doctor-patient relationship [5][6][7][8][9][10] .…”

“…In 1969, the pioneer, Enid Balint 1 , who devoted much of her career to the study of the doctor-patient relationship, introduced the term "patient-centred medicine", which was related to the understanding of the patient as a unique human being 2,4 . Since then, various educational strategies have been adopted in the teaching-learning process aiming at the improvement of the doctor-patient relationship [5][6][7][8][9] . It should be highlighted that this contact is a special process of human interaction comprising significant dimensions of the clinical practice that includes technical, humanistic and ethical knowledge.…”

A review of longitudinal clinical programs in US medical schools

“…The Lancet Commission Report [1] urges educational leaders to develop curricula that will serve patient and population needs, foster better understanding of the clinical context, emphasize continuous care over episodic encounters, and broaden training venues beyond inpatient care. To address these goals, medical schools are implementing curricular structures grounded in educational continuity [5–9], including longitudinal clinical programs (LCPs) [10–13] and a subset of LCPs, longitudinal integrated clerkships (LICs) [14–16]. …”

“…In the LIC model, students care for a diverse panel of patients whom they follow across multiple clinical settings over extended periods of time, in lieu of traditional block rotations within discrete specialties [6,14,17]. The literature describes LIC goals, structures, and outcomes [15–21]; less is known about the broader array of LCPs that do not meet LIC criteria [10,13,22].…”