ANNUAL FEATURE: IN PROGRESS: REPORTS OF NEW APPROACHES IN MEDICAL EDUCATION: CURRICULUM: Clinical Science Education
Objective: A significant overlap exists between the work done by general internists and that done by family physicians in the ambulatory care setting. Consequently, the curriculum committee at the University of California, Los Angeles, UCLA School of Medicine decided to join the two clinical experiences in order to promote interdisciplinary teaching and learning. UCLA has developed and implemented a curriculum for combining the family medicine clerkship and the outpatient portion of the internal medicine clerkship. The new format streamlines teaching obligations in ambulatory sites while standardizing the curriculum with weekly, shared didactic instruction on campus.
Description: UCLA is in the midst of a significant curricular revision for the clinical years. All third-year clerkships have been modified to incorporate a greater proportion of case-based instruction and to concentrate on particular aspects of the physical examination in 2000–01. The ambulatory education merge began with a needs assessment that identified topics taught by the respective curricula to eliminate duplication and ascertain areas not addressed. The outcome is a combined ambulatory didactic curriculum, offered as a continuum for one eight-week clerkship. Teaching responsibilities for the new shared sessions were assigned based on departmental strengths and constructed to emphasize the clinical needs of the ambulatory setting, particularly the ability to function in this time-constrained atmosphere. New case-based instruction was developed in geriatrics, cardiology, and musculoskeletal exam skills (using patients with rheumatologic diseases), and for diabetes and hypertension. These additions supplemented existing instruction modules that students had enjoyed in dermatology (using Web-based cases), prevention, contraception, nutrition, and complementary medicine. The majority of instruction has shifted to small-group format; faculty lacking experience in this teaching approach have received individual faculty development.
The students begin with a single orientation for the eight-week clerkship, with an introduction to the focused workup in the outpatient setting. The faculty give individual feedback while observing the students' skills with standardized patients. Overviews of family medicine and general internal medicine as disciplines are presented, and logistic information is given. The clinical portions of both clerkships remain intact, as the students spend four weeks at either the family medicine or the internal medicine site, followed by four weeks at the opposite site. Returning to UCLA each Friday for these shared sessions, the students participate in group activities, lectures, demonstrations, patient interviews and examinations, and a review of informatics and the use of the computer for presentations.
Every student is required to complete a case write-up or do a PowerPoint presentation before his or her peers, based on a patient seen during the rotation. A single combined exam with questions covering basic principles in each discipline closes the rotation. A grade for each specialty is generated based upon the student's clinical performance, the final paper or presentation, and the portion of the exam devoted to that specialty
Discussion: This format allows the clinical experiences in each discipline to remain distinct, thus permitting each specialty to retain its own identity. The ambulatory clerkship is viewed as a work in progress during this inaugural year as our course-evaluation process continues to prompt modifications. The students consistently rate sessions with handson learning activities and small-group sessions highly. The next goal is to develop an on-line examination.
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