Letters to the Editor
We appreciate the observations of Dwyer Brooks and colleagues on the impact and importance of workplace learning in the University of Minnesota's Rural Physician Associate Program (RPAP). We believe the need for students to learn the practice of medicine in authentic roles under the guidance of trusted coaches is reflected in our finding that one-third of residency program directors described interns as having difficulty applying knowledge in clinical settings. Somewhat counterintuitively, as medical students progress from the third year to the fourth, the opportunities to play meaningful roles in patient care diminish, with the notable exception of the subinternship. In a developmental sense, the current structure of the senior year may do more to allow students' clinical skills and professional identities to erode than it does to foster their ongoing development.
We agree with Kanter1 that the senior year of medical school is ripe for further study. We support the creation of a vision for this transitional year that is based on empiric evidence and, as Kanter suggests, encompasses an even broader perspective and understanding of the role of the fourth year. While we would agree that the fourth year serves multiple purposes, preparing students for internship is an important one and was the focus of our study. To ready students for this role, we conclude that the fourth year should include clinical experiences that build on the foundation of workplace learning that students, such as those in RPAP, begin to forge in the third year.
G. Michael Harper, MD
Associate professor, Department of Medicine, University of California, San Francisco, School of Medicine, and staff physician, San Francisco VA Medical Center, San Francisco, California; Michael.firstname.lastname@example.org.
Pamela Lyss-Lerman, MD
Resident, Department of Psychiatry, University of California, San Francisco, School of Medicine, San Francisco, California.
1 Kanter SL. How to win an argument about the senior year of medical school. Acad Med. 2009;84:815–816.