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Educational Outcomes of the Harvard Medical School–Cambridge Integrated Clerkship: A Way Forward for Medical Education

Hirsh, David MD; Gaufberg, Elizabeth MD, MPH; Ogur, Barbara MD; Cohen, Pieter MD; Krupat, Edward PhD; Cox, Malcolm MD; Pelletier, Stephen PhD; Bor, David MD

doi: 10.1097/ACM.0b013e31824d9821
Clerkships

Purpose The authors report data from the Harvard Medical School–Cambridge Integrated Clerkship (CIC), a model of medical education in which students’ entire third year consists of a longitudinal, integrated curriculum. The authors compare the knowledge, skills, and attitudes of students completing the CIC with those of students completing traditional third-year clerkships.

Method The authors compared 27 students completing the first three years of the CIC (2004–2007) with 45 students completing clerkships at other Harvard teaching hospitals during the same period. At baseline, no significant between-group differences existed (Medical College Admission Test and Step 1 scores, second-year objective structured clinical examination [OSCE] performance, attitudes toward patient-centered care, and plans for future practice) in any year. The authors compared students’ National Board of Medical Examiners Subject and Step 2 Clinical Knowledge scores, OSCE performance, perceptions of the learning environment, and attitudes toward patient-centeredness.

Results CIC students performed as well as or better than their traditionally trained peers on measures of content knowledge and clinical skills. CIC students expressed higher satisfaction with the learning environment, more confidence in dealing with numerous domains of patient care, and a stronger sense of patient-centeredness.

Conclusions CIC students are at least as well as and in several ways better prepared than their peers. CIC students also demonstrate richer perspectives on the course of illness, more insight into social determinants of illness and recovery, and increased commitment to patients. These data suggest that longitudinal integrated clerkships offer students important intellectual, professional, and personal benefits.

Dr. Hirsh is assistant professor, Department of Medicine, Harvard Medical School, and physician, Cambridge Health Alliance, Cambridge, Massachusetts.

Dr. Gaufberg is assistant professor, Departments of Medicine and Psychiatry, Harvard Medical School, and physician, Cambridge Health Alliance, Cambridge, Massachusetts.

Dr. Ogur is associate professor, Department of Medicine, Harvard Medical School, and physician, Cambridge Health Alliance, Cambridge, Massachusetts.

Dr. Cohen is assistant professor, Department of Medicine, Harvard Medical School, and physician, Cambridge Health Alliance, Cambridge, Massachusetts.

Dr. Krupat is associate professor of psychology, Department of Psychiatry, Beth Israel Deaconess Medical Center, and director, Center for Evaluation, Harvard Medical School, Boston, Massachusetts.

Dr. Cox is adjunct professor, Department of Medicine, University of Pennsylvania School of Medicine, and chief academic affiliations officer, U.S. Department of Veterans Affairs, Washington, DC.

Dr. Pelletier is senior project manager, Center for Evaluation, Harvard Medical School, Boston, Massachusetts.

Dr. Bor is associate professor, Department of Medicine, Harvard Medical School, and chief of medicine, Cambridge Health Alliance, Cambridge, Massachusetts.

Correspondence should be addressed to Dr. Hirsh, Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139; telephone: (617) 665-3132; fax: (617) 665-1671; e-mail: david_hirsh@hms.harvard.edu.

© 2012 Association of American Medical Colleges