Transitions AND the Advanced Clinical Experience

1. Transitions AND the Advanced Clinical Experience Hofstra North Shore-LIJ School of Medicine Curriculum Committee Presentation October 22, 2012

2. Transitions

3. Time Frame • Spring Break: 3/25 – 4/1/13 • Comprehensive Basic Science Test: 4/2 – 4/5 • Step 1 Study Time: 4/6– 5/31/13 • Deadline to Take Step 1: Friday May 31st To the best of our knowledge i.e. subject to change • Transitions: 6/1 – 6/30/13 • 3rd Year ACE: 7/8 – 6/29/14 • Includes 3 weeks vacation and 9 weeks selective • 4th Year ACE: Starts 6/30

4. Transitions • Recertify in BLS • Acclimate to hospital settings • Navigate hospital systems and EMR • Refresh basic skills- CXRs, EKGs, phlebotomy, IV placement, suturing, knot tying • Learn new skills- new procedures, inpatient and outpatient notes, the 1min/3min/15min presentation • Experience new horizons- e.g. anesthesia • Pick up some longitudinal patients

5. Preliminary Schedule

7. The Advanced Clinical Experience

8. Unintended Consequences of the Traditional Clerkship Experience • Lack of meaningful responsibility or an authentic role • Insufficient development of clinical reasoning skills • Conflicting interests between learning and getting a good grade • Inadequate information to make an informed career decision • Inadequate assessment data

9. What we can do to improve the Third Year Experience

10. We CAN Give students authentic responsibility for patients and place them where the thinking occurs Cultivate “whole illness” relationships with patients and develop longitudinal coaching relationships with faculty Assess students in a way that drives learning and integrates science into clinical education Give students better insight into careers in medicine and facilitate “differentiation” through self-directed learning time and electives

11. Longitudinal Integrated Clerkships…PROVEN • to be feasible as tracks in leading medical schools (a decade of experience) • to improve long term retention and capacity for learning • to provide students with a superior clinical experience in terms of depth and volume of core diseases (by orders of magnitude) • to create patient-centered doctors

12. Challenges • Feasibility for our class size • Considerable multi-tasking for students

13. The Best of Both Worlds

14. “Hybrid” Model for 3rd Year • Keeps the discipline-specific focus of traditional clerkships while • Integrating cumulative and longitudinal features of a Longitudinal Integrated Clerkship

15. Discipline-specific focus • 6-week cycles focused on one discipline • Discipline-specific morning “ACE” rounds • Discipline-specific class time, one full half day per week • Shelf exams(national multiple choice exam-one for each specialty) every 6 weeks

16. Cumulative and Longitudinal Features • Self-directed time for follow-up of patients • Ongoing, cumulative experiences in Internal Medicine and Surgery • Longitudinal continuity clinic experiences in Internal Medicine • Highly select group of longitudinal patients to follow • Week-long “Reflection, Integration, and Assessment” (RIA) weeks at the end of each trimester

17. New Model

18. Sample Schedule: Neurology

19. Infrastructure and Support • ACE Manager – combo course manager and student affairs – at both campuses • ACE Directors – at least one for each discipline – paid to dedicate half of their time to you • Me – office on campus with candy

20. Our students will be highly sought after!! • Grades will be given for each discipline • Honors, High Pass, Pass, Fail • Assigned at the end of the year (though will have tentative grades at the end of each trimester) • Will reflect achievement of real milestones • Dean’s letters will not only look familiar but will include more robust data • We will have AOA and Gold Humanism chapters

21. And to top it all off….

22. Fourth Year

23. Discussion