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university of california, san francisco school of medicine Parnassus Integrated Student Clinical Experiences university of california, san francisco Location of the Program school of medicine University of California, San Francisco Public State University

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parnassus integrated student clinical experiences

university of california, san francisco

school of medicine

Parnassus Integrated Student Clinical Experiences

slide2

university of california, san francisco

Location of the Program

school of medicine

  • University of California, San Francisco
  • Public State University
  • Two urban academic medical centers (Parnassus and Mount Zion campus) and a community outpatient site
  • Patient population includes tertiary care referrals from northern California, urban primary and secondary care, multiethnic and underserved
slide3

university of california, san francisco

Challenges in Current Third Year

school of medicine

  • Erosion of relationship with the patient, the inpatient team, faculty and the course of illness.
  • Lack of authentic roles in patient care.
  • Lack of exposure to undiagnosed patient.
  • Fragmentation of medical care (e.g. inpatient/outpatient, specialty clinics/services, 80 hour work week, shorter attending rotations).
  • Limited observation of skills, professionalism, communication.
  • Lack of continuity between rotations regarding skills development across third year.
origins

university of california, san francisco

Origins

school of medicine

  • Curriculum retreats w/ broad participation [2005]
    • Work groups prior and after
  • Task Force for Clinical Innovations [2005-6]
  • Existing models/programs
    • Fresno; South Dakota; Cambridge
  • Incremental innovation pilots [2005- ]
  • Funding: Support for faculty leadership [2005- ]
    • centralized (Office of Medical Education and UCSF Academy of Medical Educators) and external
  • Mandate to create and pilot an integrated third year clerkship [2006- ]
key guiding principles for improving clinical core

university of california, san francisco

Key Guiding Principles for Improving Clinical Core

school of medicine

  • Continuity with patients/populations
  • Relevant core curriculum
  • Continuity of site / learning about health care systems
  • Longitudinal student cohort
  • Continuity with faculty; Mentoring
  • Experience with “undifferentiated” patients
slide6

university of california, san francisco

school of medicine

  • One-year integrated longitudinal clerkship
  • Core clerkship training for anesthesiology, family and community medicine, internal medicine, neurology, obstetrics and gynecology, ophthalmology, orthopedic surgery, otolaryngology, pediatrics, psychiatry, surgery and urology
  • 8 student volunteers selected by lottery out of 18 applicants (class size 155)
  • Launch of program in April 2007
slide7

university of california, san francisco

school of medicine

  • Core Elements
    • Longitudinal Preceptor clinics
    • ER and OR sessions
    • Patient cohort
    • Inpatient immersion
    • Longitudinal curriculum
    • Advising/mentoring program
    • Comprehensive student assessment
    • Program assessment
slide9

university of california, san francisco

school of medicine

  • Mini-inpatient immersion
    • Obstetrics
    • Internal Medicine
    • Surgery*
    • Selective
  • Longitudinal curriculum (PISCES school)
    • ½ - 1 day per week interdisciplinary sessions including clinical skills sessions, student run case-based
    • Reflection sessions
    • Stress rounds
    • Palliative care
    • Hospital systems sessions
slide10

university of california, san francisco

school of medicine

  • Faculty Participation
    • Faculty liaison from each participating department
    • Preceptors (60) from core disciplines plus clinical sessions with faculty from anesthesia, surgical subspecialties, dermatology, emergency medicine
    • PISCES school sessions by topic appropriate faculty from the core disciplines, radiology, and palliative care course
    • Hospital administrators for hospital systems sessions
    • Office of Medical Education, Academy of Medical Educators Office of Educational Technology, and hospital IT partners
slide12

university of california, san francisco

Program Assessment

school of medicine

  • Focus groups
  • Patient log data
  • Global Course evaluation surveys
  • PISCES School session surveys
  • Preceptor evaluation surveys
  • Monthly check in with course directors
  • Mini CPX and CPX
  • USMLE part 2
  • Individual clerkship student assessment measures
  • C3 survey and Patient-Provider Orientation Scale
  • Interviews of preceptors and advisors