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An Alternative Model for Third Year Surgery Clerkship: Is it Effective ?
Arundhati Ghosh, Wendy Gutterson, David Hirsh, Barbara Ogur, Ronald Weintraub, Steven Schwaitzberg
Cambridge Health Alliance, Cambridge, MA

Objective: The traditional clerkship (TC) model of medical education has deficiencies which include incomplete patient encounters, no exposure to whole illness episodes and limited longitudinal contact with faculty. The Harvard Cambridge Integrated Clerkship (CIC) is a complete redesign of the third year which addresses these issues and aims to improve the quality of medical education.
Design: Prospective Control Trial, 2 years' data.
Setting: Academic Community hospital, Harvard affiliated.
Participants: 3rd year students
Interventions: A single integrated year-long experience replaces block rotations in core disciplines. Each student attends a specific assigned preceptor’s clinic monthly for the entire year, allowing faculty to adopt a developmental approach to teaching. During a four-week immersion, students accompany their preceptor continually - seeing inpatients, taking call, attending clinic and assisting in surgeries. Each student follows 2 newly-diagnosed cancer patients (gastrointestinal and breast) year-long across all venues. Master Clinicians meet students weekly to discuss patients, focusing on critical thinking and clinical judgement.
Main Outcome Measures: Quantitative - standardized test scores; Qualitative - surveys.
Results: CIC students scored at least as well as matched TC controls on tests of content knowledge. CCSSA scores: Year1 CIC=513.8, TC=398.9, p<0.05; Year2 CIC=477.5, TC=477.1, p=1.0. Surgery Shelf exam scores: Year1 CIC=77.4, TC=73.2, p=0.4; Year2 CIC=73.1, TC=73.8, p=0.95. OSCE scores: Year1 CIC=70.05, TC=63.91, p<0.01; Year2 CIC=65.99, TC=62.7, p=0.25. Around 80% of CIC students, compared to 30% of TC students, received feedback, evaluation and mentoring from faculty rather than residents. Most CIC students reported seeing patients before initial diagnosis and after discharge, rare amongst TC students.
Conclusions: An integrated longitudinal clerkship can successfully teach the surgical core curriculum in a manner that is patient-centered and enthusiastically accepted by students.


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