College System Hones Medical Students’ Clinical Skills

	UW medical students practice physical examination skillls on each other during an Introduction to Clinical Medicine class.

To acquire the basic skills essential for all doctors, University of Washington medical students are learning at the bedside. As a result of the school’s new curriculum, every second year medical student receives clinical practice training at the bedside every week. Each student will receive this instruction from a physician preceptor assigned to the student’s small group. This preceptor will mentor the student through the entire four years of medical school. Through an increased commitment of faculty time, resources, and funding, the curriculum leaders hope to ensure that this basic component of medical education is done well.

The curricular changes for the School of Medicine officially began with students who entered in 2001. Because the greatest impact of the changes occurs during the second year of training, everything was put in place for implementation in fall 2002. The student experience of learning medicine is significantly different from the past.

One major element is the new medical college structure. Thirty physicians known for their dedication to teaching were selected from the medical school faculty to lead clinical education and be student mentors. Upon matriculation, all medical students are randomly assigned to one of five colleges and to one faculty member within that college. The five colleges have been named after natural wonders in every state of the WWAMI region: Rainier (Washington), Wind River (Wyoming), Denali (Alaska), Big Sky (Montana), and Snake River (Idaho). Each college has a total of 144 to 150 students. Faculty mentors are assigned six to seven students per year.

During the second year, the only year when all UW medical students are based in Seattle, the college mentors teach the course Introduction to Clinical Medicine II (ICM II) to their student groups. Each group meets weekly for three hours and rotates quarterly through one of three major teaching hospitals: Harborview Medical Center, University of Washington Medical Center, and Veterans Affairs Puget Sound Health Care System.

In the past, each of the 180 or so second-year medical students received clinical training from different doctors working at one of the various teaching hospitals or in the community. The immense difficulty of scheduling clinical faculty meant that the medical student experience was variable, with discussion of cases not always happening in the presence of the patient. The college system, with thirty faculty members devoting a quarter of their time to the job, makes bedside clinical training a regular weekly session for all second-year medical students.

“Some other medical schools organize students in colleges, often with mentors for academic advising or career counseling,” said Dr. Erika Goldstein, associate professor of internal medicine and director of the new college system. “This is the first program that we know of in which the mentors will function as the lynchpins for teaching clinical skills.”

Their students will obtain patient medical histories and conduct physical exams. They’ll learn patient interview, clinical reasoning and diagnostic skills and how to present a case to colleagues. They’ll also learn documentation skills and how information technology is applied to medical record keeping and retrieval of medical information. In addition, they’ll receive instruction in professionalism and medical ethics.

“There’s evidence in the literature that training in basic clinical skills has gotten worse throughout the country; for example, that students are not able to discern as much in a physical exam,” said Goldstein. “Going back to the bedside is going back to a way of teaching medicine that has been around forever.”

Naturally, the college system also will provide students with traditional mentoring throughout their medical education. The college faculty will help students plan and assess their own progress, advocate for them, and counsel them on their career choices. In the third and fourth years, the mentors will oversee the completion of clinical evaluations and help students meet research requirements.

The curriculum reform is wider than the college structure. It includes broad changes that reduce the hours of anatomy, add a required neurology clerkship in the third year, require additional weeks of surgical sub-specialties, and ensure experiences in continuity of care, in which the student sees the same patient over time.

“Excellent clinical skills are essential to being a good doctor,” said Goldstein. “We owe it to our students to create the best possible teaching model.”

Susan S. and Durward A. Huckabay, Jr., have been steadfast supporters of UW Medicine through the years and have a specific interest in medical education and other areas. A portion of the distribution from the Durward A. Huckabay, M.D. Endowed Fund supports the medical school’s new college system and provides scholarships for individual students.