This Month's News
"Third-year theory": Making rotations patient-centered and restoring empathy
As medical students embark upon their clinical rotations during the third year of medical school, the development of skills and knowledge may come with an unwelcome side effect: a so-called "ethical erosion," a decline in humanism and a tendency "to refer to their patients not as people but as diseases, that dehumanizing shorthand of the wards" (New York Times "Well" blog).
This is not a new problem (see for example a JAMA commentary on this issue from 1997), but today's educators are seeking a different approach to this critical stage of medical education and the development of professionalism.
Moving from the traditional block rotations to what are called "longitudinal integrated clerkships" can help students develop a deeper relationship with their patients and reduce any tendency toward dehumanization by students, as described in a December 2011 American Medical News article. Similarly, a study of the Harvard Medical School-Cambridge Integrated Clerkship published in the March issue of Academic Medicine found that this new model "offer[s] students important intellectual, professional, and personal benefits."
Some have raised concerns about adequate exposure to inpatient care and learning how to coordinate care across a hospital's services, writes a student who took part in the Harvard program. On balance, however, he believes that such programs can reinforce "TLC" in medical care and ensure "more socially conscious physicians, truly capable of addressing the big problems that American health care faces."
These and related questions are part and parcel of an AMA-convened study of the medical education learning environment through its Innovative Strategies for Transforming the Education of Physicians (ISTEP). This project encompasses 28 participating schools from the U.S. and Canada, with data on approximately 5,500 medical students.
At a recent meeting at AMA headquarters, ISTEP leaders nationwide gathered to consider multiple methods for collecting information and measuring the impact of the variety of clinical experiences that occur primarily during the third and fourth years of medical school. Another critical question is how to collect data on students' development of professionalism during this time and the ways in which the educational philosophy of the school and the climate of the learning environment may influence this process.
What do you think? Join our online conversation and express your opinion on this and other medical education concerns.