The transition from the preclinical to clinical clerkships in medical school:
a benchmarking study.
Proposal to the Academy of Medical Educators
Ann Poncelet, M.D., Lydia Segal, MS IV
Goals of project
The ultimate goal of this project will be to develop a bridging curriculum that
will enable students to arrive at the clerkships with the background and skills
needed in order to maximize the learning experience. Before undertaking a major
curricular initiative, however, we propose an initial research phase to assess
various approaches at other medical schools. This proposal requests support
for Stage I of the process, a self-limited, investigational survey of other
schools' curricula, with a focus on the transition to the clerkships. The information
gathered during this first stage can then be used as a springboard for subsequent
curricular development at UCSF.
The impetus behind this proposal is not only identification of an area of need,
but also acknowledgement that this need falls outside the current structure
of UCSF's curriculum. The consolidation cases address application of clinical
thinking, and Preparation for the Clerkships introduces various technical skills
with a focus on "terror reduction". The Foundations of Patient Care
Course addresses patient interviewing and physical examination skills longitudinally
across the essential core curriculum. However, application of the essential
processes of information-gathering, focused history-taking and physical exam,
and approaches to differential diagnosis and clinical problem-solving and the
practicalities of being a clerk as an intensive preclerkship experience at the
end of the essential core has yet to be integrated in the curriculum. The proposed
project will necessarily increase interdisciplinary collaboration, involving
faculty from Foundations of Patient Care, Preparation for the Clerkships, Consolidation
Cases Block as well as from the clerkships.
Stage II will be development and implementation of a transition/bridging curriculum,
whether a longitudinal course; an intensive clinical skills block; or a "pre-clerkship"
experience. Stage III will be evaluation and assessment of these measures.
Project outline
A preliminary step will be to conduct a literature review of current and innovative
approaches to the "transition", using online and library-based resources.
The major work of this project will be an investigational survey of selected
United States and international medical schools to identify elements in their
curricula that could help inform similar developments at UCSF. A survey instrument
will be developed and will be distributed either by e-mail or regular mail,
with telephone follow-up. Following this, a smaller number of schools would
be contacted for follow-up in greater depth. Specific areas of inquiry will
include time devoted to "pre-clerkship" training; the organization
of "pre-clerkship", faculty effort; administrative support; and outcomes
measurement for efficacy. A database will be designed to track incoming data.
A final report will be compiled, including the results of the literature review
as well as of the surveys. This report would then be reviewed at the appropriate
curriculum committees including CCOC, ECSC, and CSSC. The results of this project
are likely to be useful for other medical schools that are actively addressing
the transition to the clinical years. We intend to publish our results in a
peer-reviewed journal in academic medicine. We also hope that the dissemination
of this information with support of the Academy would further the mission of
the UCSF Academy of Medical Educators in improving medical education at a national
and international level.
Plan for measurement and documentation of project efficacy
Project efficacy will be tracked according to accomplishment of specific goals:
completion of literature review; number of schools contacted and percentages
responding; number and percentage of completed in-depth interviews. The primary
outcome would be the impact on curricular development at UCSF regarding "pre-clerkship"
preparation. A secondary outcome would be dissemination of the results nationally
and internationally, through publication and presentation at a national or international
meeting.
For further information, please contact:
Ann Poncelet, M.D.: ann.poncelet@ucsf.edu
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