As third-year medical students stepped back from clerkships at local clinics and hospitals, they returned to the classroom to hear a panel of national experts debate how and when to incorporate new evidence on hormone replacement therapy into clinical care. The panel was part of a curricular innovation called “intersessions” that covers clinical decision-making, health systems, recent scientific advances, ethics, and professional development. Intersessions reunite students from core clerkships as a class to integrate new knowledge into the practical context of everyday clinical experiences.

“Key educational objectives best taught in the clinical years were difficult to implement in competition with direct patient care and across clerkship sites,” says Cindy Fenton, MD, who directs the Intersessions program. “And back-to-back clerkships frequently left students feeling isolated, missing the camaraderie that was so much a part of their first two years.”

Third year restructured

As a result, the third year of medical school was restructured into six eight-week blocks of clerkships, punctuated by three weeklong intersessions. The new format was phased in starting in 1999 and fully launched in 2001-02. Each intersession consists of 20 hours of instructional time, including lectures, stimulating panel discussions, and plenty of small group sessions that draw upon students’ own clinical experiences.

A theoretical discussion of quality of care, for example, quickens as students reveal challenging clinical situations from their clerkships in which they felt quality of care could have been better. Students analyze these experiences to learn to measure and improve quality in various health care settings.

“The material resonates better in the context of clinical care,” says fourth-year student Ralph Ermoian, “and examples from clerkships make it real.”

The Advances in Medical Science component reinforces the School of Medicine’s commitment to integrating basic science into the clinical years. A recent session featured the physician-scientists who had helped clone the capsaicin receptor, a sensor derived from hot chili peppers. The investigators discussed how this sensor can advance the understanding of how we perceive pain, and how further research may lead to new therapies to counteract acute and chronic pain.

Initial evaluations from students have been very positive, and the format has already become a model for other schools. Plans are underway to extend intersessions into the fourth year, emphasizing clinical and procedural skills along with professional development.

“We want to bring back one more time those small groups that have been together for four years - to look at where they’re going, learn internship survival skills, and prepare for the teaching role expected of house officers,” says Molly Cooke, MD, director of the Academy of Medical Educators, who helped construct the intersessions model.