Clinical curriculum: Students learn clinical skills from Day One

The Medical School curriculum always has contained robust training in clinical skills and development, as well as ample opportunities for students to access the clinical environment.

However, in three courses launched during the recent curriculum transformation, students now develop those skills over their entire medical school career — beginning with their first day on campus.

In Doctoring, students are mentored by faculty for four years; in Chief Concern, students learn to think about authentic clinical problems from Day One of medical school; and in Interprofessional Clinical Experience, students immediately join the clinical setting to work within teams of health professionals from multiple disciplines.

All three courses give students an early glimpse at life as a doctor, and also how the scientific knowledge they are gaining links to clinical care.

Here’s an in-depth look at what each of these courses has to offer:

Doctoring

This aptly-named course teaches students to record patient histories, conduct physical examinations, communicate with patients and prepare oral and written presentations.

“This is a course that really focuses on the skills and attributes needed to become a good doctor — in all facets of the profession,” said Jennifer N. Stojan, M.D., assistant professor of internal medicine and pediatrics and communicable diseases and director of the Doctoring course.

What is unique about U-M’s course is that it runs throughout all four years of a med student’s training.

During the first year, groups of 10-12 students meet for four hours every week with two faculty instructors. They also meet with volunteers who have chronic diseases in order to better understand the way patients interact with health care providers.

“During their second year, students go into clerkships, where they are observed applying their new skills,” Stojan said. “In the third and fourth years, they will get together to talk about things they have seen and reflect on different themes, with an emphasis on social behavioral topics.”

Chief Concern

Chief Concern is another requirement for first-year students. It teaches them to develop clinical reasoning skills and understand how physicians approach a clinical case. Students receive actual cases and information that helps them make a diagnosis. They also write a formal assessment and care plan.

“The idea is to get students thinking about differential diagnosis — the distinguishing of a particular disease or condition from others that have similar features,” said Sandro K. Cinti, M.D., professor of internal medicine and director of Chief Concern. “The main takeaway is that focusing on a particular diagnosis too early can lead to misdiagnosis.”

Cinti said 15-20 students in each session are given bits of information. They then ask questions and receive more information, including a patient’s family history. At each step, students must close in on a diagnosis.

“In this course, we aren’t entirely focused on always getting the right diagnosis, as much as how students get there,” Cinti said.

“In the modern era, knowledge is at our fingertips. This makes it that much more important to understand how to approach clinical problem solving and have a method to critically analyze and apply both established medical knowledge and cutting-edge research,” said Michael A. Cole, M.D., assistant professor of emergency medicine and co-director of the Chief Concern course.

Chief Concern has proven to be a hit with students, recently earning a Provost’s Teaching Innovation Prize from U-M for creative and inventive approaches to learning.

M3 student Jacob Cedarbaum said the course gave him a better understanding of the clinical thought processes that clinicians use.

“While we were learning the ‘what’ of medical science in our daily lectures, the course gave us an early foundation in the ‘how’ and ‘why’ of practicing clinical medicine,” Cedarbaum said. “I learned to be more deliberate in the way I approach cases and more thoughtful about each of the decisions that I made.”

Interprofessional Clinical Experience (ICE)

Finally, as students gain scientific knowledge, Interprofessional Clinical Experience provides them with clinical exposure on a regular basis throughout their first year.

Students form early connections with patients and families, interact with faculty from other health professions and gain an understanding of the roles and responsibilities of all team members within a health care system.

“The benefit of ICE is seeing real patients from the beginning of medical school and having the ability to link what they learn to the Doctoring course,” said Joseph B. House, M.D., assistant professor of pediatrics and communicable diseases and emergency medicine, and director of interprofessional education. “When they get to the clinical setting they are better prepared to know who to go to when they have a question or need something for a patient.

“In the end, it makes them better doctors.”

This is one in a series of Headlines stories highlighting the medical school curriculum transformation.