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VUSM bolstering students’ clinical experiences

Jun. 20, 2013, 10:08 AM

Willie Melvin, M.D., right, talks with patient Kathleen Kemp in the General Surgery clinic, while first-year School of Medicine students Daren Diiorio, left, and Shaun Mansour look on. (photo by Dana Thomas)

Willie Melvin, M.D., assistant professor of Surgery, trains residents and more advanced medical students, so he was pleasantly surprised by first year Vanderbilt University School of Medicine students Darin Diiorio and Shaun Mansour, who had no clinical experience before arriving in his clinic last September.

“I found I would ask a clinical question, then I’d walk into a patient’s room and return two minutes later and Darin would have found an answer on his phone. He might not understand what the answer meant, but I learned just how informative some newer online resources, and even YouTube, can be,” Melvin said.

Last academic year, every first-year School of Medicine student was part of either a new program called the Continuity Clinical Experience (CCX), or the smaller, three-year-old Vanderbilt Program in Interprofessional Learning (VPIL).

Clinical experience from the beginning of medical training is one of the most important aspects of VUSM’s Curriculum 2.0. Last year’s launch of the new CCX was a success for students and participating clinics alike.

Now, as VUSM brings the class of 2017 into the fold, CCX and VPIL directors are looking for more physicians and clinics willing to precept young medical students both at Vanderbilt and in the community setting.

“Our goal is not to have students shadowing physicians — we want students to assume a meaningful role, engender curiosity at the clinic site, and of course we hope to add meaning to students’ coursework. The course is structured so students can provide real value early on in the clinical setting,” said CCX course director Jesse Ehrenfeld, M.D. Ph.D., associate professor of Anesthesiology, Surgery and Biomedical Informatics.

The 92 students in the CCX program in the 2013-14 academic year saw 5,096 patients with their faculty preceptors. Ehrenfeld said that is more than ever before in the history of the school.
The CCX or VPIL students spent about four hours per week in their assigned clinical setting. Students will return to the same clinics again throughout their training in order to allow them to develop a deeper understanding of patients seen over time, as well as the systems, processes and inner workings of a specific health care site.

“We are working to integrate the clinical experiences with our new Curriculum 2.0, to reinforce where appropriate, but not duplicate. The clinical sites include specialty, pediatric, surgical and other clinic settings, and we are looking forward to expanding opportunities into the community next year,” Ehrenfeld said.

The onus of education is not on the clinic. Ehrenfeld and his course co-directors, Jennifer Green, M.D., MPH, assistant professor of Internal Medicine and Pediatrics, Morgan McDonald, M.D., assistant professor of Internal Medicine and Pediatrics, and Heather Ridinger, M.D., work to create structured learning goals that the students will achieve themselves. Rising second-year student Cameron Upchurch said he went into his clinical continuity experience determined to find a way to be useful.

“It was great that they set it up so our first month we learned from non-physician staff like the nurses, techs and office managers. I learned how to give flu shots and how to see on the white board who was due for one, so the staff would say, ‘Oh good, it’s Thursday, Cam will be here and can do that,’” Upchurch said.

As the year progressed, Upchurch said he was able to pick up on basic skills like talking with patients, collecting histories and taking blood pressure — things he might not have been able to learn until the third year at other medical schools. Next year he hopes he will be able to work on a quality improvement project for the clinic he works in.

Melvin said the medical school let him know weekly or monthly what students were learning in class so he could dovetail clinical experiences with students’ coursework. He also appreciated medication reconciliations projects the students performed at the end of the year. Reconciliation is a time-consuming, but important task that is difficult for busy clinics to complete with every patient.

“There were challenges, certainly, but it is great to feel that you are contributing to the training of the next generation of physicians. They learn in a different way than I did, or even than the residents did five years ago. It generates excitement and a drive to learn at every skill level,” Melvin said.

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