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Landmark Study Finds Harvard Clerkship Improves Students’ Learning and Commitment to Patients
Posted Date: 3/29/2012
Cambridge, MANew research released today upends prevailing notions of medical education and points to a better way to teach and learn. Published online today by Academic Medicine, the study marks one of the most significant developments in medical education in over 100 years, since the Flexner Report of 1910 instituted fundamental standards and principles across U.S. and Canadian universities.

The study, the most comprehensive of its kind, reported data from the Harvard Medical School-Cambridge Integrated Clerkship (CIC), a highly innovative model of medical education based at Harvard-affiliated health system Cambridge Health Alliance that completely restructures the students’ (and their patients’) experience of caregiving. This patient-centered redesign eliminates traditional “block rotations” in favor of students learning the core skills of doctoring by following a large panel of patients longitudinally. Students see patients through all phases of diagnosis and treatment, including hospitalizations, discharge follow-up, and even home visits. This model returns to the roots of medical education, and the study demonstrates that this wholesale restructuring makes a difference.

Researchers compared the knowledge, skills, and attitudes of students completing the CIC with those of students completing traditional block third-year clerkships and found that CIC students performed as well or better than their peers on academic and clinical measures while also expressing a stronger sense of connection with their patients. The students also had substantially higher satisfaction with their medical training.

“We created the CIC because the patient must be our center — we seek to master science in order to serve patients. Traditional block rotations do not allow students to connect to, know, and serve their patients the way master clinicians and scientists should,” said David Hirsh, MD, Director and co-founder of the CIC, Assistant Professor of Medicine at Harvard Medical School, and lead author of the study. “The new data validate our hopes that the CIC improves students’ academic abilities and scientific learning and supports their humanistic professional character.”

The new study, which will appear in the May issue of Academic Medicine, is the most extensive trial comparing longitudinal integrated and traditional clerkships to date. The authors, faculty members at Harvard Medical School at the time of the study, include practicing physicians at Cambridge Health Alliance. They compared 27 students completing the first three years of the CIC (2004-2007) with 45 students completing clerkships at other Harvard teaching hospitals during the same period. The study measured students’ performance on standardized tests, perceptions of the learning environment, and attitudes toward patient-centeredness. CIC students delivered better academic performance overall and demonstrated richer perspectives and insight on the course of illness and recovery, increased commitment to patients, and retention of the idealism that initially drew them to the profession.

The CIC’s continuity of care curriculum, first described in the New England Journal of Medicine in 2007, emphasizes whole patient care and has become a model for medical education transformation nationally and internationally. Institutions across the U.S., Australia, and Canada successfully use the model for an array of critical educational and health systems missions. In rural settings, the model has long served to enhance physician workforce needs. Schools such as Columbia University College of Physicians and Surgeons and the University of California-San Francisco School of Medicine now use the model for enhancing leadership and academic missions. The success of the CIC model is now being confirmed with the largest known medical education trial to date, featuring nearly 50 schools worldwide and set to launch this year. Harvard’s CIC was selected as a site to lead the U.S. national study.

“What is most important about this new model of medical student education is that it gets at the very heart of professional identity formation – forging and maintaining relationships among patients, learners, and teachers,” said study co-author Malcolm Cox, MD, Dean for Education at Harvard Medical School when the study was initiated and presently Chief Academic Affiliations Officer at the U.S. Department of Veterans Affairs. “And what is especially impressive is the idealism reignited in the students, who truly place their patients’ interests at the center of the learning experience.”

“The goal of the CIC is to return to our highest ideals in all fields – to foster the excellence that patients rightly expect of us,” said Dr. Hirsh, who also serves as a practicing physician at Cambridge Health Alliance. “The program seeks to inspire greatness in service to patients and to scientific discovery. We intend to prepare leaders who will use their gifts to relieve human suffering. The CIC model makes a difference to our students and to our patients.”

“Educational Outcomes of the Harvard Medical School-Cambridge Integrated Clerkship: A Way Forward for Medical Education.” David Hirsh, MD, Elizabeth Gaufberg, MD, MPH, Barbara Ogur, MD, Pieter Cohen, MD, Edward Krupat, PhD, Malcolm Cox, MD, Stephen Pelletier, PhD, and David Bor, MD. Academic Medicine, online publication ahead of print.

Cambridge Health Alliance is an integrated, award-winning health system that provides high quality care in Cambridge, Somerville, and Boston’s metro-north communities. It includes three hospital campuses, a network of primary care and specialty practices, and the Cambridge Public Health Dept. CHA is a Harvard Medical School teaching affiliate and is also affiliated with Harvard School of Public Health, Harvard School of Dental Medicine, and Tufts University School of Medicine.

Cambridge Health Alliance is an academic community health system committed to providing high quality care in Cambridge, Somerville and Boston’s metro-north communities. CHA has expertise in primary care, specialty care and mental health/substance use services, as well as caring for diverse and complex populations. It includes three hospital campuses, a network of primary care and specialty practices and the Cambridge Public Health Dept. CHA patients have seamless access to advanced care through the system’s affiliation with Beth Israel Deaconess Medical Center in Boston. CHA is a Harvard Medical School teaching affiliate and is also affiliated with Harvard School of Public Health, Harvard School of Dental Medicine and Tufts University School of Medicine.