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Commitment to Patients Endures in Harvard Medical School-Cambridge Integrated Clerkship
Posted Date: 4/9/2014
Cambridge, Mass. Research released today demonstrates longer-term successes of redesigning medical education. A new study of the Harvard Medical School-Cambridge Integrated Clerkship (CIC), a transformative medical education model based at Harvard-affiliated health system Cambridge Health Alliance, shows that the CIC model drives increased levels of patient-centeredness that endure for years beyond the students’ tenure in the program.

Published online in the journal Medical Education, the study suggests the program will have an impact in a healthcare environment where patient experience of care is now a critical performance measure.

The CIC model, already influential nationally and internationally, completely restructures students’ (and their patients’) experience of caregiving. This patient-centered redesign eliminates the traditional, short “block rotations.” Instead, students learn the core skills of doctoring by following a large panel of patients longitudinally, over substantial time. Students see patients through all phases of diagnosis and treatment, including hospitalizations, discharge follow-up and even home visits.

The new study illustrates for the first time that the documented benefits of this relational model make a difference for years after participation in the program.

The current findings expand on a 2012 trial by the same authors that assessed longitudinal integrated and traditional clerkships. In that paper, published in Academic Medicine, researchers compared the knowledge, skills and attitudes of students completing the CIC with those of students completing traditional “block” third-year clerkships. That research found that CIC students performed as well as their peers on academic and clinical measures while also expressing a stronger sense of connection with their patients. The CIC students also had substantially higher satisfaction with their one-year clinical clerkship experience.

A question remained: Would the benefits last?

The authors, who are Harvard Medical School (HMS) faculty members, examined the same first three cohorts of CIC graduates and compared them with traditionally trained HMS students over time. The students answered a series of survey questions that elicited their ideals, values and perceptions. The students also completed a validated survey instrument that assessed patient-centeredness. The authors compared the results from the traditionally trained students and the CIC students and also analyzed their original responses recorded years earlier.

They found that CIC students’ higher level of caring and commitment to patients was sustained over four to six years following completion of the program, beyond school and into practice. The authors hypothesize that the integrated clerkship experience may help to “immunize” graduates against the adverse influences of graduate and post-graduate training.

Graduates of the CIC recalled their clerkship experience as more satisfying, more humanizing and more transformational than did the traditionally trained group. They were also more likely to engage in health advocacy work, and attained awards and published papers at the same rates as peers.

CIC graduates believed more strongly than the traditionally trained group that the clerkship experience provided good preparation for doctoring and was valuable for informing future career choice. Both groups chose a wide range of specialties for their residency programs. Among those expressing a preference, no CIC graduates said they would choose a traditional clerkship, while 27 percent of the traditionally trained graduates said they would choose a longitudinal integrated clerkship.

David Hirsh, MD“We created the CIC because the patient must be our center,” said David Hirsh, MD, director and co-founder of the CIC, an HMS associate professor of medicine at Cambridge Health Alliance and a co-lead author of the study. “Our 2012 research validated our hopes that the CIC supports their humanistic professional character. The new study goes further by demonstrating the graduates’ longer term accomplishments and revealing that their humanistic values endure over time.”

The CIC emphasizes whole patient care and has become a model for medical education transformation around the world. Institutions across Australia, Canada, and the United States, including small cohorts of each class at Duke University School of Medicine, Columbia University College of Physicians and Surgeons, and the University of California-San Francisco School of Medicine, have created successful versions of the CIC model for an array of critical educational and health systems missions. The success of the CIC 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 to lead the U.S. national study.

Elizabeth Gaufberg, MD“Beyond their academic excellence, what is especially impressive is their humanism, level of commitment, and sense of duty,” said study co-lead author Elizabeth Gaufberg, MD, MPH, a founding CIC team member and an HMS associate professor of medicine and psychiatry at Cambridge Health Alliance.

Patients also benefit from this approach. “I was able to survive my treatments because of my student,” remarked a breast cancer patient.

Drs. Gaufberg and Hirsh agree: “Our research suggests that the CIC model, which places the patients’ interests at the center of medical students’ learning experience, makes a significant difference to both our students and patients. It shapes professionals who deliver care that is aligned with medicine’s highest ideals.”

A professorship grant from the Arnold P. Gold Foundation supported this study.

Into the future: patient-centredness endures in longitudinal integrated clerkship graduates.” Elizabeth Gaufberg,* David Hirsh,* Edward Krupat, Barbara Ogur, Stephen Pelletier, Deborah Reiff, and David Bor. Published online by Medical Education.

*These authors share joint first authorship of this paper.

Cambridge Health Alliance is a vital and innovative community health system that provides essential services to 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 a vital and innovative community health system that provides essential services to 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 Department. 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.