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NEWS FROM CAMBRIDGE HEALTH ALLIANCE

March 28, 2007

Harvard Faculty Collaborate at Cambridge Health Alliance on Early Results in Medical Education Reform

Research Alert

Study Title: The Harvard Medical School-Cambridge Integrated Clerkship: An Innovative Model of Clinical Education

Subject of the Study: The Harvard Medical School-Cambridge Integrated Clerkship is a complete redesign of the principal clinical year in medical school. Launched at The Cambridge Hospital campus of Cambridge Health Alliance and co-directed by Barbara Ogur, MD, and David Hirsh, MD, the program’s transformative method fosters students’ learning through close and continuous contact with patients in the disciplines of internal medicine, neurology, obstetrics-gynecology, pediatrics, psychiatry and surgery. This model is now serving as a model for clinical education reform nationally and internationally.

Objective of the Study: The authors collected data from the pilot year of the Harvard Medical School-Cambridge Integrated Clerkship (HMS-CIC) program (July 2004–July 2005) to measure its success.

How HMS–CIC Works: With year-long mentoring and close faculty oversight, HMS-CIC students followed a cohort of patients through their entire course of illness, actively participating in the core skills of doctoring: information gathering; diagnostic reasoning; the planning, implementation, and assessment of therapy; and the provision of comfort and support to the patient. Students participated in weekly tutorials, based in their actual care of their patients, integrating instruction in the basic sciences with training to address the common and important issues in medicine, as identified by national organizations. In addition, they participated in a social science curriculum, also based in the realities of their caregiving, which focused on self-reflection, communication skills, ethics, population sciences, and cultural competence.

Research Findings: HMS–CIC students performed at least as well as traditional students in tests of content knowledge and skills, as measured by National Board of Medical Examiners subject exams and Harvard’s fourth-year Objective Structured Clinical Exam, and they scored higher on a year-end comprehensive clinical skills self-assessment examination, suggesting that they retained content knowledge better. HMS-CIC students were much more likely to see patients before diagnosis and after discharge and to receive feedback and meaningful mentoring from experienced faculty than were their traditionally educated peers. HMS-CIC students expressed more satisfaction with their curriculum and felt better prepared to cope with the professional challenges of patient care, such as being truly caring, involving patients in decision making, and understanding how the social context affects their patients.

Authors: Barbara Ogur, MD, co-course director of the Integrated Clerkship, a physician at Cambridge Health Alliance, and Assistant Professor of Medicine at Harvard Medical School; David Hirsh, MD, co-course director of the Integrated Clerkship, a physician at Cambridge Health Alliance, and an Instructor in Medicine at Harvard Medical School; Edward Krupat, PhD, Director of Evaluation and Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School; and David Bor, MD, chairperson of the Integrated Clerkship Steering Committee, Chief of Medicine at Cambridge Health Alliance, and Charles S. Davidson Associate Professor of Medicine at Harvard Medical School.

Journal: Academic Medicine, April 2007, Vol. 82, No. 4 Website: www.academicmedicine.org

Funding: The project was supported by funding from Cambridge Health Alliance and the Academy at Harvard Medical School as well as a grant from the New York Academy of Medicine.

Cambridge Health Alliance is a regional healthcare system with three hospitals and more than twenty primary care practices in Cambridge, Somerville, and Boston's metro-North communities. As a teaching affiliate of Harvard Medical School, Cambridge Health Alliance offers medical residency/training programs and undergraduate learning experiences in hospital and community settings. Cambridge Health Alliance also includes the Cambridge Public Health Department, CHA Physicians Organization (CHAPO), and Network Health, a managed Medicaid plan.