Excellent clinician – The realities of modern medical practice – insistent time constraints, technologies which erode the patient-physician relationship, intrusive regulation, fragmented healthcare delivery systems – present formidable barriers to the clinical education of medical students. Yet, the need to educate deeply caring and exceptionally competent physicians that will both treat and comfort patients has never been more acute. The Technion American Medical School identifies an Excellent Clinician as a physician who is equally steeped in science and humanism, and who can bring both to the care of each individual patient. To consistently educate students to achieve this status, we have adopted a Curriculum for Clinical Excellence, which is designed as an interwoven continuum of clinical milestones leading to a staircase of clinical achievement. Our template for inclusion of curricular elements has been the Core Competencies of the Accreditation Council for Graduate Medical Education (ACGME). At the Technion American Medical School, clinical experience starts the first week of attendance. The CLINIC, CAREER AND COMMUNICATION (CCC) course meets every other Thursday throughout the first year. It provides an introduction to the settings of clinical practice—hospital and clinic—and an initial foundation in clinical communication and experience. The purpose of the course is to make the clinical environment familiar to the students, to begin the complex and multifaceted process of skillful patient communication, and to start building the students perception of themselves as medical professionals.
At the Technion American Medical School, clinical experience starts the first week of attendance. The CLINIC, CAREER AND COMMUNICATION (CCC) course provides an introduction to the settings of clinical practice—hospital and clinic—and an initial foundation in clinical communication and experience. The purpose of the course is to make the clinical environment familiar to the students, to begin the complex and multifaceted process of skillful patient communication, and to start building the students.
perception of themselves as medical professionals. Some of the skills learned, and experience gained, during CCC include:
Familiarity with the clinical environment: hospital and clinic
Greeting the patient, introducing oneself, expressing empathy
Beginning the patient interview: presenting symptoms
Communication in difficult situations: life-threatening illness; breaking bad news; the uncooperative patient
Observation of professional behavior: senior faculty in the patient care environment
Self-care and mindfulness: caring for oneself as a physician
The second year of instruction starts with INTRODUCTION TO CLINICAL MEDICINE (ICM), a 4-month course which includes the foundational pathophysiology of system-based human disease: Cardiovascular, Respiratory, Gastrointestinal, Nephrology, Endocrine, Psychiatry, Hematology-Oncology, Obstetrics and Gynecology, Rheumatology and Neurology. Throughout the course, students prepare for class by reviewing a detailed Faculty-compiled/authored syllabus of materials regarding a cardinal topic. Following this self-learning, classroom sessions consist of student team-led review and approach to assigned clinical scenarios with discussion moderated by Faculty members. The “classroom” experience is highly interactive and dynamic and may include interview and examination of Standardized Patients presenting with syndromes just studied by the students. Competencies emphasized in ICM include:
Familiarity with the clinical presentation and treatment of the cardinal disease processes of each major organ system
Initial experience operating as a clinical team in the solution of clinical scenarios
Application of basic science and pathophysiology to patient case scenarios
Student teaching of concepts and application to patient cases in a “flipped classroom” format
Application of new research to treatment paradigms
Aspects of disease prevention related to lifestyle decisions
Multimodality knowledge acquisition and integration
INTRODUCTION TO THE CLINIC (ITC), which is held the second semester of 2nd year, deepens and systematizes the introductory communication and patient relational skills of CCC, and teaches a thorough multisystem physical examination. ITC is an intense, 6-week clinical immersion experience which consists of didactic presentation by faculty, student-composed written and oral case presentations, and daily physical examination drill on both normal volunteers and hospitalized patients. The course is taught by senior clinical faculty. Integral elements of ITC include:
1. A highly structured approach to the comprehensive patient interview
2. Instruction in active listening
3. Differential diagnosis systematically incorporated into History of the Present Illness.
4. Clinical reasoning incorporated into the Assessment and Plan of the patient interview.
5. Drill in oral presentation.
6. Competency in comprehensive physical examination (92 elements) with emphasis on patient bedside drill at hospital.
7. Initial experience with Objective Structured Clinical Examination (high-stakes summative assessment of Physical Examination skills).
8. Making a personal connection with the patient and establishing trust.
9. Progress note composition and concept of longitudinal care.
10. Appreciation of and sensitivity to very broad diversity of ethnic and socioeconomic origins.
11. Professionalism in appearance, bearing and presentation.
12. Beginning assumption of personal professional persona.
13. Respect and support for members of peer team.
14. Centrality of patient privacy and modesty, and cultural considerations.
15. Initial interaction with patient families.
The CORE CLINICAL CLERKSHIPS (CCCL) comprise the heart of the clinical curriculum in the third year of TEAMS. As is true for most allopathic medical schools, these ward-based rotations in the core specialties provide the students an opportunity for direct patient contact, supervised management responsibilities and in-depth exposure to the hospital environment. The core clerkships at TEAMS consist of rotations in: Internal Medicine, Surgery, Pediatrics, Family Medicine, Obstetrics and Gynecology, Neurology and Psychiatry. In addition, the TEAMS Curriculum for Clinical Excellence supplements the core clinical exposure with a one day a week curriculum at the Technion Clinical Skills Center throughout each rotation. This day-long session, led by a senior subspecialty clinician, assures that all TEAMS students, regardless of their individual experience on the wards, share a foundational curriculum of cases central to each specialty. Standardized Patient scenarios and specialty-designated mandatory cases accessed on Aquifer.org, are employed for this purpose. In addition, the supplemental curriculum includes small group bedside tutorials in advanced physical examination, a specialty-directed imaging curriculum and basic procedures competence drills. In aggregate, the central elements of the Core Clinical Clerkships include:
1. Extensive direct patient contact.
2. In-depth simulated patient cases (Standardized Patient format)
3. Mandatory performance of layered patient care cases and fund of knowledge review (Aquifer.org).
4. Required specialty text reading assignments.
5. Application of the extensive physical examination skills learned in ITC and construction of an individualized core physical examination under faculty supervision.
6. Presentation of multiple structured interviews of patients with a wide spectrum of specialty specific conditions.