Shifting Medical Education to Better Prepare Students

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Medical training is designed to prepare individuals to become successful future physicians. One specific area of training that does this? Clerkship.

“During the clerkship year, medical students learn clinical aspects of medicine,” says Erin Pete Devon, MD, a Pediatric Hospitalist in the Division of General Pediatrics at Children’s Hospital of Philadelphia (CHOP). She and Stacey R. Rose, MD, a fellow Pediatric Hospitalist, have devoted their time and scholarship efforts to serving as Directors of the Pediatric Clerkship at CHOP.

Erin Pete Devon, MD and Stacey R. Rose, MD (L) Erin Pete Devon, MD and (R) Stacey R. Rose, MD While clerkships start at different times depending on the institution, medical students at the Perelman School of Medicine at the University of Pennsylvania (Penn) typically complete 1½ years of primarily classroom learning prior to their clinical clerkships. During clerkship, students rotate through different specialties throughout the University of Pennsylvania Health System and neighboring Children’s Hospital of Philadelphia.

Penn students complete their pediatric clerkship at CHOP, spending five to six weeks learning as much as possible about pediatric medicine and developing a “solid knowledge base around pediatric conditions,” notes Dr. Rose. “Since many students have not chosen a medical specialty when they enter clerkships, and are first exposed to pediatrics, the program also serves as a recruitment opportunity.”

Fostering learning in virtual world

Traditionally, clerkships have been a “hands-on, in-person experience.” However, at the onset of the COVID-19 pandemic Drs. Pete Devon and Rose, in conjunction with medical school leadership, had to make curriculum changes and get creative in the ways they foster student learning – both in and outside the hospital.

Accommodations for COVID-19 brought about significant changes to the clerkship structure and the traditional didactic curriculum. This year there is an intensive two-week curriculum, referred to as the “intersession,” which was implemented at the beginning of each 12-week block. The intersession allowed students the ability to practice social distancing and quarantine while providing foundational knowledge for specific clerkships.

Because of COVID-19, the prior in-person didactic sessions shifted to a virtual format. Drs. Rose and Pete Devon’s approach uses a “flipped” classroom model. Through asynchronous work that includes videos, recommended readings and synchronous, case-based content, students learn some of the foundations of pediatric medicine. The task, Dr. Rose says, was not without its challenges. “It definitely took a lot of trial and error and some ingenuity.”

Unfortunately, the challenges didn’t end there.

Program shift to meet learners’ needs

Although shifting to an upfront instructional curriculum allowed the students to feel more prepared for the beginning of their clerkship, asking them to think about pediatrics when they had little to no contact with pediatric patients could make the information “foreign,” explains Dr. Pete Devon. To further complicate matters, some students had their instructional curriculum “five to six weeks before coming to pediatrics.”

So, how did Drs. Rose and Pete Devon ensure the content they created was meeting their learners’ needs?

Both Dr. Pete Devon and Dr. Rose are currently enrolled in the University of Pennsylvania’s Masters in Medical Education program, led by Donald L. Boyer, MD, MSEd, and Anna K. Weiss, MD, MSEd, both dual employed at CHOP and Penn. One course focuses on curriculum structure, and Drs. Pete Devon and Rose incorporated these lessons when creating the pediatric intersession curriculum.

The duo began by conducting an informal needs assessment, using student feedback to ensure they considered the learner’s perspective. They worked closely with other clerkship directors, including colleagues from the Perelman School of Medicine, and drew heavily from core concepts found in the clerkship curriculum outlined by the Council on Medical Student Education in Pediatrics (COMSEP). In thinking more about scholarship, they met with CHOP’s Center for Leadership and Innovation in Medical Education (CLIME) leadership, specifically Daniel C. West, MD, and Dorene F. Balmer, PhD, to discuss team-based learning and conceptual frameworks.

Dr. Rose and Dr. Pete Devon say their ultimate goal was to make “high yield” program content.

Sharing what they’ve learned

While Drs. Pete Devon and Rose’s main focus has been adapting the clerkship curriculum at CHOP during the COVID-19 pandemic, they’re open to sharing what they’ve accomplished – and how – to bolster other clerkship programs across the country.

“The content we’ve developed can be useful if shared as individual modules or a longitudinal curriculum,” says Dr. Pete Devon.

They plan to submit their curriculum for consideration to the open-access teaching and learning journal, MedEdPORTAL, run by the Association of American Medical Colleges, as well as present their work at the 2022 COMSEP Annual Meeting in Cincinnati, OH. For now, they’ve presented their adapted curriculum to Penn’s clerkship directors and have recently applied for a grant from CLIME that would allow them to conduct a qualitative assessment of the new curriculum.

Along with these plans, Drs. Rose and Pete Devon are considering how to best adapt their curriculum once again as COVID-19 restrictions ease and they can return to an in-person environment with their learners.

“I think what we’re most interested in is the impact of the current structural changes, and if there are benefits to intensive upfront learning before the clerkship,” says Dr. Pete Devon. “I do think there is something to be learned from our current changes, and to understand how it affects students.”

Adds Dr. Rose, “I think ‘what’s the best way to learn clinical medicine?’ in this post-pandemic era is exciting and is something that can have a broad impact.”