Many medical students can lose their sense of empathy during their third-year rotations—but one Harvard-based program may have successfully reinvented its curriculum to prevent "ethical erosion."
Writing last week in the New York Times, surgeon and author Pauline Chen explains how the rotations—"a speed-dating introduction to the major disciplines of medicine and the issues patients face"—often make students less empathetic toward their patients. She notes that many third-year students begin to refer to patients by their diseases rather than as individuals.
Various educators have worked to recreate the third-year curriculum to avoid this "ethical erosion," Chen writes.
Possible model: Caring for a set group of patients
A recent Academic Medicine article detailed the success of a Harvard Medical School-Cambridge Integrated Clerkship that assigns third-year students to a panel of as many as100 patients; the students then provide continuous care to their assigned patients in Cambridge Health Alliance clinics. Students also are charged with providing outside consultations, care during hospitalizations, and home visits.
"Our goal was to use the students’ idealism and altruism as a frame for their learning and mastery of the science," says program director David Hirsh.
Since the program's launch in 2004, its students have performed better on tests assessing a physician’s ability to involve patients and family members in decision making, as well as ethics tests. Moreover, program graduates said they feel better prepared for clinical practice and tended to receive more guidance from senior physicians because they interact with them for a full year, rather than for one- or two-month rotations.
In addition, Hirsh found that patients enjoyed having a medical student assigned to them for a year. “Patients have gone on to tell their friends about the program,” he says, adding, “Now we are having difficulty keeping up with [patients' requests'] for their own medical students.”
Hirsh says the program is part of a “growing movement” to rethink medical education, and Chen adds that schools nationwide are strengthening or launching similar programs (Chen, “Well,” New York Times, 4/19).