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Education


Clerkships Allow Students to Become Comfortable as Caregivers

While waiting to be seen at Harlem Hospital's adolescent clinic for a checkup recently, a teenager didn't need to spend her time thumbing through magazines. Instead, she was greeted by first-year P&S student Andrew Davidson, who was in the second semester of his Clinical Practice I (CP I) clerkship at the hospital. Mr. Davidson began by inquiring about the teen's daily life. How was she adjusting to her first year of high school? Did she like running track? How were her studies coming along? When he learned about the girl's fondness for McDonald's he cautioned her gently about the danger of too much fast food.

When the girl's regular physician, Fred M. Donkoh, M.D., assistant clinical professor of pediatrics, was ready to see her for the medical exam, Mr. Davidson filled him in on what he and the patient had discussed, flagging the potential problem area – too much junk food. As part of his exam, then, Dr. Donkoh counseled the girl further on the importance of a good diet.

Mr. Davidson, who is interested in community pediatrics, has gained valuable experience at Harlem Hospital conducting patient interviews as part of the first-year clerkship in the CP I course, required for all first-year P&S students.

"Under Dr. Donkoh's guidance, I've become more comfortable interacting with patients this year," Mr. Davidson says. "The confidence I've gained working directly with patients and being treated as their health care professional will spill over into all my third-year clerkships so I can go in and learn about the specialty, not go in frightened of my new role as caregiver."

A wide array of opportunities are available in the clerkship component of the CP I course, which students learn about in classroom lectures and at a "Clerkship Fair" at the start of the school year. They range from clerkships at several NYPH and Ambulatory Care Network sites such as the Young Men's Clinic; the Door (a comprehensive service program for adolescents in lower Manhattan); Callen Lorde (a community health center in Chelsea); Calvary Hospital (a hospital in the Bronx that provides palliative care for terminally ill patients) as well as with individual providers throughout the CUMC system.

"The clerkships give students the chance to step back from their textbooks and get to know and identify with patients," says Bruce Armstrong, D.S.W., associate clinical professor in the Heilbrunn Department of Population and Family Health at the Mailman School of Public Health, who directs the CP I clerkship. "Involving medical students in patient care during the preclinical years is now established educational practice, however, each medical school organizes the experience differently. The approach at P&S is one we should be proud of – all 150 first-year students are involved in organized, interactive, supervised clerkships for 3 to 4 hours per week during both semesters of the academic year."

The CP I course is organized so that students learn through classroom activities and clinical experiences in clerkships and then have opportunities each week to reflect on classroom- and clinic-based experiences in small preceptor groups.

Students typically choose one site in the fall semester and a different site in the spring. The pediatrics first-year clerkship program at Harlem Hospital, led by Stephen W. Nicholas, M.D., associate professor of clinical pediatrics at P&S and director of pediatrics at Harlem, has proven so popular that four of the six students who began their clerkships there last fall asked to spend their entire year there. Dr. Nicholas and his staff are working with 10 students in the first-year class. The first semester at Harlem offers a "smorgasbord" introduction to pediatrics, whereas the second semester allows students to focus more on one area of the specialty, such as the sickle cell clinic, pediatric surgery or the adolescent clinic.

"Being a good doctor is not just about medicine and medications," Dr. Nicholas says. "It's about listening, problem solving and, especially in pediatrics, knowing the patient's family circumstances."

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