=========================== JeffNEWS, November 15, 1994 =========================== Generalist Medical Education... Preparing JMC Students to Be Doctors of the Future -------------------------------------------------- "At Jefferson Medical College, we believe that preparation for the role of generalist is fundamental to the education of all physicians," said Jonathan E. Gottlieb, MD, associate dean for academic affairs and associate professor of medicine/pulmonary and critical care medicine. By "generalist," Dr. Gottlieb means the first physician patients bring their medical problems to - a clinician who has the skills to address a wide variety of patient problems. Dr. Gottlieb said that despite the nationally recognized success of Jefferson Medical College's (JMC) curriculum, we still had opportunities to strengthen our students' generalist education. Two of these changes instituted earlier are now in effect. o A required clerkship in ambulatory care has been in place for years in the fourth year providing increased exposure to physician role models and added emphasis on skills and knowledge the generalist needs. This change was instituted to more effectively nurture and encourage the enthusiasm and idealism of entering students and emphasize professional skills and attitudes. o Before the words "primary care" were on everyone's lips, Jefferson had already instituted a required family medicine clerkship INTERNALLY FUNDED PROGRAMS "The current climate of healthcare reform has inspired more new initiatives, which are natural extensions of JMC's history and commitment to excellence," Dr. Gottlieb said. Five new programs the medical college itself funds are: o Patient encounter documentation - As economic pressures shift medical care from the bedside to the outpatient setting, medical education must shift its focus. To evaluate the experiences of students with patients in outpatient settings, a project was undertaken by the Office of Academic Affairs, the Center for Research in Medical Education and Health Care and the department of family medicine. So far, more than 20,000 student encounters with patients have been recorded, including patient demographics, disease category and severity, procedures performed, supervision and other data. The results will be used to correct inconsistencies in clinical material and to document clinical experiences. In addition, students have received a report comparing their performance to the class aggregate. o Early Patient Interaction - Under the direction of James D. Plumb, MD, assistant professor of family medicine, 60 first-year students visited medical offices or clinics on six occasions to experience different aspects of the doctor-patient interaction. The course aims to sensitize students to what patients expect and experience when they visit their physicians. Students meet twice with faculty preceptors in small groups to discuss their observations. The course has expanded to accommodate 90 students. o Life Cycle: Doctor-Patient Communication - Four years ago, a course, "The Life Cycle," was introduced to present the biological, psychological and social aspects of medicine. An interdepartmental faculty addresses topics such as violence, growth and development and the doctor-patient relationship. This year, a section of the course will be devoted to medical interviewing, so every student can interview a variety of patients and then be evaluated. The course emphasizes the skills of effective listening, information gathering, patient education and fosters compassion, sensitivity and respect. o Maternity Continuity Experience - Beginning this year, first-year medical students can follow a pregnant patient with Jefferson obstetricians to learn about the physiological, emotional, cultural and other aspects of pregnancy and childbirth. The students will also be present at delivery. In addition, they can follow newborns and their families with primary- care physicians to emphasize many aspects of primary care. o January Semester - For three weeks in January, first- and second- year students have a break from the "major" courses. During this period, new courses have been introduced emphasizing clinical judgment, medicine and the law, public health, nutrition, ethics and health policy, among others. These broad topics are frequently addressed by primary-care physicians, stressing their importance as role models for students. EXTERNALLY FUNDED PROGRAMS o Commonwealth Generalist Initiative - Last year, Jefferson received a $150,000 grant from the Commonwealth to develop a plan to increase the number of generalist physicians in Pennsylvania. The funds supported faculty in the departments of medicine, family medicine, pediatrics and obstetrics/gynecology so as to increase the visibility of generalist role models; for development of a curriculum to better prepare students for generalist careers; to support generalist participation in admissions, and to influence clinical experience through faculty and student support. Jefferson recently received notification from the Commonwealth of a three-year, $1.2-million continuation grant, awarded on a competitive basis, to implement many of the projects described above. This was the largest award made to any such program in the Commonwealth, according to Dr. Gottlieb. o Medical Scholars Program - More than five years ago, a program was conceived by Joseph S. Gonnella, MD, senior vice president for academic affairs and dean of Jefferson Medical College, and others, resulting in an agreement with the University of Delaware. The agreement assured early medical-school acceptance of Delaware students to reduce the cost and stress of the application process if the students met and maintained stringent academic standards. It also shifted basic medical science courses to the undergraduate years, freeing time during medical school for special study and experiences in healthcare systems, medical humanities and self-directed learning. The program also provides practical and clinical experience during the undergraduate years. The first Medical Scholars entered Jefferson this fall. o Health of the Public: Jeff CARES - Under this program, sponsored by The Pew Charitable Trusts, the Robert Wood Johnson Foundation and nominally the Rockefeller Foundation, $150,000 has been awarded to JMC over a three-year period to focus on involvement of academic medical centers in community health. Jefferson's proposal includes this focus under the title, Jeff CARES. "We propose to identify populations in need, including the homeless (under JeffH.O.P.E.), the Asian population in neighboring Chinatown, the patients who go to Jefferson's emergency department for their primary care, and others. A research portion of the proposal aims to determine the demographics of those served by the department. o Bridging the Gaps: PCHIP (Philadelphia Community Health Internship Program) - This program, funded by The Pew Charitable Trusts and begun at the University of Pennsylvania, focuses on students having summer experiences in the community with some faculty supervision. Funding has increased from a few thousand dollars two years ago to more than $500,000, of which Jefferson's share was almost $125,000. The program was recently judged by the Association of American Medical Colleges as a finalist for a special recognition award. Project director for Health of the Public: Jeff CARES and Bridging the Gaps: PCHIP is Sylvia K. Fields, EdD, RN, coordinator, primary care and community programs, office of academic affairs, JMC. FUTURE DIRECTIONS "At Jefferson Medical College, we're fortunate to be able to initiate different educational experiments simultaneously. The variety of experiences serves the additional function of allowing each student some latitude in choosing experiences with particular individual appeal," Dr. Gottlieb said. Over time, he noted, it's likely that several major themes will emerge: increased clinical experience early in medical school; increased emphasis on self-directed learning, and strengthening of knowledge and skills fundamental to generalist disciplines. Stay tuned! ------------------------------------------------------------------------------ Information provided by: Editor, JeffNEWS (215) 955-6204 ------------------------------------------------------------------------------