Keeping Clinical Skills Fresh

Helping Future Physician-Scientists Develop Their Clinical Skills

While the clinic may look like a typical doctors' office, with a sign-in desk, scores of patients waiting, and doctors scurrying around, it's actually a combination of medical center and classroom. Its purpose is to provide a dozen or so Einstein M.D.-Ph.D. students — who are enrolled in Einstein's Medical Scientist Training Program (MSTP) — with hands-on experience in examining and diagnosing patients, from taking histories and performing physical examinations to preparing a treatment plan and presenting their case to an attending physician.

Dr. Lisa Rucker discusses clinical matters with several students
Dr. Lisa Rucker discusses clinical matters with several students
The MSTP Continuity Clinic, as it's formally known, meets every Thursday night at the Jacobi Medical Center Ambulatory Care Pavilion, in the Van Etten Building. "Regular medical students generally have two years of basic science training with an introduction to clinical skills, then spend their third and fourth years immersed in clinical training," explained Dr. Lisa Rucker, professor of clinical medicine and director of the Continuity Clinic. "But MSTP students have this long break after their first two years, while they are doing their Ph.D. thesis research. They don't begin their third- and fourth-year clinic training for as many as four or five years. The clinic allows them to maintain their skills, and possibly build on them, over that time period."

The Continuity Clinic was established in 1997 by Dr. Betty Diamond, professor of microbiology & immunology and of medicine, who was director of the MSTP at that time. "Since its inception, the clinic has brought medical education into the Ph.D. thesis research years, furthering the integrated nature of the training program and helping to better prepare MSTP students for their eventual return to clinic clerkships once they have finished their thesis research," noted the program's current director, Dr. Myles Akabas.

Students who elect to take part in the clinic undergo a three-day orientation and are paired with a student from the outgoing group for a month or so. "This allows them to meet some of the patients and see how everything flows," explained Dr. Rucker.

"The key to the clinic's success is the team of internist-researchers who volunteer to serve as preceptors, offering guidance and advice as the students practice their clinical skills," she added.

Students confer about a case
Students confer about a case
"After a few weeks, students are able to see a patient, look up their history, and come up with an assessment. They then review the case with an attending physician, who offers guidance before they both go to examine and speak with the patient. As part of the process, the student may order labs or EKGs, write prescriptions and so on, all of which will be co-signed by an attending."

All the equipment for any sort of test, from blood pressure monitoring to urinalysis, is on the clinic floor, creating "one-stop shopping" for the patients, who avoid getting shuttled around during their exam.

Since the clinic runs for a year — which is longer than the typical clinical rotation during clerkships — students are able to see patients on a regular basis, getting to know them both medically and personally. "The patients are wonderful and very accommodating, plus it's rewarding when you realize you can make a difference for them," said Toni Roberts, a former student coordinator for the clinic who will graduate this year.

"I once treated a woman for shingles and then discovered that she had been HIV-positive for over a decade without telling anyone. I got her into treatment, and she started to do really well," she recalled.

She added, "They're very grateful for the care that we provide."

In demonstrating their gratitude, patients have been known to bring in assorted homemade treats. One even named her dogs after a student (one dog got her first name, the other her last name).

"It was very gratifying to have patients come back and be able to see real changes in their health, whether it was improved blood pressure or better controlled diabetes," recalled Dr. Dmitriy Kedrin, an Einstein MSTP alumnus who is currently an intern at Boston's Beth Israel Deaconess Medical Center.

"Medicine and research are usually separated," noted fourth-year MSTP student Vivek Patel. "The Continuity Clinic shows us what life could be like if we were to do both."

Posted on: Friday, March 18, 2011