Wednesday Evening Clinic is a Popular/Valuable Elective

Among the clinical elective experience options available to medical students at Yale School of Medicine (YSM), the Wednesday Evening Clinic (WEC) stands out. Directed since 2012 by Pinar Oray-Schrom MD, CPE, FACP, FAAP, assistant professor (general internal medicine), and with help from medical student leader Brandon Hubbard, the WEC is a student-staffed primary care clinic at the adult New Haven Primary Care Consortium (NHPCC). Located on 150 Sargent Drive in New Haven, the NHPCC largely serves an under-served patient population mostly insured by Medicaid and Medicare. The mission of the WEC is to provide an extensive primary care experience for senior Yale medical students, in which they manage their own cohort of approximately 20-30 adult patients as primary care physicians (PCP) under supervision of attending physicians.

Overview

WEC is a one-year long, longitudinal ambulatory elective open to any qualifying medical student, with a significant fraction of the student-providers comprised of MD-PhD students who are in the PhD phase of their training. Each year, up to 15 Yale medical students beyond their third year participate. As part of WEC, medical students take ownership of multiple aspects of patients’ care, including general health maintenance, chronic disease management, age-appropriate screening, counseling, and patient-care coordination. During the COVID-19 pandemic, WEC adjusted its operations to provide telehealth when in-person sessions were not feasible. Currently it operates under a hybrid model, in which each week half of the students are on site while the other half performs visits via telehealth.

Clinic Operations

Clinic night starts with a 30-minute student-led teaching conference covering important topics in primary care. Teaching is done in the format of patient case presentations and interactive group discussions with topics and questions selected from the Yale Office-Based Medicine Curriculum.

Clinic structure is modeled after standard resident clinics, with student providers divided into three patient care teams, each led by a designated team-attending physician. This team structure ensures that each student is supervised by one designated faculty team-attending physician throughout the year. In addition to precepting students on Wednesday nights, team attendings are also the physicians of record for the patient cohort, responsible for overseeing the medical care of these patients. One of WEC’s great assets is the pool of very experienced voluntary attending physicians from greater New Haven who also participate in the clinic on a rotating basis. Their role consists of observing and teaching the medical students and supervising patient care. Each medical student provider is responsible for seeing up to three patients per clinic night. During a clinic visit, each student independently takes a history and performs a physical examination and formulates an assessment and plan under the supervision of an attending physician.

Unique Features of WEC

WEC offers a novel combination of increased student responsibility and continuity of care rarely encountered in the traditional medical school curriculum. Being imbedded within the NHPCC, the WEC allows medical students to experience care provision within a large healthcare system, while the hours of the clinic benefit patients who prefer evening appointments. Medical students find WEC valuable for their educational experience because of features not otherwise found in traditional clinical clerkships, including unmatched autonomy and level of responsibility, ability to maintain long-term physician-patient relationships, and the opportunity to observe the development of chronic diseases and the effectiveness of management plans over time.

First Hand Experiences with WEC

Current WEC students agree that being able to care for the community is a rewarding training experience that they are thankful to have.

Fourth-year MD-PhD student, Brandon Hubbard, said, “Wednesday Evening Clinic has allowed me to meaningfully participate in the care of our community members, and in turn keep my clinical skills sharp during my PhD training. I’ve also gotten a glimpse of what life may be like as a physician-scientist, balancing research with clinical care.”

Elizabeth Woo, fourth-year MD-PhD student, who feels privileged to care for the community through the clinic, said, “Wednesday evening clinic has given me a glimpse into what it means to have a longitudinal physician-patient relationship. By working with my patients on the specific health, socioeconomic, and structural barriers that they face, I’ve learned a great deal about how I can better advocate for them as well as the ways in which our health care system falls short and succeeds in supporting our patients. I have also had the joy of gradually building trust with my patients and in turn, being able to provide better care.”

Fourth-year MD-PhD Dan-Dan Li concurred. "It is a privilege to take care of the patients and establish personal connections with them over time at Wednesday Evening Clinics. There is nothing more satisfying than seeing how the patients make progress toward their health and healing through treatments and lifestyle modifications. Wednesday Evening Clinics gives us a chance to practice integrative medicine — by kindly sharing their life stories with us, our patients have taught us how personal experiences, lifestyles, social-economical situations, and social supports all play vital roles in the process of staying healthy. The patients had to overcome many barriers, and their strength is beyond inspiring.”

“WEC has been one of the most rewarding experiences I’ve had at Yale. It lives up to the idealistic notions I had of medicine before I started medical school. It’s inspiring to work with the compassionate attendings and students. In building longitudinal relationships with my patients and taking ownership of their care, I feel that I am growing tremendously as a provider,” said James Nie, MD-MBA student.

Current volunteer attendings, Margaret “Peggy” Bia, MD, and Frank Bia, MD, MPH, commend the leadership of WEC. “It is always a privilege to help the next generation of doctors learn the values and knowledge of good medical care. Pinar Oray-Schrom should be commended for her administrative leadership in the WEC with her emphasis on student learning,” said Peggy Bia.

WEC director Pinar Oray-Schrom who is a clinician educator and supervises internal medicine resident in their outpatient clinic as well said, “Wednesday Evening Clinic has been one of the most rewarding experiences to me as an educator. The students’ passion for primary care and dedication to their patients is inspiring. Not only do they develop close relationships with their patients but also with their peers and attendings. It is a privilege to be able to contribute to their growth into medical doctors.”

Summary

The Wednesday Evening Clinic is a unique and extensive primary care clinical training experience for senior Yale medical students that provides them with increased responsibility and patient continuity of care. Students manage their own cohort of approximately 20-30 adult patients as PCPs under supervision of attending physicians. In addition to YSM faculty, many of the attendings are drawn from a pool of voluntary attending physicians from greater New Haven who provide their expertise to observe and teach YSM medical students and supervise patient care. WEC provides an experience in which students and patients alike benefit and thrive.