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From Generation to Generation

January 28, 2020

“We learned about kindness by watching our coaches with patients. We thank you from the bottom of our hearts, you have made us better physicians.” Nathaniel Bachtel ’22 shared these thoughts at a December 5, 2019 gathering to recognize the 56 coaches and 104 Yale School of Medicine (YSM) MD students, who recently had completed their Medical Coach Experience (MCE) course prior to starting their clerkship year.

In MCE, four MD students meet, as a group, with physician coaches over the course of 20 sessions. This occurs after students complete the Interprofessional Longitudinal Clinical Experience (ILCE) with nursing and physician associate students in the Spring of their first year, and before clerkships start the following January.

The MCE grew out of a tutor program created about 15 years ago by Margaret Bia, MD, professor emeritus of medicine, where groups of MD students were matched with doctors for 52 sessions over a two-year period. With increased focus on interprofessional education, and clerkships beginning earlier under the new MD curriculum, the tutor program was transformed into the ILCE and MCE courses, first as pilots, and now as embedded, highly-praised, components of the pre-clerkship curriculum.

The MCE prepares students for their standardized history and physical exam assessment by strengthening their clinical skills, history taking, physical examination, clinical reasoning, and presentation skills, and provides opportunities to develop proficiencies they will need on their clerkships and beyond. Many students benefit most from the formation of a strong mentor/mentee relationship.

Alex Moushey ’22, who just completed the MCE, says the most rewarding part was “building a close relationship with my group's preceptor, Dr. DeMayo,” explaining, “while I can list a million reasons Dr. DeMayo was an effective teacher in the clinic, his impact on us went far beyond building a differential diagnosis. Dr. DeMayo treated us like colleagues, even friends, taking the time to learn about us as people—showing interest in our hobbies, goals, worries, and development as young physicians. He brought us into his family, going so far as to invite us to his daughter's wedding. When someone demonstrates that level of commitment to our education, I become that much more motivated to learn.”

Christopher Schenck’22, says the MCE is “intended to introduce you to the hospital and the very basics of interacting with patients,” adding that it “focuses on the very core competencies of the history and physical examination. These are your best tools in medicine, so having this dedicated time to hone these skills and receive constant feedback is incredibly helpful. Dr. Elder helped us in learning to really listen to your patient with all of your attention, and carefully observing the patient and their environment to aid in the process of gathering information about your patient.”

Schenck described how some days he would interview patients and give oral presentations about them, while other days were used exclusively to develop differential diagnoses for some of the common symptoms people present with in internal medicine. MCE director Barry Wu, MD, FACP, professor of clinical medicine, explains that MCE teaching also happens “by watching the physician in action, and picking up on nonverbal things they do such as closing the door and sitting down when they talk with a patient, or handing a tissue to a tearful patient.

Each year about 75% of MCE coaches continue on in this role. At the December 5 event, 17% of coaches were recognized for serving for at least five years, and 3% for 10 or more years, factoring in the predecessor tutor program. Wu says many doctors tell him how fulfilling the coaching role is; they are not grading students, but helping them be better doctors, by mentoring them in a safe-learning environment. Wu adds that the longitudinal nature of the program enriches coaches’ sense of well-being, as they form strong mentor relationships with a small group of students and are able to pass on the skills of a physician to the next generation.

I don't think Dr. DeMayo knows what kind of impact he's had on my medical education. I'll consider him a mentor for life.

Alex Moushey ’22

The 56 participating coaches this past year included 27 hospitalists, eight full time faculty, five Emergency Department faculty, four Veterans Administration faculty, two renal fellows, six chief medical residents, and four retired physicians. Because hospitalists see the largest number of patients in the hospital, they are particularly well-situated for the coaching role.

Hospitalist Irina Schiopescu, MD, who has served as a coach for five years, enjoys how her students question everything, which helps her keep up-to-date on medical issues and energizes her. Moreover, she finds it rewarding because the students are so grateful.

At the December 5 event, each student group shared one lesson their MCE coach taught them. Clear themes emerged among the 26 groups, such as that coaches taught students much more than technical skills, the importance of being kind, compassionate, and a human being, and listening to the patient. Additionally, the coaches’ hard work and dedication were repeatedly praised. For example, Cindy Du ’22 said “our coaches stayed late after their shifts to teach us and treated us like adult colleagues. We are so thankful, more than any words can say.”

Deputy Dean for Education Richard Belitsky, MD, Harold W. Jockers Associate Professor of Medical Education, echoes this appreciation. “We are so grateful to our MCE coaches. The close mentorship and careful guidance they provide have an enduring impact on the clinical skills and professional development of our students, and their approach to teaching is very much at the heart of the Yale System of Education.”

The evening also gave the coaches a chance to share the one thing they each wished they knew during their clerkship. Stephen Baldassari, MD, assistant professor of medicine, who has been an MCE coach for five years, emphasized that residents and attendings do not have all the answers, encouraging students to “embrace every moment you have, learn something every day, take advantage of observing every day; the learning process goes into perpetuity.” Leila Haghighat, MD, chief medical resident, Internal Medicine, cited William Olser: “Do the kind thing and do it first,” and then encouraged the students to “keep this as your guiding principle and the rest all follows. This is going to make a big difference in the big picture for your patient.”

MCE embodies the YSM’s education mission “to educate and inspire scholars and future leaders who will advance the practice of medicine and the biomedical sciences.” This is evident in Moushey’s comment, “I don't think Dr. DeMayo knows what kind of impact he's had on my medical education. I'll consider him a mentor for life. If one day I have the honor of educating the next generation of physicians, I'll do my best to emulate what Dr. DeMayo did for my team during MCE."

Submitted by Abigail Roth on January 15, 2020