Cardiac arrythmias. Managing your personal finances during residency. What do we owe our patients? Graduate oath. These are a small sample of the topics discussed in the MD Class of 2022 Capstone course, which ran from March 14 through April 1, and is a graduation requirement. The variety of subjects in the experiential course reflects its holistic approach, intended as a mix of practical clinical information students should know before starting their residencies, life skills, philosophical discussions about the practice of medicine, and reconnecting students before graduation.
The Class of 2022 took a variety of paths through their journey at Yale, some beginning as early as 2012. Thirty percent obtained a second degree along with their MD. The vast majority will begin residencies in less than two months, which makes preparing them for the experience a priority.
In addition to sessions focused on practical clinical skills such as managing acute medical problems and interpreting EKG readings and radiographic imaging, there were boot camps in surgery, internal medicine, emergency medicine, neurology, pediatrics, and psychiatry, in which faculty and residents focused on practical information students should know to be ready for the first day of residency, ranging from clinical skills to how to ensure you get enough sleep. Students participated in at least one of the specialty-specific boot camps.
Capstone sessions on well-being and life skills included managing wellness and personal finances during residency, as well as homebuying.
Preparing for an overnight rotation
Jessica Illuzzi, MD, MS, deputy dean for education and Harold W. Jockers Professor of Medical Education, and Michael L. Schwartz, PhD, associate dean for curriculum and director of innovation in medical education, suggested incorporating simulation into Capstone this year. Instructor Sam Buck, MD, and the Yale Center for Medical Simulation team designed a pilot simulation that gave students the experience of being the only intern on the floor while taking care of patients on an overnight rotation—a position many students soon will be in. Students worked in pairs to assess common overnight complaints, such as shortness of breath, altered mental state, or fever, using high fidelity manikins. Buck, who says the pilot received positive feedback, hopes more students can participate next year and that his team can create residency-specific scenarios.
Julian Campillo, who is going into emergency medicine, says that unlike previous simulations during medical school that “focused quite a bit on the ‘realize that this can be scary and get help early’ part of medicine,” in the pilot “they absolutely flipped the script on us,” sending the message that the situation “may look scary but you need to know what you can deal with in the middle of the night without needing to wake everyone up, and what you need to rouse alarms for.” The most valuable lesson for Campillo was to trust himself. “They did a great job reminding us that we can and will be competent in our new role as interns, and that we have indeed been preparing for this quite a long while.”
Assistant Professor Oluwatosin Adeyemo, MD ’13, MPH ’20, led another new Capstone element—“Empower to Thrive,” a workshop aimed at equipping graduating students from racial/ethnic backgrounds underrepresented in medicine on strategies to successfully navigate residency training amid unique challenges they may encounter. Kelechi Umoga, who will graduate with a joint MD/MBA degree, appreciated how Adeyemo pushed the participants to be self-reflective, for example, about their strengths, weaknesses, and what they looked forward to working on in residency. He also appreciated the focus on the value of seeking mentorship on time, rather than struggling to figure something out oneself.
Capstone is the “other bookend” of Introduction to the Profession (iPro), the first course MD students take in medical school, which introduces them to their professional identity in medicine by focusing on issues including professionalism, bias, health equity, identity, power, and privilege. Professor Barry J. Wu, MD, is the director of iPro and Capstone, and Adeyemo is associate director of both courses.
Former Associate Dean for Student Affairs Nancy Angoff, MD ’90, MPH ’81, MEd, who for years played an active role in Capstone, explains that the impetus for launching the course—originally called Integrative Clinical Medicine (ICM) —over twenty years ago was a concern among academic institutions that the final few months of medical school were not being used effectively. While YSM was a leader in addressing this issue, Angoff says ICM was not originally popular among students, who were used to unstructured time at the end of their fourth year. The positive student feedback from this year’s Capstone reflects this has changed.
An invaluable opportunity
Isaac Freedman, MPH, who will be starting residency in anesthesiology at Mass General Hospital next year, said Capstone “was a fantastic opportunity to refresh some of the key practical skills that will serve us well in residency, while saying farewell to our beloved faculty and seeing old classmates and friends again.” He also found Capstone was “an invaluable opportunity to discuss structural racism, social determinants of health, and medical ethics,” as well as prepare for residency by reviewing important skills, like rapid chest X-ray and ECG interpretation, and “reviewing critical ethical and social aspects of being a new physician.”
For Umoga, who is starting residency at Harvard in emergency medicine, seeing people, some of whom he had not seen for a few years, was a priority going into Capstone. He also was excited to be in a classroom being taught again, after several years of self-learning, for example in clinical rotations. He found it useful to go over basics such as opioid use, fluids, EKGs, and difficult conversations, since he will be seeing everything in emergency medicine. Because of the sequencing of his joint degree, he had not focused on the basics for a few years.
Professor of Pediatrics (Neonatology) Mark Mercurio, director of the YSM Program of Biomedical Ethics, who gives the first talk in iPro, led the final Capstone session: “What Do We Owe Our Patients?” For Umoga, this discussion was particularly powerful. “Dr. Mercurio brought it all in,” challenging the students to create time to acknowledge all the people they interact with—such as patients, janitors, other health care professionals—no matter how busy residency feels.”
With Capstone’s focus on preparing students for residency, it is fitting that the course included the Match Day celebration, with students learning where they will be spending their next years as residents.