Learning To Be A Physician Through Relationships

Yale School of Medicine (YSM) second-year MD students gathered on November 30, to celebrate completing the eight-month Medical Clinical Experience (MCE) course, and thank the 60 physician tutors who are central to the success of the course. The tutors, who come from different specialties and practice at Yale New Haven Hospital (YNHH), Yale Medicine (YM), the VA Hospital, and private practices, each meet with a group of four MD students once a week in a clinical setting.

A central purpose of MCE is to prepare students to successfully complete the standardized history and physical exam assessment, providing students opportunities to develop the skills they will need on clerkships. The mentorship provided by the physician tutors also is critical, as students are developing their identities as future physicians. MCE runs from April of the students’ first year of medical school through November of their second-year, ending shortly before they begin clerkships. (MCE follows the Interprofessional Longitudinal Clinical Experience (ILCE), designed to help first-year YSM MD and Physician Associate (PA) students begin to work effectively as part of an interprofessional health care team, and build a working knowledge of the clinical environment and health care organizations.)

Saahil Chadha, a second-year MD student, says it is hard to cite the most valuable lesson he learned from his MCE tutors, because “I’ve learned so much!” For example, he shares, although students are often taught the importance of patient-centered care in the classroom, “MCE is where we’ve learned to apply this theory within the constraints of a real-world clinical setting.” He describes how his group recently learned about the importance of holistic and collaborative medical care, and how one of his MCE tutors, Joseph Demayo, MD, MPH, “often talks about how disease management is just part of our job; even if a patient is mobile, are they able to get groceries, exercise, socialization? In addition to the chief concern, we need to consider our patients’ entire lifestyle and inquire about what matters most to them.”

MD student Sarah Ho points to how her MCE tutors “taught me how to balance relationship-building with history-taking and how to build a thorough differential diagnosis, assessment, and plan.” Additionally, Ho says MCE allowed her to practice applying classroom knowledge in clinical settings, and she became more comfortable with history-taking, physical exams, and patient presentations, helping her “feel more prepared for clerkships because I’ve been able to familiarize myself with the flow and environment of the hospital.”

Chadha shares that when he started medical school, “I distinctly remember my anxiety around history-taking, but the practice I received through ILCE and MCE has made the process much less stressful.” Chadha adds, “even though I’m admittedly still nervous to start on the wards in January, MCE has at least given me a glimpse into what’s to come, which has been incredibly reassuring.”

Similarly, second-year MD student Catherine Yu, shared that “MCE provided a safe space to practice and receive constructive feedback on interviewing, physical exam, and presenting. I really appreciated having a judgement-free space to build these skills for clerkship rotations.”

Yu adds that she believes guided, immersive experiences in clinical settings are very valuable medical education tools, and that she “would be happy to coach medical students in such a way if given the opportunity in the future.” Reflecting on the MCE experience, Ho states “an integral part of medicine is teaching, and I’d love to be a part of that once I’ve accumulated more knowledge and experience.” Similarly, Chadha shares “I believe the best medical educators make the best doctors, and I really hope to be able to give back one day.”

Tope Imevbore, MD, a Yale New Haven Health System hospitalist attending who has been an MCE tutor since 2006, said she had a mentor in medical school who she believes “helped me become the physician I am today, and this is also what motivated me to become a mentor myself.” Imevbore felt it was a calling to teach the pre-clerkship medical students clerkship skills, which she says are very important to make them excellent fact-finding physicians. She explains, “It is not enough to have the medical knowledge, but great clinical skills and compassionate bedside manners, makes a good physician, exceptional! I want to help teach this to our new physicians. One day they might be the ones taking care of me or my family.”

The most rewarding part of being a tutor, for Imevbore, “is seeing my students blossom into confident and excellent physicians. Growing in the knowledge and understanding of being compassionate and caring physicians.”

MCE Director Barry J. Wu, MD, FACP, professor of medicine reflects, “With the impact of technology in medicine, the MCE reminds us of the value of relationships with our patients and colleagues.”

During the November 30 celebration, students shared one thing they learned from their tutors, and the tutors shared one piece of advice to the students before they begin their clerkships. The students also all received pen lights, a gift from YSM alumni, which will be a useful tool for the students' clerkships and beyond.