Yale School of Medicine (YSM) second-year MD students and Medical Clinical Experience (MCE) tutors gathered in YSM’s Donald J. Cohen Auditorium on the evening of November 21, 2024, for a celebration. As MCE Director Barry J. Wu, MD, professor of medicine explains, “The celebration marks a milestone in a student’s journey in medicine from their pre-clerkship experience to the clerkship year, which starts in January, and for leaders in medical education to acknowledge the contribution of the full-time, voluntary, and retired faculty who serve as tutors.”
From mid-March of their first year through November of their second year, MD students work in groups of four with MCE tutors. Assistant Professor of Medicine Stephen Baldassarri, MD, MHS, who has served as an MCE tutor for seven years, explains, “The focus of MCE is building the fundamental clinical skills that allow students to thrive on their clerkship rotations and mature into outstanding physicians. The students learn the basics of how to communicate effectively and empathetically with patients, to take a comprehensive history, to examine a patient, and to communicate their findings to other health professionals.” Baldassarri continues, “These skills are crucial for allowing the students to go on to have successful careers in medicine.”
Student experiences
Second-year MD student, Elise Wolf, PhD, says MCE was critical for improving her physical exam technique. She explains that students’ introduction to the physical exam involves practicing on each other; while that is a good start, she points out that young, healthy adults lack many of the exam findings relevant when assessing a patient. Therefore, at the beginning of MCE, she was able to go through the motions of a physical exam, but “didn't feel confident that I could interpret findings in the context of a disease process or use findings to guide a more targeted physical. I feel much more able to do those things now.”
For Wolf however, “the most rewarding part of MCE was learning about patients' social histories and their goals of care.” During MCE, she explains, “I became more aware of my assumptions about what patients want from their care and gained a deeper appreciation of patient-centered interviewing.” Additionally, Wolf says MCE was “an opportunity to work on ‘soft’ skills that can't be learned from a lecture or textbook, but are crucial to providing effective care.”
For second-year MD student Laura Evans, the most rewarding part of MCE was “getting to watch my classmates grow in their interview and physical exam skills. I got to see three of my classmates go from being slightly nervous and hesitant when talking to patients, to confidently conducting an entire interview and physical exam, with excellent clinical reasoning and comprehensive questioning in just a few months.” Evans continued, “It was wonderful to get to grow alongside them, and to see the ways our MCE mentors guided us through this experience and challenged us to continue to improve every week.”
In addition, Evans now is confident she can “come up with at least a preliminary differential diagnosis for patients, and to reason through their symptoms and story to piece together what might be happening.” Evans says her MCE tutors “were excellent at challenging us to back up our solutions with evidence and our knowledge of physiology, and it greatly strengthened both my skills, and my comfort in discussing patients with physicians.”
Wolf’s and Evans’ appreciation of MCE was echoed by other students at the November MCE gathering. For example, Isabel Wang said her MCE tutor inspired her “because she greeted and had a great relationship with everyone on the unit. She taught us the importance of caring for not only patients and families, but also the staff working in the hospital. It helped in so many ways in the care of our patients.”
Tutors' perspectives
The MCE tutors similarly praise the experience. Baldassarri became an MCE tutor in part because he finds “joy in teaching, coaching, and mentoring at multiple levels of medical training.” He describes how “the students participate actively, ask great questions, and always teach me a new thing or two. They keep me on my toes.” Furthermore, Baldassarri says he “benefited in the past from some amazing teachers and mentors who have helped me get to where I am and have inspired me to help others,” and his goal is “to help each student become the best physician they can be.” Baldassarri adds, “It’s remarkable to see the transformation in their skills and confidence that occurs over a single year.”
Benjamin Cherry, MD, assistant professor of medicine (general medicine), who has participated in MCE for eight years, describes how “seeing students succeed in any context is rewarding, but there’s something especially magical about knowing that they will take the skills they have developed in MCE and use those in thousands of patient interactions—tragic, triumphant, and otherwise—for the rest of their careers.” While Cherry has precepted and taught in other clinical skills settings, he explains that “MCE stands apart because the small group sizes and course duration facilitate the students and faculty really getting to know one another. It makes it easier and more natural for the faculty member to really invest their time and energy into teaching each student, and I think it allows the student to be more honest and vulnerable with demonstrating their knowledge and skills.” Cherry continues, “It’s a special relationship that I haven’t really found anywhere else.”
Humans v. AI
Wu believes MCE is especially valuable today, explaining, “With the rapid growth of technology and artificial intelligence in medicine, highlights of MCE are fostering relationships between students, patients, and MCE tutors, and the humanity in medicine.” Baldassarri echoed this point, noting “MCE is all about embracing your humanity. Medicine has become awash in technology. Generative AI can now outperform medical students on board exams. It can store and retrieve an incredible amount of information, and it can assist us in our work. But AI can’t replace what you do. It can’t look a patient in the eyes. It can’t hold a patient’s hand, or express empathy. It can’t decide how much time to spend with someone. And it can’t adapt on the fly and adjust to rapidly changing circumstances the way you can. MCE is all about making you better at the things that make you human. And these are the things your patients really want and need from you.”
Wu expressed his gratitude to the 64 doctors who devote two hours a week to serve as MCE tutors, about 75% of whom are hospitalists. Wu also is grateful to the Association of Yale Alumni in Medicine and the Alumni Fund for providing Yale penlights to the second-year students to use in their upcoming clerkships.
Reflecting, Wu stated, “MCE tutors have the privilege of passing on the skills of a physician to the next generation and the time with students reminds them why they went into medicine.”