Administrators of the Yale Department of Psychiatry’s Third Year Clerkship program have been seeing double since January.
Two curricula running simultaneously.
Twice the number of students.
Double the clinical placements.
The temporary program expansion – in effect through June -- is the result of a Yale School of Medicine curriculum change in 2015 that consolidated clerkships for primary care and psychiatry into one Integrated Clerkship for Primary Care and Psychiatry (ICPCP).
The change resulted in a six-month double teaching period of medical students that began in January and will run through June. Twenty-five students typically participate in the clerkship, but during this period 50 students are enrolled.
The challenge for the department’s Office of Medical Education Administration has been finding classroom space large enough for didactics, and enough clinical placement sites and tutors for every student.
Kirsten Wilkins, MD, Associate Professor of Psychiatry and Director of Clerkships at the medical school, said the transition has required more coordination and communication from everyone involved, but that “all people have come together. It’s working well.”
She cited efforts by the entire medical education administration team: Robert Rohrbaugh, MD, Professor of Psychiatry, Deputy Chair for Education and Career Development, and Residency Program Director; Jennifer Dolan-Auten, Director of Medical Education Administration; Gina Franco, Associate Director of Medical Education Administration and lead clerkship administrator; and Matthew Goldenberg, Interim Medical Student Clerkship Director.
The medical school clinical clerkship now comprises four 12-week blocks that combine disciplines. Besides primary care and psychiatry, there are rotations in internal medicine and neurology, surgery and emergency medicine, and obstetrics & gynecology and pediatrics.
Wilkins said integration and collaboration are central to the new curriculum, and that 21st century medicine requires that students understand how various specialties relate. “We practice with physicians and clinicians from all disciplines, not just psychiatry,” she said.
Traditionally, clerkships have been completed in the third year of medical school, however in the new curriculum the clerkship now spans the second half of the student’s second year, and the first half of the third year – running from January through December.
The change provides students with an earlier clinical experience, and gives them more time to conduct research and apply for residency after completing their four rotations. It also shortens first and second year pre-clinical studies from two years to 18 months.
The primary care and psychiatry block – like all four rotations – begins with an orientation known as a Precede (or “boot camp,” as Wilkins calls it) where students are told what to expect and what skills they will learn. Teaching is done in classrooms and at clinical sites that include Yale New Haven Hospital, Yale New Haven Psychiatric Hospital, Connecticut Mental Health Center, Yale Child Study Center, the VA Connecticut Healthcare System in West Haven, and Middlesex Hospital in Middletown.
Integrating the curriculum allows for better exploration of the similarities and differences between each discipline to help students decide which field of medicine to pursue.
The psychiatry component of the ICPCP includes training in inpatient psychiatry and consultation-liaison/emergency psychiatry. Tutoring is offered by psychiatry faculty and residents with special emphasis on interviewing and writing.
More residents have gotten involved since the curriculum changed, especially during the six-month double teaching period.
“We’ve asked the residents to really step up and participate in the program where they might not have done so in the past,” Franco said.
Students wrap up their 12-week psychiatry clerkship with a “Postcede,” where they practice the skills they learned and take an exam. Feedback for the faculty and resident instructors is also solicited.
“I think our faculty and resident teachers are consistently highly ranked by the students,” said Wilkins, who added that the clerkship is constantly evolving and improving based upon student input.