Faculty Senate retools School of Medicine's requirements for graduation

By RUTHANN RICHTER

Starting in June, medical students will have to complete a more rigorous clinical curriculum in order to graduate, including two new required clerkships in neurology and critical care, the School of Medicine's Faculty Senate agreed Jan. 16.

The senate unanimously approved new guidelines, which will not increase the length of the clinical program but will decrease time allotted for electives. In addition to two new clerkships, students will have to spend two months in a revamped ambulatory care clerkship and take part in a more demanding subinternship designed to closely mimic what interns do.

Eddie Atwood, MD, professor of medicine (cardiology) and chair of the Committee on Courses and Curriculum (CCC), presented the rationale and goal for these new clerkships to some 40 attendees at the senate meeting. The change grew out of a CCC retreat last summer, in which committee members agreed there were too many gaps in the clinical training of many students.

"The sense was that there were some deficiencies in the program," Neil Gesundheit, MD, associate dean for medical education, told senate members. He noted that one student satisfied his graduation requirements by devoting all his elective time to a single specialty, dermatology. "That doesn't suggest the depth of clinical training we consider appropriate," Gesundheit said.

The senate decided to add a one-month neurology clerkship, as students now get little exposure to this specialty. Stanford is currently the only one of the top 20 medical schools in the country that does not require neurology training, Gesundheit said. The senate also included a new month-long clerkship in adult and pediatric critical care to reflect the fact that between 25 and 30 percent of hospital-based practice now involves care of critically ill patients. These two new clerkships will replace spots previously reserved for electives.

The senate had initially proposed the addition of a two-week clerkship in radiology, but the radiology faculty universally opposed this change, Garry Gold, MD, an assistant professor of radiology, told senate members. The radiologists would prefer to keep the existing, one-month elective, which is more comprehensive and popular with students.

The senate also added a new two-month clerkship on the "fundamentals of ambulatory practice" which will begin in 2003. This clerkship will combine two previous ones — clinical care basics and ambulatory care — and will focus on ambulatory practice, since the bulk of medical practice today occurs in an outpatient setting.

The last curriculum change involves beefing up the subinternship, which currently does not require direct patient care and may not be reflective of the bread-and-butter experience of the medical intern, Atwood said.

The senate also agreed that the one required elective remaining should be a clinical elective so that students could not spend this month doing research or other activities not directly related to patient care.

With these changes, students will still spend a minimum 15.5 months in clinical training. Senate members noted that this was a relatively short amount of time in comparison to other medical schools, and they encouraged students to expand the time to explore other electives. Students now spend 17 months on average in clinical training, Gesundheit said.

Students were invited to preview the proposed changes at a town hall meeting on Jan. 10, but fewer than 10 students attended, and none expressed major objections to the change. The new guidelines were approved by the senate on a 29-0 vote.