Pilots and Models

One of the things they've really pushed for clinical rotations are "pilot" or "model" programs. These programs encompass 3 or 6 blocks, emphasize a theme, and take place all at one site. For example, there is a longitudinal VA experience with internal medicine, surgery, and neuro/psych focusing on the veteran population. An SFGH model targets underserved communities by integrating internal medicine and family medicine at the county hospital. Those wanting to try Fresno can do a combined six month experience in family medicine, ob/gyn, and pediatrics there. There are more interesting ideas. Some students may do a set rotation schedule, starting with medicine, then neuro/psych, peds, surgery, ob/gyn, and finally family medicine. This is intended to outline a logical order in which to do rotations; having surgery experience may enhance ob/gyn, and knowing ob/gyn issues will help with family medicine. I think the concept is cool, but it sounds like few people want to brave medicine first. Lastly, the most radical model program involves a complete integration of all the blocks in a year at Parnassus. This is a heavily outpatient based program. Students have their own cohort of patients to follow throughout the year; when they go to surgery, you go to surgery with them, and when they go to outpatient clinic, you follow. In theory, it seems very neat, but I feel like it requires a very particular person with a lot of initiative and independence to get the most out of it.

While I think the principle behind model and pilot programs is fantastic - an integrated approach for a more longitudinal experience, focusing on certain populations of patients, more time spent at a particular setting - I don't know if any are particularly for me. While SFGH and the VA program are most appealing to me, I don't know if they have exactly what I'm looking for. I think perhaps I prefer the flexibility of the traditional system, being able to rank what I would like to do, where, and when.

We've been having a lot of lunchtime or dinnertime talks from the different clinical core clerkship directors. It's been pretty interesting, though they really like emphasizing that all sites are about equal and there's no bad time to do a rotation. What's interesting to me is the rumors that are floating out there, and whether they should or can be debunked or not.