Clinical clerkships play a critical role in ensuring medical students have the knowledge, skills and abilities to deliver safe and effective medical care. During these clerkships, which take place in the third and fourth years of medical school, students work with—and learn from—physician preceptors, other healthcare providers and patients.
“Clinical clerkships are an exciting time for our students as it provides the opportunity to gain hands-on experience in the healthcare field,” said Jay S. Feldstein, DO ‘81, president and chief executive officer of Philadelphia College of Osteopathic Medicine (PCOM), during a recent episode of the PCOM Perspectives podcast.
Feldstein was joined by Michael Becker, DO, MS, FACOFP, associate dean of clinical education for PCOM, and Marla Golden, DO, MS, FACEP, associate dean of clinical education for PCOM Georgia and PCOM South Georgia to discuss the importance of clinical clerkships in medical education. Drs. Becker and Golden work to ensure PCOM osteopathic medical students secure the clerkship placements necessary to develop patient care skills.
According to Dr. Becker, students need to work very hard during their preclinical years.
“Those first two years, they learn the science behind diseases and diagnoses, and I think that they need to learn the basics of the pathology and the physiology so that when they go out on rotations, they'll be able to really understand the patient,” Becker said.
Becker also emphasized the importance of primary care skills.
“It's critical to learn and master the history and physical, how to present, how to write a note, how to enter basic orders, and then generate a working diagnosis, a differential diagnosis, and then a threefold (diagnostic, therapeutic and educational) plan,” he explained.
Dr. Golden agreed.
“Establishing a strong fund of knowledge in the basic sciences is critical, as is mastering the history and physical because that's truly how they will communicate with their colleagues about patients for the rest of their careers,” she said.
Developing a solid grasp of osteopathic practices and principles is also important, she added.
“If they do this and they move into their clinical years, they'll be able to apply this comprehensive frame of reference and approach to every patient they treat,” she explained.
Beyond these preparations, Becker shared some advice given to him by his predecessor, Dr. Joseph Kaczmarczyk.
“He always recommended to students that they need to learn to be comfortable with ambiguity, uncertainty and change,” Becker said. “We teach them what the right answer is in the first two years, and that's how they learn how to take a test. But when they go out and see a patient, it's not necessarily always cut and dry.”
It is during the clinical clerkships that students begin to apply what they have learned during their first two years of medical school.
“They get out into the clinical setting, and I believe they continue to develop their professional identity as a physician, as they learn how to work with patients as well as other professionals in the healthcare setting,” Golden explained. “They hone their listening skills by taking those histories with actual patients. They perfect their examination skills, and all of this will give them what they need to be able to work patients up and manage their cases.”
Clinical clerkships help medical students prepare for their residency training programs and provide opportunities for the future physicians to explore different specialties and make connections with program directors and other clinicians at hospitals and in offices.
Making those connections, Becker added, is very important.
“[In] our profession, it's necessary to learn how to network because we all care for each other,” he said. “We take care of each other. We also learn to help each other out.”
This teamwork, Becker explained, benefits the patient as well.
As critical as clinical clerkships are to medical education, securing clerkships has become increasingly difficult over the past decade
“It's a very competitive environment with more and more osteopathic schools, larger allopathic classes, and competing for white coat space with other clinical programs, whether it be physician's assistant programs, nurse practitioner programs. It's just very, very competitive,” Feldstein said. “We could have a great relationship with a hospital, and tomorrow it gets sold, or two years from now, it closes. And as more and more care goes outpatient, we've got to adapt.”
Adjusting to the growth of outpatient care does present challenges, Becker said. In years past, patients were often in the hospital longer giving students more time to interact and learn with a patient. Now, Becker explained, discharge discussions begin almost as soon as a patient is admitted.
“Certainly more and more of medicine is in the outpatient environment, and we have to learn to be more and more comfortable with having our students get outpatient medical education,” he said.
Technological advances are also impacting clinical clerkships.
“They've changed the way we do things,” Golden said. “We have electronic medical records now. We have information at our fingertips. And so that puts us in a place where the pace is much higher, much faster, and the time to diagnosis is shorter.”
What that means, Golden explained, is that expectations have changed. Basic clinical skills that were once learned during clerkships are now expected to be mastered before the clerkship even begins. Furthermore, the emphasis has shifted to more specialty-specific skills.
“In the past we were happy to follow our preceptor around and learn everything about anybody who walked in the door,” she said. “Now, we try to expose our students to as much of a specialty as we can in each core rotation.”
These challenges, Golden added, are part of the evolution of medicine.
PCOM is responding to these challenges with innovative, online blended learning for all the core rotations with online preceptors.
“Because hospital business is so fast-paced, there isn't that time where an attending or a resident could stop for a half hour and give a lecture,” Becker said.
Online blended learning is designed to help students better prepare for exams, Becker explained. Improved performance on the end of the clerkship exams (COMAT), as well as the COMLEX Level 2CE Board exams, could enhance a student's chances of being selected for residency interviews.
According to Feldstein, clinical clerkships provide opportunities for students to begin to set themselves apart.
“You will get as much out of it as you put into it,” he said. “It's really your commitment to it that's going to determine the success of your clinical education”
Feldstein advises students to take responsibility for their own education and to embrace lifelong learning.
“Medicine is an ever-changing field, and you've always got to be curious,” he said.
Feldstein also encourages students to find a way to actively participate in clinical care—not just watch a fourth-year ahead of them or an intern or a fellow. Choosing a rotation in a small community hospital, he said, can provide a great hands-on opportunity and a better overall clinical clerkship experience.
“Being out in the clerkships is the ultimate active learning experience,” Becker said. “I always recommend students remember, it's not about you. It's about the patient. It's always about the patient.”
According to Becker, PCOM medical students can begin their clerkships secure in the knowledge that they are well-prepared and ready to represent the PCOM brand.
Feldstein agreed.
“We can't overemphasize that when students go out on rotations, they are representing PCOM, not just themselves, but our institution, which is why I think we put so much energy and effort into making sure they're well-prepared and well-trained,” Feldstein said.
“I think that our brand is extremely powerful and it helps our students get opportunities that other medical schools might not have,” Becker added.
Those opportunities include a vast alumni network of physicians ready to help those who are following in their footsteps.
“We tell our residents when they come for orientation, don't forget what it's like to be a student,” Feldstein said. “So when you're a fourth-year student, don't forget what it's like to be a third-year student. Be there to help that person, because we're all trying to do the same thing and that's take care of patients the best way we can.”
Visit PCOM Perspectives on Soundcloud to listen to the podcast in its entirety.
Disclaimer: The video featured in this article was produced using an AI-powered tool to transform text into visual content, including AI-generated voiceovers.
© 2024 Philadelphia College of Osteopathic Medicine