** Poster Award Nominee

COMBINED CONTINUITY OF CARE AND DIVERSE SUBSPECIALTY EXPOSURE IN A CORE SURGERY ROTATION

R.M. Walsh* and S. Preztak, Department of General Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195 U.S.A.

Purpose

Delivery of surgical care and changes in most medical school curricula have combined to limit student exposure to a broad surgical experience and reduced continuity of care.  A model for diverse exposure to a broad representation of the surgical discipline while fostering the principle of continuity of care was designed.

Methods

To meet the goal of diverse surgical exposure students were assigned to a variety of outpatient clinics over a 16 week combined curriculum.  Students were expected to prepare for the outpatient visit based on surveying faculty schedules and derive a learning objective following the patient encounter.  To meet the goal of improved continuity of care, students are freed of other clinical responsibilities to attend those specific surgeries.  In this model, students were not part of a traditional surgical ward service.

Results

Executing the curriculum demonstrated:  A diverse spectrum of clinical problems was encountered; scheduling was labor intensive; and achievement of goals was dependent on student initiative and faculty interest.  Disruption of student activities was unacceptable to faculty in Medicine which led to a revised program where outpatient clinic experience is followed by a 4-week surgery ward experience.  This truncated time-frame limits exposure to the surgical discipline and less opportunity for continuity. 

Conclusions

1.  Increased diversity in clinical experience and improved continuity of care can be achieved in a surgery discipline through a change in mentality, directed clinic scheduling, and flexibility in student activities. 2.  Optimal attainment of goals include:  faculty development, student initiative, sustained commitment from all disciplines in a combined curriculum.