Priorities in Medical Student Education in the Face of Increasing Class Size

FAMILY MEDICINE CLERKSHIP IS A TOP PRIORITY

On the ADFM survey of chairs (82% response rate), member chairs rated the family medicine clerkship highest for its importance and cost-effectiveness in reaching the goals of educating all medical students in the discipline of family medicine and impacting students’ specialty choice. Evolution of the family medicine clerkship is a major curricular priority as it represents the most effective curricular element to teach continuous and comprehensive care across clinical settings.

The diversity of patient care experiences and teaching settings is both a challenge and an opportunity. The family medicine clerkship rests on the tenuous funding platform created by the volunteerism of an aging and increasingly stressed population of community-based family physicians. All family medicine offices used as student teaching sites may face obstacles in implementing components of the new model of family medicine even further straining community practices as teaching venues. Learner saturation and diminishing sites creates competition for new sites that may increase the community physicians’ requests for financial reimbursement for teaching time.² Diversity in experience harkens the call to standardize curriculae, student assessment strategies and competency measurements which can facilitate the development of relevant national assessment tools.

THE RELEVANCE OF THE LEARNING ENVIRONMENT TO NEW MODELS

Do academic health centers and community practices facilitate the development of models of care that demonstrate the effective delivery of primary care to patients, families and populations? Student education in emerging models of care should demonstrate constant experimentation to improve health while upholding values of family medicine/patient centered care. Students also must have experiences which define and address the needs of vulnerable populations. Effective student education in academic health center practices with emphasis on training and discovery must demonstrate effective delivery of patient services while community practices with emphasis on service must demonstrate the pursuit of clinical quality and the use of evidence-based care.

ADHERENCE TO QUALITY IN THE LEARNING ENVIRONMENT

This theme relates to advancing an aspect of family medicine scholarship through practice quality improvement. Teaching practices should utilize interventions to improve quality of care, adhere to practice guidelines, and use best available evidence to demonstrate to students the impact of appropriate care on the health of individuals and populations.

ENHANCING STUDENT INTEREST IN FAMILY MEDICINE

Finally, increased class size provides an opportunity to experiment with choosing different types of students, particularly those who would more likely enter careers in primary care/family medicine. Maintaining and increasing faculty involvement in the admissions process and in mentoring students across the educational spectrum will be critical to ensure production of primary care and family physicians. There is a need to facilitate student involvement in specific clinical activities that address the social responsibility of medicine for medically vulnerable local, national and international patient populations to demonstrate the broader scope of family medicine. An appreciation of the diversity of family medicine professional activities and the impact that this career decision has on the health and welfare of society is needed to facilitate student interest in family medicine at this critical time when their numbers are increasing rapidly.