Early Clinical Exposure and ethics values

early clinical exposure as the foundation for developing medical
professionalism in the medical undergraduate Curriculum.
Rome, Sapienza Sant’Andrea Experience
G. Familiari1, L. De Biase1, P.Falaschi1, M. Relucenti1, R. Heyn1,
R. Benvenuto1, L.Carini1, G, Nati2, G. Grasso2, G. Tarsitani1 and V. Ziparo1
In collaboration with SISM Sant’Andrea Students
1
2
Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
Italian Society of General Practice/Family medicine, Rome, Italy
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Early clinical exposure and vertical integration:
•Clinical and communication skills
•Basic and clinical sciences
•Social, community and population health
•Personal and professional development
In an integrated curriculum, education and
clinical service are mutually enhanced!
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The Early Clinical Exposure program
at Sapienza, University of Rome, since 1999.
In the hospital setting
at bedside and ambulatory care
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First Year Course
At Sapienza, Early Clinical Exposure program comprised:
A six-ECTS integrated course devoted to
medical-patient-nurse communication skills,
in which students had a practical hospital setting module
with tutorial guided student-patient contact
(“psycho-social anamnesis”).
Recently, an additional module has been introduced
in general practice, carried on the community setting
in collaboration with Italian Society of General Practice (SIMG);
Familiari, Med. Chir. 2000; Familiari et al., Med. Chir. 2006
Familiari et al., AMEE Conference 2008, 2009; Torsoli et al. MEDIC, 2000;
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Second Year course
At Sapienza, Early Clinical Exposure program comprised:
• A six-ECTS integrated course concerning elements
of clinical methodology and EBM principles.
• Students had basic medical and surgical practice modules
as well as basic life support using skill-lab.
Familiari, Med. Chir. 2000; Familiari et al., Med. Chir. 2006
Familiari et al., AMEE Conference 2008, 2009; Torsoli et al. MEDIC, 2000;
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Third Year course at Sapienza, Early Clinical Exposure
program comprised:
a twelve-ECTS integrated course concerning elements of
clinical methodology,
EBM principles,
the appropriate patient-doctor relationship,
student’s communication skills,
clinical epidemiology,
diagnostic reasoning,
anamnesis,
physical examination,
clinical and instrumental semeiotics (Skills lab and bedside)
Students had basic medical and surgical practice modules in
small groups with skills lab and bedside teaching.
Familiari, Med. Chir. 2000; Familiari et al., Med. Chir. 2006
Familiari et al., AMEE Conference 2008, 2009; Torsoli et al. MEDIC, 2000
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Fourth- sixth years
ACTIVITIES OF PROFESSIONAL APPRENTICESHIP
in the hospital setting at bedside, ambulatory care
and in the community
• Curricular clinical clerkships (Hospital ambulatory care
and bedside teaching) in all medical and surgical
disciplines;
• A clerkship in General Medicine (2 Weeks in the private
office of general practitioner and lessons at University),
mandatory since 2003.
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NEW!!!
Early Clinical Exposure in General Medicine,
Since 2008
General structure
 3 years long (first, second and third year courses)
 Each year:
–
–
1-2 introductory lesson
six half/days of participation in the private office
of the GM tutor
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NEW!!!
Early Clinical Exposure in
the APPROACH TO DISABILITY
Since 2010 (organized by SISM)
General structure
 3 years long (first, second and third year courses)
 Each year:
–
–
–
1-2 introductory lessons
2-4 half/days of participation in the hospital setting
at the “Opera Don Guanella”
Section discussion
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Teaching objectives (A.A. 2010-2011):
•To sensitize medical students on the topic of disability,
from the very first years of the core curriculum, showing
them alternative models of interpersonal communication.
•To promote in students motivation and care on the topic of
social distress associated with mental and/or physical
disability.
•To trigger in the students reflections on the assistance
and understanding of people showing any kind of distress
(specular image regarding the physician-patient
relationship).
•To learn how to interpret different behaviours in disabled
persons and their helpers, learning how to manage inhospital meeting situations.
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ECE Student’s perceived satisfaction at
Faculty of Medicne and Psichology,
Sapienza University of Rome:
Students’ anonymous questionnaires (n=6537,
years 2008-2011) revealed a positive feedback:
•mean percentage satisfaction for ECE integrated
courses (1-2-3 Years course) = 87.4±4.8;
•mean percentage satisfaction for all integrated
courses of School of Medicine = 78.3±14.3;
P≤0.0001
95% CI of the difference: from -9.366 to -8.634
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Early Clinical Exposure and ethics values:
•authentic human contact in a social or clinical context
that enhances learning of health, illness and/or disease,
and the role of the health professional occurring in the
early or preclinical years of undergraduate education
(usually the first two years)
•An innovative curriculum planning promotes the use of
case studies, small group teaching, community teachers,
critical self reflection, interviewing skills and moral
decision making frameworks, in first year medicine
Dornan et al. Med. Teach, 2008; Littlewood et al., BMJ 2005; Brunger and Duke, Med Teach. 2012)
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How can experience in clinical and community setting
contribute to early medical education?
Early
experience helps medical students socialize to their chosen
profession.
It can help learners attain a number of affective outcomes and
acquire communication and basic clinical skills.
It can help make students more satisfied with their curriculum
(motivate them) and confident to meet patients (reduce the stress of
meeting patients).
It gives insight into psychosocial aspects of medical care and
strengthens learning of both the biomedical and behavioural/social
sciences.
It contextualizes students’ learning.
It can influence career choices.
It has potential benefits for teachers, healthcare organizations,
patients and populations.
Dornan et al., Med. Teach. 2008; Littlewood et al., 2005
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Why clerkship in General Medicine
For beginnig medical students?

It is the setting in which the doctor-patient relationship acquires a higher
relevance

It allows to observe the evolution of diseases within their own context,
considering the associations among health, family and society.

It allows the contact with patients suffering the most common clinical
conditions (hypertension, diabetes, bronco-pulmonar diseases, etc.),
usually coexistent in a single patient, thus designing highly complex cases.

It allows to learn some simple semiologic manoeuvres.
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Why clerkship in Disability for
beginning medical students?

It is the setting in which the doctor-patient relationship acquires a higher
relevance

this experience could be a catalyst for personal growth, change, and a
greater openess to the complexities of medicine.
The
initial feedback from the students was that the module had been a
good experience.

This format has been very successful in that the smal groups of students
begin animated and ofted passionate discussions.
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Conclusions
Students clearly enjoyed this type of precocious
experience and perceived it as an important tool.
Take home message
The ECE program reinforces the social
responsiveness of clinical education, students
attitudes, clinical and study skills, orientating medical
curriculum towards society’s needs.
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Thank You for your attention
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