The Integrated Clerkship: An Innovative Model for Delivering Clinical Education at the Zhejiang University School of Medicine

Abstract

The traditional curriculum of clinical science at the Zhejiang University School of Medicine (ZUSM) was dominated by lectures, and many critical factors in producing competent physicians (such as the development of skills and active learning) were largely neglected. During a four-year period ending in 2007, ZUSM developed and implemented a new model for delivering clinical science education-the integrated clerkship. The principal features of the model are the greater amount of time that students are exposed to and are working in the clinical environment as clerks and the great reduction in lecture hours. Unlike the U.S. model of clerkship, the integrated clerkship at ZUSM is characterized by a progressive process, with intensive preparatory lectures before the clerkship, which is divided into two levels, junior and senior. The junior clerkship is equally divided into didactic activities and clinical practice; the senior clerkship requires students to become an essential part of the work taking place on the wards. A preliminary program evaluation showed that the fundamental goals of the integrated clerkship had been largely attained, especially the mastery of basic clinical skills and retention of medical knowledge. Surveys showed that most of the integrated clerkship students and faculty members were satisfied with the new curriculum; the students felt better prepared to cope with the professional challenges of patient care, and they began to understand how social context affects their patients. As the pilot program in China, the integrated clerkship at ZUSM may serve as a template for medical schools at a similar level, in China and elsewhere.

The integrated curriculum in medical education: AMEE Guide No. 96

“…Integrating clinical exposure into earlier stages of medical education (Yu et al 2009). These are but a few examples loosely organized into categories; further review of the literature reveals a spectrum of novel curricular innovations with differing depths of integration.…”

Student perceptions of clerkship handbooks

“…Findings from this study significantly overlap with areas highlighted as important to an ideal clerkship orientation (described in the introduction) . Yu and colleagues note the use of a clerkship handbook as a part of student support . Some aspects included by Yu and colleagues in their handbook correspond with aspects that the students in this study liked (aims, objectives and assessment details) and desired (minimum knowledge and skill requirements) in handbooks .…”

“…There are very little data on the design of handbooks in medical education. Yu and colleagues describe details of a clerkship handbook within their new clinical education model with information on goals; organisation; the minimum knowledge, skills and attitude required; assessment, and faculty member involvement . Handbooks can be useful to provide essential information to students entering a clerkship, and this information may facilitate learning through guidance (e.g.…”

Reducing the Dosage: Decreasing Pediatric Clerkship Didactics

“…The extra obligation could mean less time taken for patient's care and preparing for the shelf exam. Perhaps a greater amount of time consuming to the clinical environment taking care of patients allows students to feel better prepared to deal with the challenges of patient care [5].…”