Clinical rotations — they’re the mainstay of the second half of medical school and the way that budding doctors turn their book skills into practical knowledge. The usual scene of training, whether surgery or pediatrics, is the hospital, or the clinic. It makes sense — that’s where most of health care happens.
But, it turns out there are lot of places to learn how to practice medicine, and future doctors are training everywhere from inside prisons to out in the wilderness. They are learning how to cook, as well as camp, to get their medical degrees.
“Medical schools are great at teaching theoretical medicine,” said Dr. Rich Ingebretsen, a University of Utah School of Medicine professor who founded its wilderness medicine program. “But they aren’t great at teaching practical medicine. Studying how a heart beats is important; but it’s also cool to understand how to treat people out in the world.”
Some medical schools are now offering these kinds of nontraditional experiences students can’t find inside a hospital or health clinic. Here are eight of them, from a Louisiana kitchen to a California coroner’s office, where your future doctor is learning to ply her trade.
1. Inside prison walls
New York University’s School of Medicine offers a forensic psychiatry elective for students to work with the city’s male inmates. According to NYU’s course description, patients are often younger minorities from lower-income backgrounds, but others are professionals, including doctors and lawyers. They have been diagnosed with schizophrenia, bipolar disorder, and depression. Students must carry a caseload of up to six patients and assist with consultations in the medical prison ward.
2. In the wilderness
Teachers at the University of Utah med school’s popular wilderness medicine program “assume students know how the heart beats and bones heal” — freeing them to focus on how to treat outdoorsmen venturing into remote areas. Students learn “practical skills” like how to treat snakebites or remove ticks. Then they move to lessons in search and rescue at Salt Lake, or backpacking medicine in Zion National Park. “We also take students to Moab out in the backcountry and stage actors up in the mountains,” Ingebretsen said. “They get down and learn how to open an airway, how to stabilize a neck, how to move a patient that’s been injured. The last one — moving a patient that’s injured — isn’t taught anywhere in med school, until they take this.”
3. Near the Arctic circle
Fourth-year med students accepted to the Center for Disease Control and Prevention’s epidemiology elective program work with investigators to keep tabs on infectious diseases, participate in health investigations, and draft public guidelines. The program takes place in a dozen or so cities from Atlanta to Anchorage, Alaska. In the past, students assigned to the CDC’s Arctic Investigations Program have provided haemophilus influenzae type B vaccines to Alaska Native children disproportionately affected by the disease. They also have studied how running water and sanitation services — something 20 percent of rural Alaskans lack — can slow the spread of infectious disease.
4. On a ski slope
There’s no shortage of injuries at Big Sky. That’s why Dr. Jeff Daniel has brought hundreds of med students since 1998 to this Montana ski resort during winter months. In addition to the free ski passes the students get, they also get firsthand experience tending to skiing casualties, including broken clavicles, dislocated shoulders, and torn ACLs in a clinic attached to the ski patrol’s first aid room. They also help provide general medical care for local residents. “What surprises me the most,” Daniels said, “are things I see every day yet they are not taught in their traditional setting.” Case in point: Daniels routinely has to show students who haven’t had experience diagnosing ACL tears how to move the knee in exactly the right way to show that it’s torn.
5. In zero gravity
This is as close as you’ll get to outer space as a med student. Twice a year the Johnson Space Center invites six students to come to Houston to learn all about aerospace medicine. For four weeks, NASA flight surgeons and other space and clinical operations team members gives tours and lectures on “the medical equipment available to crew members in space, space physiology, radiation monitoring.” Those accepted to the clerkship, another name for a rotation, must also complete a research project related to space medicine and present it to NASA staffers.
6. With the coroner
In partnership with Stanford University, medical students can observe forensic pathologists in the Santa Clara County Medical Examiner-Coroner Office to learn about the intersection of autopsies and the legal system. Each day, the clerkship starts with a run-through of active cases. From there, students observe, assist, or get their own cases to work on. Unlike autopsies at Stanford’s medical center, the course description says, “much more time is spent documenting pertinent external findings” and collecting samples of bodily fluids to help aid criminal investigations.
7. On the internet
With so many patients relying on Wikipedia, professors at the University of California, San Francisco, now offer a clerkship in which medical students improve articles that don’t meet the WikiProject’s medicine style guidelines. Students are assigned one topic that they must research in hopes of making it useful and accurate for the public. “Students felt they improved their articles, enjoyed giving back ‘specifically to Wikipedia,’ and broadened their sense of physician responsibilities in the socially networked information era,” wrote Dr. Amin Azzam, a UCSF professor and lead author of a study about the program, in Academic Medicine.
8. In a kitchen
Third- and fourth-year Tulane students can spend a month at the Goldring Center for Culinary Medicine — which bills itself as the “first dedicated teaching kitchen to be implemented at a medical school” — working with chefs, doctors, nutritionists, and other health professionals. They’re tasked with creating portions of the course curriculum. In addition, medical students also help lead hands-on cooking classes on topics including concepts in nutrition, culinary techniques, and, yes, even knife skills. And, since most Americans are overweight, students can gain a better understanding of the way healthy food impacts a patient’s overall health.
I believe it is the best way. It makes the students more confident to handle patients in such places and I believe the experience will help to really save lives.
There are enough reports suggesting that patient – student contact is reducing in all clinical settings – outdoor ,wards, icu s. Added to that dummy models / simulators also are available as early guides. Largely the bedside clinical component has shrunk with advances in laboratory and imaging. Therefore the places mentioned can be useful only after a sound grounding in medical school premises / campus. Dr Murar Yeolekar.Mumbai.
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