First Columbia-Bassett Class Graduates
The Class of 2014 graduating in May from Columbia’s College of Physicians & Surgeons includes eight of the 10 original Columbia-Bassett students, the first to complete an innovative program begun in 2010 to combine traditional medical education in New York City with hospital-based outpatient and inpatient clinical education at Bassett Medical Center in Cooperstown.
Among the eight (one of the original members of the group is taking an extra year to earn a master’s degree in public health, and another is completing military service in his native South Korea) are students with plans to specialize in emergency medicine, family medicine, internal medicine (cardiology or gastroenterology), international surgery, medical school or hospital administration, pediatric neurology, pediatrics/neonatology, and urology.
Variously described as a rural medicine curriculum, a primary care curriculum, and a health-care delivery curriculum, the “Bassett track” is all that but should not be limited to those definitions, says Henry Weil, MD, assistant dean for education at Bassett. “This program emphasizes relationships on all levels—relationships among students and patients, fostered by the longitudinal curriculum; among students and more senior physicians, like the preceptors assigned in their year-long clinics and the single mentor each student is assigned upon enrolling in the program; among students and the rest of the medical staff; and, perhaps most significant, among the students themselves.”
Columbia-Bassett students (10 students have been chosen each year since 2010) spend the first 18 months of medical school in New York City, studying basic science fundamentals alongside P&S classmates. In January 2012, the inaugural class started core clinical rotations at Bassett. After 10 weeks of “rapid inpatient blocks” in ob/gyn, surgery, neurology, and psychiatry, the students started a 40-week longitudinal patient care curriculum. They rotated through primary care and specialty clinics, says Walter Franck, MD, Columbia’s senior associate dean at Bassett, and built panels of patients they followed throughout their time at Bassett. “This allowed students to work with people in the fullness of their journey in pursuit of health, cure, or palliation, as opposed to seeing patients only in isolated, brief, intense periods of illness,” adds Dr. Weil.
“The Bassett program’s longitudinal curriculum gave me an interesting view of medicine, and I settled on emergency medicine after I watched a few of the patients in my portfolio come through the emergency room,” says Allan Guiney, who had not yet chosen a specialty when he started medical school. Mr. Guiney grew up in Cooperstown. “Both my parents worked as physicians at Bassett, so I expected that the Columbia-Bassett program would be a unique opportunity for me to learn medicine in a community where I had deep roots. The program provided that and also a lot more. It was rewarding to follow patients throughout the gamut of their medical care.”
“We were able to take ownership of our patients and follow them across a variety of services and specialties,” says Monica Laszkowska. “Both the longitudinal program and the opportunity to work for a full year in one hospital system lent itself well to some amazing student-patient relationships. From helping to deliver my first baby, to my first surgical case, to my first time helping to break the news of a new cancer diagnosis, to my first patient death: These are all experiences that made a huge impact on me during my clinical development and helped shape me as a doctor and an individual.”
For Haley Masterson, the curriculum contributed directly to her decision to pursue pediatric neurology: “The structure of the longitudinal curriculum involves repeated exposure to different specialties, so when I found myself drawn to pediatrics and neurology, I knew it wasn’t just because of one preceptor or one particularly good month; it was the cumulative effect of two specialties that had a profound impact on me over the course of 10 months, multiple clinics, and multiple preceptors.”
Freda Ready credits the longitudinal curriculum with allowing her to explore various areas of medicine at her own pace. “The faculty was fully engaged in my education, and many of them have been my advocate with residency programs as I go through the match process.” She plans to return to Africa to pursue a career in international surgery. For her scholarly project, she studied barriers to treatment for women with endometrial and ovarian cancers in Cape Town, South Africa. “The performance improvement training at Bassett helped me think about how to define the problems with the health care system that were contributing to delays.”
“I could not have predicted how profound my patient experiences in the longitudinal clinical curriculum would be,” says Katherine Schwartz, who plans a career in pediatrics and may specialize in neonatology. “I have had a fairly roundabout path to pediatrics. I entered medical school thinking I would go into ob/gyn, but as I was going through my first year of medical school I realized that I liked almost everything. My first semester, I was able to shadow in anesthesiology, neonatology, obstetrics, and emergency medicine, and I had the privilege of seeing several organ transplantation surgeries. When I started my major clinical year in Cooperstown, I began ruling things out, and I quickly came to know that what mattered most to me was the interaction with patients and their families during challenging times, and by the end of the year, I was deciding between ob/gyn and pediatrics. Doing a sub-internship in the NICU, I realized that pediatrics, and specifically neonatology, could give me all the things that I had identified as being important to me in medicine: contact with patients and their families, variety of pathology and acuity, and procedural work.”
The Columbia-Bassett Program not only introduced medical students to a range of career choices as physicians, it also introduced them to the idea of a career in medical education. “A big change to my career plans that developed during medical school was my desire to pursue medical education. This was not really an area I had even considered before entering medical school,” says Krista Suojanen, who plans a career in internal medicine first as a clinician educator then in an administrative role. “I had a number of fantastic teachers who really got me excited about learning and about medicine and made me realize what an impact those involved with medical education could have.”
Most Columbia-Bassett students had not yet chosen a specialty when they started medical school, while others had, but then changed their minds. Blake Alberts, a native of South Dakota, plans a career as a urologist. “My career plans were far from certain when I began medical school, but they probably remain quite similar to the loose plans I had entering P&S. I chose to enroll in the Bassett program so that I could better understand rural health-care delivery, and now I hope my future career involves developing an improved delivery model for rural urology care.”
Andrew Gomez initially planned on a career in orthopedic surgery, a good match for his undergraduate mechanical engineering degree. He now plans a career in family medicine. “I credit the Columbia-Bassett program for providing me with the information to make an informed decision regarding the future of primary care and my potential role in this field,” says Mr. Gomez.
An important aspect of the Columbia-Bassett Program is the SLIM (Systems, Leadership, Integration, and Management) curriculum, which incorporates business and public health coursework to help students understand the U.S. health care system through study of care delivery, strategies for quality improvement, and cost and payment issues. “The SLIM curriculum gave us a unique gateway to learning about health-care systems management and policy from professors at the Columbia Business School and the Mailman School of Public Health, various speakers who are leaders in health care, and hands-on performance-improvement projects with clinical and administrative mentors at Bassett,” says Ms. Laszkowska. “I have a strong appreciation for how empowering I found the SLIM curriculum to be. Through carrying out my own projects, I saw just how difficult and important it is to continue to refine how we deliver health care to patients. Most important, I realized that the scale of such efforts can vary from an individual doctor working to make their practice more efficient to an entire institution acting to try to improve patient safety and outcomes. I learned the importance of asking the right questions, and I was able to build a tool set that enables me to use data-driven, collaborative approaches to find the right answers.”
This story was adapted from an article that will appear in the Spring 2014 issue of Columbia Medicine magazine.