The Scholarly Project requirement at Columbia University College of Physicians and Surgeons gives students a chance to delve more deeply into topics that interest them. For graduating student Emily Woodbury, it was a chance to have an impact on the clerkship that she most cared about—obstetrics and gynecology.
The clerkship’s new director, Dara Matseoane-Peterssen, MD, assistant professor of obstetrics & gynecology at CUMC, enthusiastically agreed to partner with Ms. Woodbury on a pilot redesign of the clinical rotation. When compared with other clerkships, student knowledge of the subject at the end of the rotation, measured by National Board of Medical Examiners shelf exams, was right on target. But based on comments and ratings from the anonymous student surveys that are given after every clerkship block, ob/gyn would benefit from some innovation and interesting new twists to ensure continued excellence in the clinical training of our medical students.
For the new Dr. Woodbury, the further refinement and enrichment of the ways we engage, excite, and mentor medical students in ob/gyn touched a nerve. “I really love the subject,” she says. One of the challenges for the new design was the fact that students only have five weeks in the ob/gyn rotation, whereas most other schools have a six- to eight-week rotation. “Obstetrics and gynecology are two fields, but we have to learn everything on this really compressed timeline,” says Dr. Woodbury.
“This means that presentations and lectures need to be very concise and substantive to ensure that we cover all the topics we need to learn before jumping into the clinic,” says Dr. Woodbury.
Where others saw challenges, both Dr. Matseoane and Dr. Woodbury saw an opportunity to take a fresh look at the clerkship. “I was excited to have the chance to work with Dr. Matseoane-Peterssen, and knowing we could work together to make a real difference for students was extremely appealing to me.”
So what makes for a great clerkship? For Dr. Matseoane-Peterssen, who completed her training in ob/gyn at P&S, a great clerkship stems from faculty and residents who are committed to teaching and students who are engaged in the material.
“A major change from when I was a student and now is that we previously had just six to eight students per rotation, which allowed us to work closely with the residents who would observe our progress over the block and really get to know us. Now we have 14 to 16 students per block, and to accommodate the larger class size, we spread students out across our different services. Sometimes, it can be challenging for students and teachers because they have less time together.”
To Dr. Woodbury, a great clerkship also needs to be interactive. “Since many of our students have done all kinds of interesting things before starting medical school, they are looking for a real hands-on, team-based learning experience.”
Although many P&S students have completed medical education Scholarly Projects, no student had attempted to tackle an entire clerkship. The typical education-focused project is smaller in scope, such as creating a new seminar.
Over the course of several months, Dr. Woodbury and Dr. Matseoane-Peterssen embarked on a pilot test of a new ob/gyn rotation. Among the most daunting tasks was creating a new set of lectures. “We used existing material from 14 attendings, seven fellows, and eight residents to either fine-tune existing material or construct brand-new lectures that covered all of the important topics,” says Dr. Woodbury. The end result was the rollout of 22 interactive lectures that focus on important concepts in clinical skills and are presented in a logical, predetermined order that complements activities on the rotation.
The new design also maximizes opportunities to observe how ob/gyn care is practiced by consolidating the number of days a student performs each activity and increasing the amount of time spent with each clinical team. It is also more student-friendly, with a simplified course page, a more informative student handbook, and a snack budget for lecture days.
Serving to validate the substantial effort and investment in time that went into this project (Dr. Matseoane-Peterssen doesn’t call Dr. Woodbury “a force of nature” for nothing), initial results indicate that the redesign has had a positive impact on relevant metrics. End-of-rotation student surveys in 2016 boasted significant improvements: marked rises in student ratings for all eight curricular components and a 29 percent increase in overall satisfaction. For the first time in two years, mean scores, for each of the blocks surveyed to date outperformed the national average on the shelf exam.
Noting that curriculum change often occurs at a glacial pace in a series of incremental tweaks, Dr. Matseoane-Peterssen says, “I am proud of her for accomplishing so much in such a short time and elated that her efforts led to immediate improvements in student performance and satisfaction with the ob/gyn clerkship.”
In March, Ms. Woodbury’s project earned second place in the annual P&S research competition’s scholarly projects category.
“Rumor has it that medical education projects never win,” says Dr. Woodbury, who will begin her residency this summer in ob/gyn at NewYork-Presbyterian/Weill Cornell Medical Center. “My mom, who is a physician, had flown in from Memphis to attend the poster session, and we decided to stick around for the awards ceremony to congratulate my classmates. It was a total surprise when my name was called, especially with my mom there.”
Student satisfaction indeed.