Inside a crowded North Seattle medical clinic, Aubriana Ard watched in awe as the heart of an emergency cardiac patient beat with such ferocity that it looked as though it might burst out of his chest.
Fresh into her second quarter as a student at the UW School of Medicine, Ard had just learned about treatments for acute arrhythmias the day before. The lesson covered a condition known as supraventricular tachycardia, or SVT, an irregularly rapid heart rate that, if not treated quickly, can escalate to cardiac arrest. Now, while taking part in a new clinical training requirement for first-year medical students, she was observing a real patient with the condition struggle to remain calm as medical professionals hustled to stabilize him.
“It looked like the examples we were given in class the day before,” says Ard, who also learned in class about anti-arrhythmic drugs, including adenosine, a short-acting medication that is used to stabilize heart rhythm. Paramedics who had been called to assist injected the patient with it.
While classroom instruction is crucial for learning the scientific foundations of medicine, there is no substitute for firsthand clinical experience. That’s why the UW School of Medicine launched a new curriculum last year that puts an earlier and greater emphasis on clinical training. “We want to get our students thinking like doctors from the first day they are here,” says Suzanne Allen, vice dean for academic, rural and regional affairs.
By rebooting its curriculum, the UW is breaking from a traditional but increasingly antiquated model of medical-school education that has served students across this country for more than a century—two years of intensive classroom-based education in the basic sciences followed by two years of clinical training. Now, first- and second-year UW medical students attend class four days a week for no more than four hours a day (instead of eight) for a year and a half.
This frees them up to spend a day every other week at a community clinic or doctor’s office and to participate in faculty-guided clinical skills workshops on alternate weeks. In addition, each student spends a morning every other week in a hospital setting.
“They now are able to learn basic science and apply that in a clinical setting at the same time, which they hadn’t been able to do previously,” Allen says.
The curriculum renewal is taking shape inside the framework of the school’s five-state, multi-institution partnership—called the WWAMI program—where students spend their first 18 months of medical school in their own states. WWAMI also offers students clinical rotations in different medical specialties throughout Washington, Wyoming, Alaska, Montana and Idaho.
The curriculum change also ushered in a new immersion-style orientation where first-year students from each region spend two weeks together to begin bonding as classmates and start learning about real-world medicine.
For new students from Alaska, that meant spending time with Steven Floerchinger, a well-known Anchorage general surgeon and avid horseman. Floerchinger introduced students to the power of body language and energy in medicine—how a physician’s presence and touch can either soothe or frighten patients, and ultimately build or destroy a trusting relationship.
“We went to his stables, where we met and interacted with several of his horses,” says Ian Isby, who starts his second year of medical school this fall. “He showed us how to approach the horses so they felt comfortable and would reach out to you. He then reminded us that we are animals, too, and no different.”
At first, Isby didn’t quite make the connection. But as his first year of medical school proceeded, he said he began to realize what Floerchinger and his horses were trying to show them: Patients have their best medical experiences when their doctors are calm and collected, not harsh and hurried.