New education model improves residency transition

or medical students, the transition from pre-clinical to clinical work can be a difficult one. Learning in the classroom versus learning by the bedside is a big shift, and students often feel unprepared to realign from a learning-focused environment to a patient-centric environment.

Devon Rupley, MD, saw this firsthand, first as a resident in the department and later in her role supervising medical students and residents as an assistant professor of obstetrics and gynecology at NYP/CUIMC.

“The students we recruit for our medical school are used to personal success through rigorous dedication to their academic careers, which they achieve by studying hard and performing well on exams,” Dr. Rupley said. “That’s completely different to the skills required to be excellent health care providers, where they need to utilize a team-based approach. It’s no wonder that we’re having students who blow us away with their intelligence in the classroom and then flounder in a clinical setting.”

As the recipient of the Vanneck Bailey Award in 2020, Dr. Rupley redesigned the Ready for the Major Clinical Year (R4MCY) course, creating a curriculum structured with a two-week block composed of simulation, standardized patients, and small group sessions based on each core clerkship. The program now guides students into the clinical environment as learners, as well as effective members of the health care team. She leads the course with Bill Fuller, MD, an internal medicine faculty member and co-course director of R4MCY.

The program is largely simulation and active learning-based, taking skills and concepts that students have learned about in lectures and putting them in a clinical context. 

“They have the knowledge, and now we work on accessing that knowledge,” Dr. Rupley said. “It’s also helping them get used to constant transitions in the environment. The learning they do in the simulation environment is ungraded, so they get comfortable making mistakes, and we build trust so that they can disclose errors and learn and grow.”

Dr. Rupley’s most recent undertaking is to build a multi-modal trauma-informed care (TIC) curriculum to help prepare medical students and Ob/Gyn and Family Medicine residents to perform TIC pelvic exams. The curriculum includes didactic videos and teaching sessions, online interactive modules, and in-person workshops with standardized patients. 

Dr. Rupley oversaw the development of an interactive online module to allow students to learn the basics of the pelvic exam. To supplement resident learning, she worked with psychologists from the NewYork-Presbyterian Family PEACE Center to incorporate teaching around how social determinants of health factors impact patients and can predispose them to trauma. She also developed an interactive workshop where medical students can practice explaining the pelvic exam from a trauma-informed care lens in different clinical scenarios, a skill that is increasingly needed to deliver high-quality women’s health care.

“We can teach them the skills, but we also need to develop attitudes in students to help them become accountable and trustworthy medical providers,” Dr. Rupley said. “We teach a patient-centered approach to addressing challenges, like when a patient might refuse a particular type of care for religious or cultural reasons. As a medical provider you have power in these situations, and patients are in a vulnerable position, so you have a great deal of responsibility. We have to approach not just sensitive exams but all the care we provide with humility and empathy.”