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Teaching to Care for the Chronically Ill: The InterACT Program
WHAT WE CREATED
In 2010 we challenged ourselves to create a longitudinal-integrated clerkship at an urban tertiary medical center - something that several institutions like ours had tried and terminated or ultimately never launched. Incorporating several unique venues at the Icahn School of Medicine such as a student-run free clinic and an adult and pediatric home visit program, we aimed to expose a select group of third-year medical students to the rewards and challenges of caring for the chronically ill in diverse ambulatory settings. We created a clerkship very different from our parent models—a more hybrid structure embedding weeks of high immersion ambulatory care within the existing block-based clinical curriculum. Our clerkship, titled InterACT, offers students an unparalleled experience in which they partner with patients, physicians and health care teams to achieve an enhanced understanding of advocacy and primary care for vulnerable and chronically ill persons within and beyond the healthcare system.
VIRTUES OF THE PROGRAM
The success of our program hinges on the mentorship students receive from senior peers and physicians who are not only skilled teachers but model advocacy and patient-centeredness at their core. Peer and physician mentors work side-by-side with InterACT students over the course of a year, nurturing growth, teaching through the spectrum of illness and fostering professional development. These relationships evolve from teacher-student to true partners in care and promote high degrees of independence, autonomy and critical thinking in students.
WHO WE’VE IMPACTED
InterACT students are not daunted by caring for complex patients in resource-rich or poor settings. Our students appreciate the virtues of team-based care in multiple contexts and harbor an even deeper understanding of the hand-offs and coordination that need to happen to keep our patients healthy in the community. They’ve learned that persistence, fearlessness, creativity and meeting their patients halfway, rather than not at all, are crucial to excellent patient care. They grow to understand that caring for the chronically ill is as up and down as the disease itself. And they become teachers and mentors for the next generations of InterACT students. Not surprisingly, over half of our students declare primary care as their career path.
WHAT WE’VE LEARNED
Running a longitudinal clerkship that integrates so many disciplines is complex and recruiting champions within each discipline has been crucial. We’ve tailored faculty development to focus on promoting the learner’s development over time and nurturing enhanced degrees of autonomy. It took us a lot of trial and error to get it right and what developed organically at first needed a lot of fine-tuning to allow us to incorporate new disciplines. A major challenge was appreciating the need for different expectations in different disciplines-what a student learns to master in the primary care setting isn’t always possible in the mental health setting. By encouraging our multidiscplinary faculty to network regularly throughout the year, however, we’ve pushed them to see more similarities than differences in the way that they teach and SHOULD teach.
CREATING IMPACTS BEYOND THE PROGRAM
Through InterACT, we’ve played a significant role in shaping Icahn School of Medicine’s new curriculum which emphasizes service to vulnerable populations, cost-effective quality care, self-directed learning, enhanced career planning and mentorship and longitudinal clinical immersion beginning in year one. Protected time is now granted to medical students to pursue scholarship in service to East Harlem. Guided reflective practice, which is such a central component of InterACT, is now essential for all students. Educating students about the values and challenges of providing primary care to vulnerable populations in an urban setting has also assumed more attention as we begin to roll out the new primary care curriculum. We’ve helped define key aspects of this curriculum in which longitudinal mentorship and the care of the poor and chronically ill will be central.
For more about the new curriculum at the Icahn School of Medicine, please visit our website.