Clerkship Decisions for MS-2’s

Michael J Ryan, MD

Associate Dean for Curriculum.

UW School of Medicine

Goals of clerkships

• Help to improve the health of the patients you will see

• Further develop your clinical reasoning, clinical skills

• further Explore career options – Academics?

– Private practice?

– Rural?

– Larger community?

Clinical Curricular Requirements Clinical Curriculum, 3rd year • Family Medicine (6 weeks) • Internal Medicine (12 weeks) • Obstetrics/Gynecology (6 weeks) • Pediatrics (6 weeks) • Psychiatry (6 weeks) • Surgery (6 weeks) • Elective (6 weeks) 48 weeks Required clinical clerkships in third or fourth year: • Emergency Medicine (4 weeks) • Rehabilitation Medicine/Chronic Care (4 weeks) • Neurology (4 weeks)

• Surgery Selectives (4 weeks) Other electives (16 weeks)

UWSOM: three main options • Tradition program

• Traditional program at a Track site

• Longitudinal

integrated clerkship (LIC)

WRITE

Olympic (LIC)

Bonners Ferry

Note: Alaska not to scale

Sandpoint

SaintMaries

Moscow

Grangeville

Salmon

Driggs

Mountain Home

Jerome

Shoshone Rupert

Preston

Blackfoot

American Falls

Council

Emmett

Caldwell

Nampa

Boise Fam

IntMd Ob/G Psych Surg

IntMd Fam

Orofino

X

A

X

McCall W

Hailey

W

Plummer

Payette

Cascade Challis

Mud Lake

Arco

Gooding

Fam

Bozeman

Superior

Ronan

Libby

Whitefish

Cut Bank

Shelby

Choteau

Havre

Helena Deer Lodge

Dillon Ennis

Livingston

Red Lodge

Big Timber

Harlowton

Columbus

Lewistown

Glasgow

Sidney

Wolf Point

Glendive

Miles City

Fam

Peds

Fam

IntMd

Missoula

X Billings

IntMd Fam

Fam

A Belgrade

Butte

Kalispell

Laramie

Cheyenne

Casper Fam

Fam

Rawlins

Newcastle

Graybull/ Basin Sheridan

Torrington

Green River

Thermopolis

Montpelier

Ferndale Bellingham Anacortes

Darrington

Everett Forks Pt. Towns

end Shelton

Bremerton

E. Grays Harbor

Shoalwater Bay Tribe

Cathlamet

Mt. Vernon

Vancouver

Toppenish

Wenatchee

Othello

Odessa Ellensburg

Yakima Wapato

Grandview

Tonasket

Omak

Chewelah

Friday Harbor

Olympia Madigan US Army

Tacoma

Spokane

Pullman

Fam

Ob/G

IntMd

X Ob/G

IntMd Peds

IntMd Psych

Ob/G

Peds

X A

Fa m

Fa m

Fam 5

x

Seattle

Psych Fa m

7 x

Fam

Fam Fam

Moses Lake

Tulalip Tribes

Garfield County

South Bend

Federal Way

Sunnyside

Cle Elum

Colville Fam

X

Columbia County

Asotin County

Colfax

White Salmon Fa m

Puyullap

Republic

A Renton

Pt. Angel

es

Fam Goldendale

Fam 2 x

Pasco

Morton Ob/G

Peds

Fa m

Fa m

A

Peds Peds

Peds

Pocatello Fam Fam Peds

Peds

Powell

IntMd

IntMd

Jackson

Buffalo

Afton

Lander

Riverton

Saratoga

Ob/G

Rock Springs

Wheatland

Juneau

Kodiak Island

Kotzebue

Metlakatla

Petersburg

Sitka

Haines Cordova

Glennallen

Seward

Valdez

Palmer Wasilla

Kenai Soldotna

Naknek

Fam

Dillingham

Nome

Homer

A

Fam Ob/G

Psych Int

Md

Peds

Fam Bethel

W

Plains Ob

/G Stevensville

Fam

Fam

W

W W

Mossy Rock

Gillette

Worland

Cottonwood

Lewiston

Weiser

Fam

Wrangell

Surg

W

W

W

Cody

Kemmerer

Coeur d’Alene

Sun Valley

Prince of Wales Is.

White Sulphur Springs

Sundance

Malad City

Conrad

Ephrata

Ekalaka

Bonners Ferry

Meridian

Ob/G

Ob/G

Douglas

Galena Fairbanks

Polson Thompson Falls

Colstrip

Poplar

Fort Benton Chattaroy

Walla Walla

Mattawa Westport

Longview

Woodland

Auburn Enumclaw

Kettle Falls

Great Falls

Heart Butte

Eureka

Fa m

What about career choices?

• All three options will prepare you well for your chosen career, and the match

Traditional Program (including Track): Clerkships are in blocks.

Traditional Program: Clerkships are in 1 of 8 sequences

Summer 2013 Autumn 2013 Winter 2014 Spring 2014

Student: A B A B A B A B

Abner Elective Pediatrics Medicine

Win

ter Break Elective

OB/GYN Family Med Surgery Psych

Bertha Pediatrics Elective Medicine Family Med OB/GYN Psych Surgery

Clem OB/GYN Family Med Elective Pediatrics Surgery Psych Medicine

Biff Family Med OB/GYN Pediatrics Elective Psych Surgery Medicine

Edna Medicine Surgery Psych Elective Pediatrics OB/GYN Family Med

Fritz Medicine Psych Surgery Pediatrics Elective Family Med OB/GYN

Grover Surgery Psych OB/GYN Family Med Medicine Elective Pediatrics

Hortense Psych Surgery Family Med OB/GYN Medicine Pediatrics Elective

July 8

- to -

August 16

August 19

- to -

September 27

September 30

- to -

November 8

November 11

- to -

December 20

December 23

- to -

January 4

January 6

- to -

February 14

February 17

- to -

March 28

March 31

- to -

May 9

May 12

- to -

June 20

What about the order of clerkships?

Ultimately…

-It doesn’t matter

You do need to

consider the elective period

• life events

• Step one prep time

• Your wellness

Bonners Ferry

Note: Alaska not to scale

Clerkships: WWAMI Program Site

Map

Residency Sites

IntMd

Psych

Fam Family Practice

Internal Medicine

Psychiatry

Pediatrics

Clerkship Sites

Peds

Family Medicine Internal Medicine

Ob/Gynecology

Pediatrics

Psychiatry

Surgery

Psych

Surg

Fam

IntMd

Ob/G

Fa m Indicates presence of both Family Medicine

Clerkship & Family Practice Residency

1st Year Sites

Programs for Healthy Communities(PHC)

Rural / Underserved Opportunities Program (R/UOP)

Area Health Education Center Sites (AHEC)

A

Indicates presence

of both PHC and RUOP

LEGEND

Sandpoint

SaintMaries

Moscow

Grangeville

Salmon

Driggs

Mountain Home

Jerome

Shoshone

Rupert

Preston

Blackfoot

American Falls

Council

Emmett

Caldwell

Nampa

Boise Fam

IntMd

Ob/G

Psych

Surg

IntMd

Fam

Orofino

X

A

X

McCall

W

Hailey

W

Plummer

Payette

Cascade Challis

Mud Lake

Arco

Gooding

Fam

Bozeman

Superior

Ronan

Libby

Whitefish

Cut Bank

Shelby

Choteau

Havre

Helena Deer Lodge

Dillon Ennis

Livingston

Red Lodge

Big Timber

Harlowton

Columbus

Lewistown

Glasgow

Sidney

Wolf Point

Glendive

Miles City

Fam

Peds

Fam

IntMd Missoula

X Billings

IntMd

Fam

Fam

A Belgrade

Butte

Kalispell

Laramie

Cheyenne

Casper

Fam

Fam

Rawlins

Newcastle

Graybull/ Basin Sheridan

Torrington

Green River

Thermopolis

Montpelier

WWAMI Rural Integrated Training Experience (WRITE)

Ferndale Bellingham

Anacortes

Darrington

Everett Forks Pt. Townsend

Shelton

Bremerton

E. Grays Harbor

Shoalwater Bay Tribe

Cathlamet

Mt. Vernon

Vancouver

Toppenish

Wenatchee

Othello

Odessa

Ellensburg

Yakima

Wapato

Grandview

Tonasket

Omak

Chewelah

Friday Harbor

Olympia

Madigan US Army

Tacoma

Spokane

Pullman

Fam

Ob/G

IntMd

X Ob/G

IntMd

Peds

IntMd

Psych

Ob/G Peds

X A

Fa m

Fa m

Fam

5 x Seattle

Psych

Fa m

7 x

Fam

Fam

Fam

Moses Lake

Tulalip Tribes

Garfield County

South Bend

Federal Way

Sunnyside

Cle Elum

Colville

Fam

X

Columbia County

Asotin County

Colfax

White Salmon Fa m

Puyullap

Republic

A Renton

Pt. Angeles

Fam

Goldendale

Fam 2 x

Pasco

Morton Ob/G Peds

Fa m

Fa m

A

Peds

Peds

Peds

Pocatello Fam

Fam Peds

Peds

Peds

Powell IntMd

IntMd

Jackson

Buffalo

Afton

Lander

Riverton

Saratoga

Ob/G

Rock Springs

Wheatland

Juneau

Kodiak Island

Kotzebue

Metlakatla

Petersburg

Sitka

Haines Cordova

Glennallen

Seward

Valdez

Palmer Wasilla

Kenai

Soldotna

Naknek

Anchorage

Fam

Dillingham

Nome

Homer

A

Fam

Ob/G

Psych

IntMd

Peds

Fam

Bethel

W

Plains

Ob/G

Stevensville

Fam

Fam

W

W W

W

Mossy Rock

Gillette

Worland

Cottonwood

Lewiston

Weiser

Fam Wrangell

Surg

Revised 09/02

W

W

W

Cody

Kemmerer

Coeur d’Alene

Sun Valley

Prince of Wales Is.

White Sulphur Springs

Sundance

Malad City

Conrad

Ephrata

Ekalaka

Bonners Ferry

Meridian

Ob/G

Ob/G

Douglas

Galena Fairbanks

Polson Thompson Falls

Colstrip

Poplar

Fort Benton Chattaroy

Walla Walla

Mattawa Westport

Longview

Woodland

Auburn Enumclaw

Kettle Falls

Great Falls

Heart Butte

Eureka

Fa m

What about Housing for traditional schedule?

• Most housing does not accommodate families or pets

• Transportation to sites, housing funded by UWSOM

Family, pet (on the right)

Traditional schedule

Features

• Wide variety of practice settings

• Wide variety of community sizes

• Test drive different states, different systems

• Academic vs. community practices

• Academic centers = Residents

• Moving around

• Can be disruptive

What is a Track?

• 3rd year: 5/6 required 3rd year clerkships are in one region throughout the WWAMI region

• Most are state tracks; some are city tracks (Billings, Missoula, Spokane)

• Application process

Track options

Alaska

Billings

Idaho

Missoula

Spokane

Wyoming* * (Wyoming rural clinical experience)

Track

• May or may not be in the same city the whole time

• Eg: Idaho Track:

– Boise: 4, Pocatello: 1, Caldwell:1

Track: Housing and transportation?

• Housing is not paid for in the home of record

• Housing IS paid for if you go to site other than the home base

• Eg: Idaho Track, living in Boise

– Boise – not paid for.

– Pocatello – paid for

Features of track

• Majority of rotations in one setting

• Students get familiar with one system.

• Students get to know the community physicians

• ?closer to home?

• Less disruptive

• Potentially beneficial for families

Note: Depending on students requests, You may not get the order of rotations that you request.

Another Option : Longitudinal integrated clerkships: (LIC’s):

The W.R.I.T.E. Program Approximately five-month program with a primary care preceptor in a rural area

Longitudinal experience

First set of rotation done at other sites

35 WRITE sites, 13 open slots

Olympia LIC

Features of WRITE

• Continuity of care

• Connection to one community

• Get to know what primary care practice is really like

• Students are extremely useful members of the team

• Often only student there

• Housing is paid for at WRITE site

Sample weekly WRITE schedule

Mon Tues Wed Thurs Fri Sat Sunday

Internal med

Surgery Internal med

Fam med Ob-gyn ED call ED call

Psychiatry Fam. med Off Pediatrics Pediatrics Ed call ED call

Traditional, Track WRITE

1. Not all WRITE site experiences start at the same time 2. Not all WRITE site experiences are the same length 3. Not all WRITE sites are available 4. We preplan the rotations before or after you travel to your WRITE site

UWSOM

Expectation –

• You will travel

• 24 weeks outside Puget Sound area

What is Seattle/Puget Sound Region?

Roughly 50 mile radius.

Requests to be in Seattle/Puget Sound Region

The compelling reasons

1. personal illness, such that your health would be negatively impacted if you leave Seattle/Puget Sound Region

2. Family situation that would be significantly negatively impacted by being outside Seattle/Puget Sound

3. ill relative; you are only provider of support and help

If necessary make appointment with Connie Lamb celamb@uw.edu

• MS3 Track applications sent out

Dec 1, 2014

• MS2 Clerkship Talks (Part II):

• Round robin session for MS2s

Nov 18, 2014

October – Nov., 2014

• MS2 Clerkship Talks (Part I):

• Associate Dean for Curriculum overview

• Regional Deans

Sept 30, 2014

• Registrar completes MS3 scheduling

Feb 2 – April, 2015

• MS2s submit 3rd year surveys to Registrar

Jan 30, 2015

• WRITE Interviews

Jan 22, 2015

• Registrar provides paperwork/online survey to MS2s for 3rd year

Jan 5, 2015

• MS3 Track Applications due to Curriculum

Dec 17, 2014

Clerkship Scheduling 2015-2016

presentation materials posted on Curriculum website for review.

• Thank you.