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: 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
• 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
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 [email protected]
• 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.