Five Reasons I loved my Longitudinal Integrated Surgery Clerkship

by Sophia Kim McKinley


“I don’t understand.”

This is the most common response when I tell people that during my third year of medical school, I did all of my core rotations simultaneously for a year. As a student in the Cambridge Integrated Clerkship, I was paired with an attending physician in each discipline for 12 months and juggled clinic sessions, operating room days, inpatient weeks, and didactics for seven different fields. While most medical students participate in traditional block rotations, I was learning the fundamentals of clinical medicine in a longitudinal, integrated model. “Longitudinal” refers to the fact that my experience in each field stretched across a year, “integrated” refers to the opportunity to follow individual patients across multiple disciplines.

An example of one of my most memorable days was when I had radiology teaching rounds followed by a pediatrics clinic in the morning and internal medicine in the afternoon. In the early evening, I conducted a home visit on one of my geriatrics patients. Then, I was paged to labor and delivery because a prenatal patient had presented with regular contractions. At 2 A.M. when the fetal monitor suggested distress, I scrubbed into her C-section. Within 24 hours, I had been a student in radiology, pediatrics, internal medicine, and ob-gyn.

What the longitudinal, integrated model meant for my surgery rotation is that I had half a day of clinic per week in addition to one day in the OR. Four weeks of time on the resident-led inpatient team was distributed across the year, but most of my rotation was spent learning from my preceptor, who was the surgical chair. Many surgeons have expressed some skepticism about this introduction to surgery, but here are 5 reasons I loved my longitudinal integrated surgery clerkship.

1. Continuity of Care – I was able to follow individual surgical patients across an entire year. For example, I met a woman with newly diagnosed colon cancer in June and continued to participate in her care until the following May. I was present at her pre-op cardiology clearance all the way to her first follow-up CT scan. Six months after I finished my third year, she called me to ask if I could be present for her ventral incisional hernia repair.  
2. Continuity of mentorship – My surgical attending taught me for months in a row. He became very familiar with my strengths and weaknesses both inside and outside the OR, and I was constantly challenged based precisely on my learning needs. When he was on call, he would send me text messages and I would go to the hospital to assist on urgent and emergent cases.
3. OR privileges for a year – need I say more? I spent all my free time for the entirety of my third year going to the OR and scrubbing cases. The OR staff became like a second family, the attending surgeons all got to know me very well, and I had the chance to practice technical skills regularly for 12 months straight.
4. Side-by-side comparison – Because I was doing all seven disciplines at once, it was easy to figure out which field attracted my interest the most. I always looked forward to Mondays, because those were my days to go to the OR. I lamented Monday holidays because there wouldn’t be elective cases scheduled. I couldn’t stay away from the OR. The other fields were great, but it was clear my future was in general surgery.
5. View into the life of an attending surgeon – While my classmates in the traditional block rotations may have finished third year with a better understanding of the life of a house officer, I certainly had an excellent perspective on life after residency. Because my primary teacher was an attending physician, my surgical rotation reflected the workflow of an attending surgeon from how he spent his time to the kinds of relationships he had with patients. I still had some insight into life as a resident during my 4 weeks of dedicated inpatient time, and my fourth year surgical subinternships were another way to expose myself to what life during surgical residency might be like. I’m happy to have had both types of experiences during medical school.

A longitudinal integrated surgery rotation isn’t available at every medical school, but they are becoming more common. Here are a few links and papers to read about this model of third year clerkships:

• NYTimes Well Blog (http://well.blogs.nytimes.com/2012/04/19/reinventing-the-third-year-medical-student/)
• American Medical News (http://www.amednews.com/article/20111226/profession/312269951/2/)
• Teaching medical students about cancer impact through a longitudinal surgical experience: a case study. (2012) (http://www.ncbi.nlm.nih.gov/pubmed/22490098)
• Educational outcomes of the Harvard Medical School-Cambridge integrated clerkship: a way forward for medical education. (2012) (http://www.ncbi.nlm.nih.gov/pubmed/22450189)

What are your thoughts on the longitudinal integrated surgery clerkship? What are surgical rotations like where you train(ed)? Given the option, which type of clerkship model would you prefer?

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Sophia is a dual-degree M.D./Ed.M. student at Harvard Medical School and the Harvard Graduate School of Education. She received the 2012 Association of Women Surgeons Patricia Numann Medical Student Award and spent a year as a Zuckerman fellow at the Center for Public Leadership at Harvard Kennedy School. Sophia is passionate about medical education and she hopes to be an academic surgeon who brings educationally-sound innovations to surgical training. Her clinical interests are gastrointestinal and minimally invasive surgery. Sophia will be applying for general surgery residency during the 2014 Match cycle.