The Role of Third Year Medical Students and the Potential for Change 2017 AAMC WGEA Regional Meeting Catherine Burke MS4 Dylan Masters MD Patricia O’Sullivan EdD Leslie Sheu MD UCSF School of Medicine 2/26/17 6/11/2018 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]

Background Abraham Flexner William Osler http://www.nndb.com/ http://www.nndb.com/ The organization of modern medical school has historical roots Curricular changes largely occur within this preexisting structure Need to better understand the current role of third year students in order to design effective pre-clinical curricular changes The Role of Third Year Clerkship Students and the Potential for Change 2/26/17 6/11/2018 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]

Research Questions What is the role of the third year medical student? What are the factors that influence this role? What is the potential for the role to change, especially in the context of curricular change? The Role of Third Year Clerkship Students and the Potential for Change 2/26/17 6/11/2018 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]

Study Methodology Qualitative research study analyzing 22 semi-structured interviews with clerkship and site directors Open-coding of transcripts using thematic analysis Construct conceptual model for understanding the MS3 role The Role of Third Year Clerkship Students and the Potential for Change 2/26/17 6/11/2018 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]

Results - Overview Factors influencing the third year role: Student Supervisor Factors Systems Factors Three archetypes of the third year student: The Apprentice The Intellectual The Communicator The Role of Third Year Clerkship Students and the Potential for Change 2/26/17 6/11/2018 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]

Results – Factors Influencing the Role Student Factors “So generally, ones who are a little bit more outgoing, take more initiative - those are the ones who generally have the more favorable experience.” Supervisor Factors “I meet with the students before they start their rotation and I go through expectations, but it is very much team-driven and team-dependent … I just don't know that everybody utilizes the medical students in the same way.” Systems Factors “When the residents are out on vacation or in clinic we do tend to tell the students, ‘We'd like you to do a little bit more.’ We do that but not without support, and not without some feedback also.” The Role of Third Year Clerkship Students and the Potential for Change 2/26/17 6/11/2018 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]

Results – Three Student Archetypes The Apprentice “The current role of a MS3 is to be a novice physician. Their role is to take care of patients under close supervision by a resident and intern, [and] to act as one of the primary care givers of a patient. It is very much an apprenticeship model.” The Intellectual “The students who stand out are the ones who are able to collate all those tests in a nice spreadsheet, know what each of them is being sent for, and what the test characteristics of each one of those tests are, […] then go to literature and pull papers that help us understand.” The Communicator “I love it when students are there with the family […] I've heard from many families and patients that they really benefited from having a student there, as far as being their proponent in their patient centered experience and relaying that to the team.” The Role of Third Year Clerkship Students and the Potential for Change 2/26/17 6/11/2018 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]

Discussion - Implications Curriculum Design Utility of pre-clinical curricular changes for third year medical students may vary depending on archetype balance Evaluation Deviation from expected archetype may lead to inappropriate grading practices Cultural Consensus Preparing students for clinical rotations Providing shared vocabulary for students and supervisors to describe expectations and roles during rotations The Role of Third Year Clerkship Students and the Potential for Change 2/26/17 6/11/2018 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]

Conclusion Future Directions The third year role is determined by intrinsic student factors, supervisor-specific factors, and systems factors There are three distinct third year medical student archetypes: the apprentice, the intellectual, and the communicator The balance of the archetypes depends on the actors involved and their shared environment Integrating the perspective of third year students into framework Reassessing the way students are oriented and evaluated Incorporating framework into faculty training and development efforts Future Directions The Role of Third Year Clerkship Students and the Potential for Change 2/26/17 6/11/2018 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]

Acknowledgements Special thanks to: - Dr. Leslie Sheu, Dr. Patricia O’Sullivan, and Dr. Dylan Masters - UCSF School of Medicine - UCSF Health Professions Education Pathway - AAMC WGEA The Role of Third Year Clerkship Students and the Potential for Change 2/26/17 6/11/2018 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]

Parnassus Aerial by Hawkeye Photography 6/11/2018 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]