1. Transforming Clerkships into an Integrated Longitudinal Learning Module: Model Madres: Maternal, Child and Family Health
Adriana Padilla, MD
Susan Hughes, MS
UCSF Fresno Medical Education Program

2. Background Clinical education reform is needed (1)
National concern that the current clinical training model is poorly aligned with society’s present and future health care needs (2)
New models of clinical education need to address a lack of connection or continuity among different learning experiences (2)
Two current models of integrated clinical education; Longitudinal integrated clerkship model (LIC) and Hybrid models (integration and longitudinal patient care within traditional clerkships)
1. Irby DM. Educational continuity in clinical clerkships. N Engl J Med. Feb ;356(8):
2. Hirsh DA, Ogur B, Thibault GE, Cox M. "Continuity" as an organizing principle for clinical education reform. N Engl J Med. Feb ;356(8):

3. Objectives
Design and implement a new 3rd year clinical educational model that integrates a thematic approach to learning clinical medicine in maternal, child and family health at UCSF Fresno.
Incorporate continuity as the overarching theme of our new curriculum (continuity of site, continuity of peer cohort, continuity of care, continuity of mentoring)
Test the effectiveness of this innovation via a core competency plan, pre/post survey and attitudinal assessments from focus groups.
Evaluate the impact on programmatic resources

4. Design 7 student participants 6 month model
Pre-program ramp up for orientation
Longitudinal training
Integrated learning
Community based education
Structured mentoring

5. Methods Pre-Program Ramp Up
Transitional clerkship time (2 days) for introductions and orientation
Hospital systems orientation
Community orientation via a “treasure hunt”
Review each discipline’s objectives and competency cards
Review patient’s options for financing of health care

6. Methods Longitudinal Training
Continuity practice with pediatric, obstetric and family medicine patients
Individual student schedules
Detailed orientation for promoting patient care follow-up/continuity

7. Methods Integrated Learning
2 half-days for interdisciplinary education each week in a small group format
Curriculum coordinator

8. Methods Community based education
4 learning opportunities with community based organizations to enhance care of the underserved (Poverty Medicine, Hmong Health, Indigenous Health, and Elder Care)
Reflection exercises

9. Methods Structured Mentoring
Mentors from each discipline (ob-gyn, pediatrics and family medicine
Faculty Development for mentoring
3 mentors for each student, representing each discipline
Formal mentoring meetings 3x over program
Mentor prep meetings

10. Other Benefits Medical Spanish tutorials Travel Stipend
Planned vacation schedule
Study sessions for final examinations in each discipline

11. Evaluation Plan Core competency based Pre/Post Survey
Attitudinal assessments from focus groups
Impact on Programmatic Resources

12. Core Competency Based Plan
Shelf Exam X
E*Value
Structured Clinical Observation
Patient Satisfaction
Clinical Practice Exam
Chart Audit
Community Project
Learner Portfolio

13. Preliminary Results Students met continuity patient care goals
Students met core learning goals
Patient satisfaction high
CPX scores within one SD of entire class
Pre/Post Survey results show improvement in
SOAP note writing
Use of translators
Focus group results are mixed

14. Discussion Educational goals were met
Optimum integration of the participating clerkships was not met
Challenges were many
Logistics
space needs
programmatic resources
educator preparation and buy in

15. Conclusion
Hybrid models, like Model Madres, are innovative and integrative and meet core learning objectives
Hybrid models can face multiple challenges
Ongoing educational research of the outcomes from the educational design of the clinical core either by LIC or Hybrid models is needed

16. Acknowledgments
Academy of Medical Educators innovations award,
UCSF Fresno leadership in supporting and encouraging collaborative training and innovation.