The New York Times has a great article on a curriculum experiment at Harvard Med. In an attempt to break through the dehumanizing impact of the traditional third year of medical school, Harvard has tried assigning students to individual patients for the whole year.
Since 2004, the Harvard Medical School-Cambridge Integrated Clerkship has assigned every third-year medical student to a “panel” of up to 100 patients to care for over the course of the year. Students see their patients in the clinics of the Cambridge Health Alliance health system where the program is based, but also follow and assist with any outside consultations, admissions to the hospital, operations and even home visits. During the year, students are also required to shadow several assigned preceptors, senior physicians from the major specialties, in their clinics every week.
Guess what? It works.
After offering this innovative third-year program for a few years, the organizers assessed the skills and experiences of the first students. They found that these students had more rewarding and humanizing learning experiences than their peers on traditional block rotations. And the positive effects continued to influence the students’ work even after they returned to the traditional track for the fourth year of medical school.
On standardized exams of knowledge and skills, most students from the new track performed as well as or better than traditional students, and many felt better prepared for clinical practice. On tests assessing important elements of care, these students were also better prepared to involve patients and their families in decisions, act in a caring way and deal with ethical issues.
What about a 6 month section of law school in which you got a client — rather than a case — and were responsible for all that client’s problems, starting with a proper diagnosis process. Much harder work and much more of a challenge for supervisors, but a much better preparation for practice, particularly low and middle income practice.
Or, perhaps even better: when you start law school, you get a client, joining and second and third year student on a team. You stay with that client and team through the three years, figuring out what you need to learn to help them. Maybe you even stay involved on a pro bono basis after graduation. Now that would be a legal education, and one that did a much better job of preparing to transition to real practice!
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As a prospective law student, and as someone who has been engaged in self education in law for the past several years (I have litigated two cases pro se, one involving workplace discrimination, the other a federal civil rights violation suit) I feel that would be a wonderful way to pursue practical skills-based legal knowledge and professional soft skills that could translate directly into a career in law, and I remember wishing desperatley back then for acess to even a law student to help me with drafting the endless motions that I was ill prepared to write/oppose.
A great model. Incredibly hard to implement with law schools (note the medical school students got 100 patients, not a single client), in part because of differences in the way users access health care versus the way they access legal services. But it touches on a larger theme, namely, what the legal profession can learn from the medical field about delivery of services. An example I’ve been thinking about for a bit: does the way in which Medicare, Medicaid, VA, etc. reimburse docs for services contribute to the unbundling of the medical profession? If so, what would happen in law if we altered payment mechanisms for legal services?