Harvard Medicine

January 29, 2008
HMS student (name withheld by request)

PCE selection

The selection of PCE for rising 3rd year students is filled with trepidation. Many of the "informative sessions" in many ways perpetuate the frustration and anxiety many students feel.

I believe there is a solution to this problem. With the amended calendar, I think there is a place for a trial experience format. The execution would entail utilizing a week-long experience where each student would be allowed to participate in an abbreviated shadowing experience at a particular hospital in a particular rotation. Let me explain.

Students would be allowed to choose a hospital site to explore for one day. In addition, they would be allowed to select a particular core clerkship to explore as well. The student could then rotate to a different hospital site on subsequent days with the option to select a core clerkship experience.

Logistically, each student would utilize three days during this week-long experience which would hopefully alleviate scheduling concerns with a large group of students descending on one hospital at any one time. Statistically it would involve finding slots for eight students per day per site, if you assume 150 total students.

Thoughts?

Thank you for this interesting suggestion. As it turns out, we learned quite a lot about how to help students choose their PCE sites from the initial attempt this fall. Even with the unanticipated rough edges, our students were able to choose wisely and carefully; 72% received their first choice, and 28% received their second choice, and no one was assigned to a lower-choice site. The students have been very thoughtful in making suggestions to improve the selection process next year, and, working with them, we are confident that the process will be smoother and more seamless than this year's. In addition, next year, we will have had everyone in a PCE, and their feedback will be very informative to the next class in making their selections.

One of the issues about which the students were adamant is that they have their PCE site selection established early in the second year. They felt that they needed time to make living arrangements and to leave/enter lease agreements for the third year (location determined by the PCE site), something which cannot be done later in the second year. Arranging hospital shadowing experiences early in the second year would be difficult, and, at that time, students would have little appreciation for what a clerkship actually means or what a hospital interaction represents. For next year, in fact, we are going to hold the introductory sessions and selection process a bit later (still early in the second year, perhaps after the winter holidays) to give students more time "under their belts" in Patient-Doctor-II before they make their choices. If the writer suggests that the shadowing experiences could be done after the completion of year-2 courses, that precious time in April has been set aside for national boards review and vacation; adding a programmed experience during that time would lead to easily predictable complaints, as have other suggestions for occupying that time.

Although shadowing PCE sites is an interesting approach, a reasonable argument could be made for the absence of any validity in having one-day, single clerkship experiences; students often make visceral choices, as they did when they were traveling to see colleges and medical schools, and what happens on any one day on any one clerkship reflects little of what can be derived from a clerkship. We do appreciate the suggestion, which we have heard as well from one of our faculty members, but the PCE directors have given this much thought and feel strongly that a process amended by the valuable experience of this year will make next year's process substantially better and less anxiety-provoking.

Jules Dienstag, Dean for Medical Education

HMS Strategic Planning

Comments and Discussion