As a doctor, knowing how to ask a patient questions can be as important for building trust and providing care as knowing what to ask.
Harvard Medical School student Felita Zhang honed this skill this spring during her Principal Clinical Experience (PCE), a year-long period in an MD student’s medical education when they are immersed completely in caring for patients.
For example, instead of making assumptions about a patient with liver cirrhosis and asking leading questions such as whether they have used alcohol, Zhang learned to ask open-ended questions, such as “What do you eat or drink during a typical day?” She found that this approach to taking a medical history helped patients feel more comfortable and offer more nuanced information, which allowed her to better evaluate them and develop care plans.
Zhang and fellow students are benefiting from enhanced skill development as a result of a new type of position at the School, called the PCE core faculty.
Implemented in January 2025, the initiative supports 80 physician-educators at the School’s major affiliated hospitals so that they have dedicated time to give personalized attention to a small number of medical students throughout one of their rotations, also called clerkships.
This model is unique for training MDs, leaders said. Typically, a large number of clinical educators instruct a student throughout a rotation, and the student may be paired with each instructor only once or twice.
“Their guidance is surely beneficial, but there’s only so much that can be gained from a series of snapshots from multiple instructors,” said Sara Fazio, chair of the Principal Clinical Experience Subcommittee at HMS and HMS professor of medicine at Beth Israel Deaconess Medical Center.
The core faculty model provides a more complete picture because one individual observes the student from beginning to end of a clerkship, Fazio said. The faculty member helps the student integrate the feedback they’ve received from their clinical instructors, identify their strengths and areas for improvement, discuss any concerns, and assess their development.
“It allows us to work with individual students on the connection of clinical skills, reflective practice, formation of professional identity, assessment, remediation, all these domains — and across time,” said core faculty member Jessica Berwick, HMS assistant professor of medicine at Massachusetts General Hospital, who has been teaching students in the PCE since 2016.
So far, the model appears to be raising satisfaction among both teachers and students.
“It’s gratifying to see students start out with no experience on the wards and then see them learn and grow week over week,” said core faculty member Kimberly Keefe Smith, HMS instructor in obstetrics, gynecology, and reproductive biology at Brigham and Women’s Hospital.
Students have expressed that they have developed trusting relationships with their core faculty members, Fazio said. More fully supported, the future doctors readily progress toward mastering clinical skills.
Zhang said she was able to refine her questioning technique because core faculty member Jacob M. Koshy, HMS instructor in medicine, part-time, at Beth Israel Deaconess, gave continual guidance and reinforcement throughout her three-month internal medicine clerkship.
Zhang contrasts the experience with several PCE rotations she completed last year, before the core faculty positions were instituted.
“We were given a ton of feedback, but once we implemented changes based on that feedback, we didn’t often hear whether we were actually improving,” she said. “The core faculty gives us that, which is amazing.”
Supporting physician-educators and administrators
Many of the core faculty have a deep commitment to medical education and have already been doing this work with very little compensation, Berwick said. Now, with the School’s support, they can dedicate 20 percent of their time each week to working with MD students.
The model also offers more opportunities for core faculty to conduct medical education research. Faculty members have long indicated that such pathways for career advancement would increase their job satisfaction, said Fazio.
Each hospital’s PCE site directors, who oversee administration of all the institution’s core clerkships, are able to generate a much fuller picture of a student’s overall progress throughout the year. Equipped with notes from the core faculty that are more consistent and comprehensive than accounts from multiple clinical instructors, the PCE directors can now synthesize feedback more effectively and thoroughly.
Providing a more consistent experience
The PCE core faculty model improves standardization across HMS clerkship sites and within specialties, Fazio said.
About 90 percent of HMS students complete their clerkships at Beth Israel Deaconess, Mass General, Brigham and Women’s, or Boston Children’s Hospital. Rotations entail 12 weeks each of medicine and surgery, 6 weeks each of pediatrics and of obstetrics and gynecology, and 4 weeks each of radiology, psychiatry, and neurology.
(Cambridge Health Alliance, which operates a longitudinal version of the HMS PCE, plans to implement its own version of the core faculty model soon.)
Because multiple hospitals operate clerkships, there had been variability in how they are structured, said Berwick. In developing the PCE core faculty, Fazio said, great care was taken to ensure the sites have the same involvement of clinical instructors and residents, learning objectives, and assessment methods.
Strengthening the medical education community
The PCE core faculty were selected in each specialty at the four clinical sites through a competitive application process.
They now gather regularly at professional development programs in which they share teaching methods, materials, and success stories while finding interpersonal connection.
“It’s hard for me to articulate how impactful the faculty development sessions have been in building a sense of community because we can come together from across sites, some of which are not geographically close,” said Berwick. “It’s huge.”
The sessions also encourage innovation with the goal of raising contemporary clinical teaching practices and standards.
In one recently shared fresh approach, some PCE sites are providing real-time feedback to students using a mobile phone-based app. Core faculty put their guidance on a dashboard so they can track changes in students’ skills and share recommendations and assessments with the clerkship director.
“This is an incredible community of people who are excited about medical education, thinking about how to do it better, looking at the literature, and trying different things to make our clinical education at HMS even better,” Fazio said.
Above all, commitment to the next generation of clinicians
The PCE core faculty model is designed to ensure that students are not only mastering the competencies required to pass the subject exams they take at the end of each rotation as well as the medical licensing exam at the end of their MD training but are also well-prepared to enter their residencies and become exceptional physicians, Fazio said.
“By creating this role, HMS demonstrates a commitment to clinical undergraduate medical education in a way that I’ve not seen before,” Berwick said.
Plans are in the works to conduct surveys and otherwise measure outcomes so the model can be continuously improved.
Leaders hope it will serve as a prototype for other medical schools.
Finding the resources to support the initiative at HMS was a challenge, but doing so demonstrates how highly HMS Dean George Q. Daley and Dean for Medical Education Bernard Chang value the School’s clinical teaching faculty and MD students, said Fazio.
The model stemmed from a 2019 Dean’s Innovation Awards in Education grant. Working groups did much of the design during the COVID-19 pandemic, reviewing medical education studies and methods, holding faculty interviews, and conducting student surveys.
The outcome “has been better than any of us expected,” said Fazio. “The joie de vivre of the learning environment has just been remarkable.”
