New Facility Offers Realistic Training for Future Physicians

A patient sits waiting as first-year Einstein medical student Christina Han enters the examination room.  She briefly talks with the man, more social banter than actual medical analysis, reassuring him while also building a relationship that can benefit both parties when it comes time to diagnosing an illness. But that lesson will have to wait until second year. 

Ms. Han is a student in the Introduction to Clinical Medicine class and her patient is a paid actor.  The realistic examination room " complete with medical tools and working sink " is really a classroom with a camera digitally filming every moment. Faculty and fellow students can observe through a one-way mirror outside or review the video later as a group, offering feedback about the patient/doctor interaction.  It is an important step in the process of becoming a physician, and it is all possible thanks to Einstein"s new Ruth L. Gottesman Clinical Skills Facility. 

"Stepping out of our anatomy labs and scrubs and into examination rooms and white coats reminds us, weekly, of our long-term goal and the fact that we are truly learning a set of skills that are eventually going to be put into practice," said Ms. Han. 

The facility, a 22,700-square-foot center, is located inside a second-floor renovation to the Van Etten Building (which Einstein has leased from Jacobi Medical Center for 99 years). In all, 7,650 square feet of vinyl floor covering, 130 sheets of sheet rock, 400 gallons of paint and countless hours of manpower helped create a state-of-the-art facility with 23 examination rooms, many of which have been wired to provide full digital videotaping capabilities that will help students better prepare for life as a doctor. 

"When a student sees what went into this building, it tells them how much Einstein values them and their ability to become physicians who are fully competent in developing and implementing clinical skills that will serve patients well," said Felise Milan, M.D., director of the clinical skills facility.  "We built this gorgeous new space that truly optimizes their learning environment."

Prior to the facility"s construction, Einstein had lacked a single, stand-alone clinical center where its medical students could master skills, such as conducting the physical exam.

"Our first-year students would take classes in the Belfer Building, which only had a classroom setting to offer. With the new facility, students learn the interview in a realistic-looking clinical setting," said Dan Myers, co-director of the Introduction to Clinical Medicine program in charge of first-year students.

"Additionally, for their clinical examination course, our second-year students would practice the skills of physical examination using yoga mats placed on top of conference tables to simulate an actual examination table," added Mimi McEvoy, fellow co-director in charge of second-year students. "Now I"m watching students get the experience they need in a beautiful, realistic setting."

She continued, "Furthermore, for clinical skills assessment exercises, second-year students had to travel to New York City, while, third-year students traveled to Newark. All these exercises can now be conducted at our new facility in the Bronx."

Today, Ms. Han and her first-year colleagues are using the facility to master their communication skills; learning to create interpersonal relationships and how to listen and react to patients and their concerns. 

"Although some of the topics seem obvious," she said, "it is useful to learn them within a clinical context so that when thrown into a potentially awkward or difficult situation, we have built a repertoire of tactics that we can rely on." 

Second-year students take it to the next level, physically examining peers in groups of eight gender-segregated classes that cover all the bases, down to properly washing their hands thoroughly in the examination room sinks.  The combination of a complete medical history and physical examination prepares students to diagnose patients just before their third year, when lessons move from the textbook into a real hospital setting. 

After completing the majority of their core clerkships, third-year students must go through a rigorous test at the clinical skills facility, moving from one examination room to the next, taking on a variety of different cases, covering areas including surgery, pediatrics, and psychiatry, among others.  As with the first- and second-year students, they are videotaped.  These recordings are reviewed with faculty members so that students receive feedback on their strengths and weaknesses, which is essential for improvement.

Those whose examinations are not up to par have an opportunity to re-test. In the meantime, everyones" videotaped performance is available online through a password protected website that allows each student the opportunity to learn from their own mistakes and enhance the positive aspects of their examination room sessions. 

The video-taping capabilities serve additional purposes, as well. "We can now film members of the faculty and help them improve their teaching and education skills," said Mr. Myers. "This is a real exciting prospect; something we"ve really never had the chance to do before."

Einstein also has the opportunity to offer other medical schools the use of its facility for making their critical assessments of students. Both New York Medical College and SUNY Downstate Medical Center have contracted with Einstein to use the clinical skills facility for their students, opening up a world of new possibilities for the Bronx-based medical school. 

"Having the clinical skills facility at Einstein allows us to have control over the program and it gives us a flexibility we didn"t have before," said Dr. Milan.  It also allows for academic collaboration with other institutions in our region."

"With the clinical skills facility, the opportunities we can pursue have expanded tremendously," agreed Mr. Myers.

Posted on: Thursday, December 3, 2009