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Vital Signs

DMS third-years: California, here they come

By Matthew C. Wiencke

'Ithink this is the beginning of a beautiful friendship," says Humphrey Bogart to Claude Rains in the film classic Casablanca. Minus the international intrigue and Moroccan café, DMS has started a "beautiful friendship" of its own—an educational partnership with California Pacific Medical Center (CPMC), a major teaching hospital in San Francisco.

Diversity: Third-year DMS students now have the option of doing some of their required clerkships at CPMC, where they will see patients with "great diversity of medical diagnoses, backgrounds, cultures, and countries of origin," explains Dr. David Nierenberg, DMS's senior associate dean formedical education. CPMC is one of the largest private, not-for-profit teaching hospitals in California.

"There's a much larger African American, Hispanic, and Asian [patient] community" at CPMC, says third-year Haitham Ahmed. He and classmate Carolyn Presley completed the first CPMC clerkship in psychiatry. Rotations in inpatient internal medicine began inMarch, and rotations in neurology will start in July.

The collaboration was initiated by CPMC. Dr. Warren Browner, vice president of academic affairs there, contacted Nierenberg and said that the California institution had a strong research enterprise, solid residency programs, and "lots of faculty members enthusiastic about teaching," but lacked a steady flow ofmedical students. The staff wanted to affiliate with a medical school—but one outside San Francisco, to avoid clinical competition with other Bay Area medical centers.

For Nierenberg, the timing was perfect. Most of DMS's clerkships are in rural areas—northern New England, Arizona, Alaska—and DMS had actually been looking for large, urban hospitals with substantial cultural diversity to use as alternative training sites.

Chronic: During their psychiatry clerkship at CPMC, Ahmed and Presley worked both on the consult service and in the inpatient unit. Many psychiatry inpatients there are homeless or on state assistance due to chronic psychiatric disorders, and 25% to 30% have substance abuse problems, says Dr. Stephen Brockway, director of the clerkship.

Factors: Ahmed recalls one patient, admitted for alcohol withdrawal, whom he presented during daily rounds. "He would always say that he was suicidal or homicidal . . . because that was his cry for help. I think I learned a lot from that patient," Ahmed says, "whether it was his socioeconomic factors—such as being homeless—impacting his clinical outcomes, or whether I was just learning about the physiology of alcohol withdrawal."

Presley enjoyed her stint on the West Coast, too. "The nurses, occupational therapists, and social workers participate in rounds with residents, med students, and attendings," she says. "I am very impressed with how easily the staff adjusted to incorporating a medical student into the team."

Option: As clerkships are added in other specialties, Nierenberg anticipates that every DMS student will have the option to do a rotation at CPMC. "It could really broaden the horizons of our students . . . and I think they would end up being stronger physicians if they had the advantage of this additional experience, on top of the terrific training that they already get here at DHMC and the VA.

"This is not in any way to replace" current training sites, Nierenberg adds. "It's like icing on the cake that's already there."

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