From Simulations to Systems

Preparing medical students to deliver collaborative, patient-centered care in today’s complex health systems

Health System Science-Informed Practice
Our graduates work within multidisciplinary health care delivery systems, focusing on safety and efficacy, to optimize individual and population-based experiences and outcomes. 

UC San Diego School of Medicine’s four-year curriculum is designed to prepare and educate future physicians to excel in core competencies, navigate complex health care systems and provide specialty experiences to support their career goals. 

In addition to the biologic and anatomic instruction that students complete during the pre-clerkship years, all medical students are required to take Practice of Medicine, a longitudinal course which provides the students with essential clinical knowledge and skills for delivering exceptional patient care with competence and compassion. Students learn how to conduct physical exams, take patient histories and communicate effectively with patients and family members among other things.

As part of their training, third- and fourth-year medical students learn and work alongside physicians and other health care team members in a variety of clinical settings. Photo courtesy of Zoe Matticks. 

“The pre-clerkship years classroom learning are intentional,” said Zoe Matticks, fourth-year medical student. “Among other things, they are teaching us how to give information to patients in a compassionate way. They help us to get our feet wet, so that on the first day of clerkship, you are not feeling completely like a fish out of water.”

While the course provides the initial framework for success, including some clinical and simulated experiences, students note that the first time walking into a patient room can still feel a bit intimidating.

“During the first two years of medical school, you complete several simulated patient experiences with standardized patient actors. With those experiences, you are learning and receiving feedback, but it can still feel kind of forced. It’s almost as if you are acting along with the ‘patient.’” Matticks explained. “Once we start clinical rotations, I think medical students sometimes get really scared that they're not going to know what's happening medically to the patient. But that’s what we're here for – we’re students and we are here to learn. We work under the umbrella of a clinical team that's guiding us so, as we are never alone when taking care of patients.”

As Matticks begins her fourth and final year of medical school, she is grateful for her clerkship experiences so far and says she is feeling more confident in her patient interactions.  Throughout her third year clinical rotations, she had opportunities for many memorable moments and a deeper understanding of what it means to be a part of the health care team.

“During clerkships, it’s like starting a new job every month. You are moving to different teams with different leaders and trying to get to know people and to understand their workflow.”

The constant change with each rotation can be challenging but it also provides the medical students with new perspectives and experiences with varying philosophies of patient care. Ultimately, the goal is always to provide the best care possible so that the patients’ outcome is the best that it can be. But there are different means to achieving that goal.

For some clerkships, medical students participate in traditional rounds where the health care team meets together to discuss all patients under their care before meeting individually with the patient. During her rotation at Rady Children’s Hospital, Matticks was immersed in family-centered rounds, where the entire medical team meets with the patient and their family to provide updates, discuss treatment plans and assure that everyone is communicating with one another.  

“The family-centered rounds are a bit of a more collaborative approach to interacting with patients,” she explained. “The patient and their parents or family members are joined by the nursing staff, specialists, attendings, residents, medical students and others. We all gather to provide a united front so that we are on the same page, and patient and family members are comfortable with the plan, have questions answered and feel heard.”

This collaborative approach led to a new diagnosis for one of Matticks’ patients. The patient was admitted with vague symptoms, so the team cast a wide net to bring in a variety of specialists to assess and analyze a myriad of test which were necessary to confirm the new diagnosis.

“It was a scary time for the patient and their mom as we all worked together to confirm the diagnosis,” said Matticks. “As the medical student on the team, I spent a lot of time with the patient, getting to know them and building trust with the family. I really got to know the person, not just their list of symptoms. For this particular patient, they were recently re-admitted, so I had already met them the first time they were in the hospital. With the continuity of care and everyone working together as a team, I think it made a difference for this family.”

Through rotations like the one at Rady Children’s, Matticks is not only learning the science of medicine, but also the human and systemic aspects of healing. As she enters her next year of training, she is looking forward to building on the skills, confidence and empathy that define a future physician ready to thrive in today’s complex health care environment.