Trinity’s Clinical Edge: Fifth Term, Step-1, and the Transition to Baltimore

Trinity students in line at a medical school clinical

Last week, we talked about Integrated Clinical and Community Medicine (ICCM) at Trinity.  We hinted towards the end of that piece that our approach to early, in-depth clinical training during basic sciences culminates in the 5th term.

Today, we’re going to explore that and dig into the benefits of more time and responsibility in the hospital, working with the World Pediatric Project, and the final push towards a great score on the USMLE Step-1 exam before heading to clinical clerkships in Baltimore, MD.

Clinical experience married to classroom lectures and independent study, as well as focused support from faculty makes great doctors. More than that, it helps students who have struggled in the past flourish. Our curriculum continues to evolve in line with best practices from around the world, further modified through our own pedagogical research. No matter how things change, we keep coming back to that same initial conclusion, though. 

Our unique fifth term is right in line with that approach and its associated student outcomes. It’s a highly transitional time for our students. They have effectively concluded the basic sciences curriculum of medical school, and are about to move on to clinical clerkships. At the same time, they’re still yet to take USMLE Step-1. To help them perform at the level they’ve reached over the past four terms on campus, our students remain on St. Vincent for that final push. And while studying for the licensing exams is incredibly time-consuming (and rightly so) there are still more hours in the day that can be spent on deepening their knowledge and sharpening skills.

You can read much more here on our dedicated 5th-term resource guide, but the highlights include:

Special attention should be drawn to the time in Milton Cato Memorial Hospital. As we covered last week, students spend time rotating through the hospital starting in the first term at Trinity. And, as Dr. Ibrahim noted, with the passage of time, so grows their responsibilities in that hospital. Under the close supervision of their preceptors, the students first observe, then conduct histories with the patients, and by the time they reach the fifth term, they are assisting physicians and nurses and performing physical examinations with no small measure of (well-supervised) relative autonomy. This is all prior to starting clinical clerkships and it is a primary opportunity allowed by Trinity’s small size. No large medical school in the region offers this level of clinical training so early.

We do it for two key reasons. First, practical learning cements the content absorbed in lab and lectures like no other. It ties the text to the patient and makes the stakes and the outcomes feel as important as they truly are. As our dean says, “We don’t use standardized patients at Trinity. We have actual patients.” [ed. standardized patients are actors pretending to be sick to help students practice.] Members of the community of St. Vincent have come to know Trinity’s students as neighbors and friends, as well as providers of aid and comfort in a healthcare setting.

Second, our students move into the formal hospital setting in the United States for clinical clerkships with the confidence of dozens of hours of patient interaction under their belts. They are confident, comfortable, and ready to not just learn but to work. This clinical acumen gets noticed, too. It’s no coincidence we have students matching into our teaching hospitals as well as returning to programs where other Trinity grads have matched in years past. Our grads are competent, reliable, and incredibly enthusiastic about the hard work of providing medical care to their communities.

The purpose of the fifth term is not just to pass, but to excel on the USMLE Step-1 exam and be situated to succeed in clerkships. The work is rigorous, but our students’ entire lives are dedicated to studying medicine, and our faculty is dedicated to helping them feel ably prepared to perform. The final fourteen weeks are a pivotal part of why our students do so well when it comes time to match.

5th term is also when Trinity students become eligible to work with the World Pediatric Project. For those unaware, the World Pediatric Project is a global health NGO that sends expert physicians and affiliated medical staff to high-need areas to provide acute surgical relief to pediatric populations. They visit St. Vincent ten times a year for nine separate specialties (spinal procedures often occupy two separate missions). When those doctors arrive at St. Vincent, they’re greeted in the hospital by our 5th-term students.

On these visits, the surgeons are more than happy to engage with, teach, and even include Trinity’s students on their work. Beyond an extended opportunity to observe and interact with patients often undergoing critical surgical procedures, this is a profoundly valuable chance to network with some of the top pediatric surgeons and specialists in the US and gain their insight into life as practicing doctors.

All of this work culminates in a moment that can feel like a conclusion but in reality, is a transition. Our 5th-term students have passed only the halfway point of their medical education with Trinity. However, at the end of those first five terms, students pack up and depart St. Vincent, bringing with them nearly two years of intense lab and lecture as well as rigorous clinical experience outstripping even their counterparts studying in US and Canadian medical schools. That’s to say nothing of extra-curricular outreach, memories of a truly unique island nation, and relationships that hold fast on throughout their career.

They sit for the USMLE Step-1 exam and perform well, laying excellent groundwork not just for the next two years in their clerkships but also in matching into a residency.

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