Integrating early clinical experience curricula at two medical schools

The University of Texas Medical Branch and Eastern Virginia Medical School have created community-based generalist clinical experiences early in the first two years of medical school as part of The Robert Wood Johnson Foundation's Generalist Physician Initiative. This article describes these experiences and related curricula, outlining the common elements and differing approaches at the two institutions. It discusses the success of the new curriculum, presenting information from performance measures and surveys of students, clerkship directors, and faculty involved in the programs, and it describes further evaluative studies being planned. The authors discuss nine lessons learned and their conclusion that early clinical experience with generalist physicians is an important element of generalist curriculum reform. It improves student satisfaction with the first two years' experience and provides a structure for teaching patient-centered, integrated clinical medicine, which is important in the general professional education of all students. Whether or not the long-term goal of increasing students' interest in generalist careers is realized, incorporating early clinical experiences with generalists into a curriculum has positive effects on students, faculty, and the overall curriculum.