Learning the most important lessons of all
Joby Morrow clearly recalls the first rotation of his medical residency. It was in UC Davis Medical Center's medical intensive-care unit, where the hospital's sickest patients are treated and death is unfortunately a common occurrence. The lessons he learned from watching the attending physicians, fellows, senior residents and nurses care for dying patients and their often distraught loved ones have remained with him.
Morrow marvels at how the nurses and physicians were able to create a sense of calm for the dying patient and the family despite the intense noise and bustle of a busy intensive-care unit.
"They would listen to the patient and the family and acknowledge their feelings," recalls Morrow, who is now in his fifth year of a combined family practice and psychiatry residency. "Then they would help them process their feelings. This experience set the tone for the rest of my training."
Although in psychiatry Morrow faces far fewer dying patients, he says he frequently draws on the methods that he saw modeled in the intensive-care unit.
'Listen first, act later'
"[The health-care team] would listen to the patient and the family and acknowledge their feelings … This experience set the tone for the rest of my training."
"When I have a patient who is having an emotional crisis in psychotherapy, those times in the intensive-care unit come back to me to help me handle it," he says. "It gave me a system – listen first, act later."
Although classroom instruction and simulation training are essential components of all health-care professional education programs, it is often such unexpected moments a student experiences during clinical rotations that create the most memorable lessons.
Matthew Settle, a nursing student from Sacramento State University who recently finished a clinical rotation for advanced medical surgery at UC Davis, also recalls a transformative experience.
Responding in a crisis
A patient had been in an intensive-care unit for several weeks, attached to a ventilator, and many of the nursing staff had grown close to her. When she went into respiratory failure and the rapid-response team was called, Settle says he was impressed by how quickly, calmly and efficiently everyone dealt with the crisis as they revived the patient.
"It really hit home for me that one can perform a thoroughly professional job and at the same time care deeply about patients."
Settle says that the clinical experiences he had at the medical center were far superior to those he had elsewhere.
"Being in a teaching hospital makes a huge difference," he says. "Everyone is willing to spend time with you, teach and treat you as a team member."
While Settle wants to return to friends and his life in the Bay Area, he says his experiences were so positive that he is interested in applying to be a nurse at the medical center despite a long commute.
In particular, Settle says he appreciates that UC Davis is embracing broader perspectives and attitudes about the role of nurses in providing health care.
"It is clear that good care for the patients is everyone's primary goal," Settle says.
The extensive clinical training offered at the medical center provides nursing students from programs across Northern California with much-needed, hands-on training. Each semester, as many as 500 registered nurse students – from American River College, Sacramento City College, Samuel Merritt College, Sacramento State University, Sonoma State and Sierra College – participate in clinical-training opportunities at the medical center. Another 22 licensed vocational nurse students are trained in an ambulatory setting at the medical center each semester, along with 20 nursing students from advanced practice programs.
"As these nursing students find employment at various health providers in the region, what they learned during their clinical rotation at UC Davis – an interdisciplinary approach to providing consistent patient care – unites them," says Kathleen Guiney, who manages the student-nurse program at UC Davis. "As a result, the entire Sacramento region benefits from the program."
Breadth of experiences
Debra Brady, associate professor of nursing at Sacramento State, agrees that UC Davis Medical Center provides a superior clinical experience for nursing students, partly because of the variety of experiences that the nursing students receive.
"The burn unit, the level 1 trauma center, the large indigent populations with the complex mixture of mental, physical and social problems all give the students a really important experience that they don't get elsewhere," Brady says.
Not only are clinical experiences essential for medical and nursing students, but they can also be invaluable for scientists whose work has clinical applications.
Translating scientific discovery
The UC Davis-Howard Hughes Medical Institute training program, "Integrating Medicine into Basic Science," provides five weeks of clinical experience to highly qualified and motivated doctoral students in biomedical research and engineering. These scholars are expected to become future leaders in translating scientific discoveries into clinical applications to improve human health.
Barbara Bailus, a doctoral student who investigates gene therapy applications for Angelman syndrome (a type of autism), spent last summer at UC Davis Medical Center in a variety of clinical experiences. One of her most memorable was observing valve replacement surgery, where seeing the procedure and discussing it at length with the surgeons afterward gave her new insights into the kinds of new devices that could prove useful to surgery.
During another rotation in the emergency room, she was struck by how the care team needs to make decisions quickly − so different from the slower, more reflective pace of a researcher − and how developing clinical assays that provide rapid results would be key in many clinical situations.
"Throughout my clinical experience, it was wonderful how everyone was willing to spend time with the graduate students," Bailus says. "I think that the experience gave everyone a better understanding of one another – how we could better understand the clinician's needs, and how they viewed the ability of our basic scientific research to help them one day."
From student to teacher
Clinical experience − especially when it involves a variety of experiences, excellent role models, ample teaching and respect for everyone − helps create the best health-care professionals and scientists. New physician Morrow, who in the final year of his residency, is often at the giving end to new residents. He says that contributing to others' training is among the most satisfying aspects of his residency.
"I take a lot of pride in being able to give back, especially realizing how much was invested in me."
Spring / Summer 2010
UC Davis Health System is proud to be home to medical, nursing, family nurse practitioner / physician assistant, public health and health informatics students and to also be the internship site for pharmacy, nutrition and other programs. Improving the health of our communities requires that we bring together these perspectives, and UC Davis is well positioned to do so.