The Doctoring Program at UC Davis is the result of a broad- based effort to rejuvenate the medical
school curriculum, in part by creating more small-group, interdisciplinary active learning opportunities
for students. Previ- ously, the curriculum was administered by separate departments, and courses often
had little collaboration or common purpose.
The Doctoring curriculum attempts to correct that, bringing together multiple disciplines to teach integrated
patient care. The Doctoring curriculum introduces a wide variety of important topics, such as doctor-patient
communication, clinical reasoning, ethics and end-of-life care. It prepares students for life-long learning
and exposes them to many more real aspects associ- ated with being a physician. The curriculum has served
as a model for schools nationally and internationally.
Michael Wilkes, School of Medicine vice dean and author of the Doctoring Program, comments on the importance
of exposing students to real-life situations to prepare them for the real side of medicine.
"In the past, medical education has focused on books, cells and organisms of the body, often at the expense
of better understanding patients, the population and society. The Doctoring curriculum is our attempt
to give significant weight to these other important aspects of being a doctor," says Wilkes.
"Doctoring addresses three ingredients believed to be missing from medical education," says Wilkes. "Too
much focus on the patient's disease rather than on the patient as a person; too much compartmentalization
of courses; and too little attention paid to the families and communities in which the patients lived.
With Doctoring, topics such as domestic violence, substance abuse, clinical decision- making and communication
issues, such as how to break bad news, began to receive greater attention. The courses are almost all
taught in small groups, making liberal use of standardized patients actors portraying the same scenario
for each student. Standardized patients had been utilized in a few other schools, primarily to assess
students' skills. Doctoring expanded their use by employing the actors not only to test, but also to teach
The Doctoring curriculum was piloted at UC Davis in 2001 and established as part of the curriculum for
all third-year medical students in 2002. The course climaxed last year with a mock malpractice trial held
in the Sacramento County Courthouse, complete with practicing attorneys, medical witnesses and a retired
judge. Students first analyzed a case in small groups, then witnessed a trial of a physician accused of
negligence after his patient became paralyzed from a cerebral hemorrhage. The trial vividly brought to
life issues of doctor-patient communication, the medical/legal system, and how to deal with patients who
suffer adverse outcomes.
This year, the Doctoring course expands to second-year students. Frazier Stevenson, UC Davis Medical
Center nephrologist and director of the second-year Doctoring course, is planning a course that brings
together all aspects of the second-year clinical curriculum, which previously resided in separate courses.
"The second year is a critical phase in which the students are bridging the gap between their coursework
in basic science and mechanisms of disease and the clinical world in which they will reside for most of
their careers," said Stevenson. "This course will bring together their clinical and scientific skills,
but also incorporate communications, epidemiology, public health, economics, sexuality, cultural medicine
During the course, students will work with individual physicians, many of whom are volunteer faculty
in the community, to polish their physical examination skills. An important part of the course is for
the students to see how they fit in the entire community of medical care. They will see patients in unusual
venues such as the Yolo County Juvenile Hall and Vacaville state prison. Students will also shadow nurses
at UC Davis Medical Center and ride with paramedics as part of this training. The curriculum will ultimately
be extended to students throughout all their four years of training at UC Davis. For Dr. Stevenson, "It
is critical that students see themselves and their patients as part of a larger medical world, one in
which they collaborate with nurses, technicians, public health administrators and many others to deliver
society the best medical care. I feel that the students can best learn this by talking to and examining
patients in diverse settings and with mentorship of a variety of medical caregivers."