INTEGRATED CLINICAL-EXPERIENCE - UNIVERSITY-OF-NEBRASKA MEDICAL-CENTER

The Integrated Clinical Experience (ICE) at the University of Nebraska College of Medicine is a required, two-year course of study for first - and second-year students. It provides early clinical experiences in primary care settings in metropolitan and rural areas, and related ins truction in the social, behavioral, and ethical foundations of medicin e. The authors describe the course goals, teaching format, topics, and evaluation of students and faculty. ICE is based on the assumptions t hat medicine is an applied behavioral science as well as an applied bi ological science, that critical reflection is important in professiona l education, and that early exposure to primary care will promote inte rest in primary care careers. The authors also describe some of the ch allenges associated with the implementation of this new course of stud y. These include student dissatisfaction with behavioral and ethical t opics, resistance to critical reflection about their personal attitude s and values, and discomfort with ''subjective'' grading. ICE has also been controversial with some basic science faculty who feel they have had to sacrifice curriculum time to make room for this new program. A lso, recruiting the large number of faculty, particular physicians, ne eded to run the program has been difficult. Finally, the organization of the curriculum, with basic sciences in the morning and the ICE in t he afternoon, may inadvertently reinforce the conceptual split between the biomedical and psychosocial dimensions of medicine. Efforts are u nder way to address this problem by exploring ways to intergrate the c urriculum better.