Doctoring III: innovations in education in the clinical years.

Despite recent major changes in the practice of medicine, there has been relatively little change in medical education, particularly in the clinical years. Important areas such as ethics, domestic violence, nutrition, preventive medicine, and clinical decision making have been neglected in the curriculum. However, in 1994 the UCLA School of Medicine began to implement Doctoring III, a multidisciplinary, centralized, longitudinal course that spans the third year of medical school. This course addresses many underrepresented topics. Students spend one day every other week in Doctoring III. Half of the day is spent in community-based clinical sites and the other half is spent in small-group teaching sessions. In the small groups, students and faculty follow and manage a panel of simulated patients over the course of the year. The students thus have the opportunity to develop a sense of the progression of common illnesses over time and to explore related ethical, social, and other concerns. The approach taken in Doctoring III has enabled the UCLA School of Medicine to overcome many barriers to curricular change, and it may serve as a model for incorporating the teaching of underrepresented topics in the clinical years.