As First Class Graduates, Columbia-Bassett Students Reflect On the Unique Experience

If the Columbia-Bassett Program set out to give a handful of medical students a close-up look at patient care in a nonurban hospital system while opening their eyes to myriad career possibilities in a changing health care landscape, the program delivered. Eight of the 10 original Columbia-Bassett students—with home states listed as Arizona, California, Kansas, Massachusetts, New York, and South Dakota—graduate in May 2014 from P&S, the first students to complete the innovative program begun in 2010 to combine traditional medical education in New York City with hospital-based outpatient and inpatient clinical education at Bassett Medical Center in Cooperstown.

The other two students are on course to graduate—one after an extra year to earn a master’s degree in public health and another after completing military service in his native South Korea. The graduating students plan to specialize in urology, emergency medicine, medical school or hospital administration, pediatric neurology, family medicine, international surgery, internal medicine (either cardiology or gastroenterology), and pediatrics/neonatology. Variously described as a rural medicine curriculum, a primary care curriculum, and a health care delivery curriculum, the “Bassett track” is all that but should not be limited to those definitions, says Henry Weil, MD, assistant dean for education at Bassett. “This program emphasizes relationships on all levels—relationships among students and patients, fostered by the longitudinal curriculum; among students and more senior physicians, like the preceptors assigned in their yearlong clinics and the single mentor each student is assigned upon enrolling in the program; among students and the rest of the medical staff; and, perhaps most significant, relationships among the students themselves.”

A common theme among the Columbia-Bassett graduates who discussed their experience is the feeling of family among the group of Columbia-Bassett students and the wider Bassett and Cooperstown community. “The Columbia-Bassett Program had a small, personal, familylike feel within the context of a large, diverse, academic powerhouse of Columbia,” says Monika Laszkowska. “The Bassett community embraced our presence and faculty proactively found ways to enhance our learning. Our preceptors got to know us well over the course of the year and could really speak to our strengths and weaknesses as we developed as clinicians.”

Columbia-Bassett students (10 students have been chosen each year since 2010) spend the first 18 months of medical school in New York City, studying basic science fundamentals alongside P&S classmates. In January 2012, the inaugural class started core clinical rotations at Bassett. After 10 weeks of “rapid inpatient blocks” in ob/gyn, surgery, neurology, and psychiatry, the students started a 40-week longitudinal patient care curriculum. They rotated through primary care and specialty clinics, says Walter Franck, MD, Columbia’s senior associate dean at Bassett, and built panels of patients they followed throughout the students’ time at Bassett. “This allowed students to work with people in the fullness of their journey in pursuit of health, cure, or palliation, as opposed to only seeing patients in isolated, brief, intense periods of illness,” adds Dr. Weil.

“The Bassett program’s longitudinal curriculum gave me an interesting view of medicine, and I settled on emergency medicine after I watched a few of the patients in my portfolio come through the emergency room,” says Allan Guiney, who did not have a specialty chosen when he started medical school. Mr. Guiney grew up in Cooperstown. “Both my parents worked as physicians at Bassett, so I expected that the Columbia-Bassett program would be a unique opportunity for me to learn medicine in a community where I had deep roots. The program provided that, and also a lot more. It was rewarding to follow patients throughout the gamut of their medical care.”

“We were able to take ownership of our patients and follow them across a variety of services and specialties,” says Ms. Laszkowska. “Both the longitudinal program and the opportunity to work for a full year in one hospital system lent itself well to some amazing student-patient relationships. From helping to deliver my first baby, to my first surgical case, to my first time helping to break the news of a new cancer diagnosis, to my first patient death: These are all experiences that made a huge impact on me during my clinical development and helped shape me as a doctor and an individual.”

For Haley Masterson, the unique curriculum contributed directly to her decision to pursue pediatric neurology: “The structure of the longitudinal curriculum involves repeated exposure to different specialties, so when I found myself drawn to pediatrics and neurology, I knew it wasn’t just because of one preceptor or one particularly good month; it was the cumulative effect of two specialties that had a profound impact on me over the course of 10 months, multiple clinics, and multiple preceptors.”

Freda Ready credits the longitudinal curriculum with allowing her to explore various areas of medicine at her own pace. “The faculty was fully engaged in my education, and many of them have been my advocate with residency programs as I go through the match process.” She plans to return to Africa to pursue a career in international surgery. For her scholarly project, she studied barriers to treatment for women with endometrial and ovarian cancers in Cape Town, South Africa. “The performance improvement training at Bassett helped me think about how to define the problems with the health care system that were contributing to delays.”

“I could not have predicted how profound my patient experiences in the longitudinal clinical curriculum would be,” says Katherine Schwartz, who plans a career in pediatrics and may specialize in neonatology. “I have had a fairly roundabout path to pediatrics. I entered medical school thinking I would go into ob/gyn, but as I was going through my first year of medical school I realized that I liked almost everything. My first semester I was able to shadow in anesthesiology, neonatology, obstetrics, and emergency medicine, and I had the privilege of seeing several organ transplantation surgeries. When I started my major clinical year in Cooperstown I began ruling things out and I quickly came to know that what mattered most to me was the interaction with patients and their families during challenging times, and by the end of the year I was deciding between ob/gyn and pediatrics. Doing a sub-internship in the NICU I realized that pediatrics, and specifically neonatology, could give me all the things that I had identified as being important to me in medicine: contact with patients and their families, variety of pathology and acuity, and procedural work.”

The Columbia-Bassett Program not only introduced medical students to a range of career choices as physicians, it also introduced students to the idea of a career in medical education. “A big change to my career plans that developed during medical school was my desire to pursue medical education. This was not really an area I had even considered before entering medical school,” says Krista Suojanen, who plans a career in internal medicine first as a clinician educator then in an administrative role. “I had a number of fantastic teachers who really got me excited about learning and about medicine and made me realize what an impact those involved with medical education could have.”

While most Columbia-Bassett students did not have a specialty chosen when they started medical school, some kept to their original plans while others changed their minds. Blake Alberts, a native of South Dakota, plans a career as a urologist. “My career plans were far from certain when I began medical school, but they probably remain quite similar to the loose plans I had entering P&S. I chose to enroll in the Bassett program so that I could better understand rural health care delivery, and now I hope my future career involves developing an improved delivery model for rural urology care.

“I would enjoy leading a urology division within a large integrated health system. My home state is South Dakota, where health care has largely been taken over in the last 10 years by two competing integrated health systems. While there are downsides to this, I think it provides opportunity for a rural state like mine to expand specialty health care services to regions that have never before had access. Currently, urology remains exclusively private practice in South Dakota; however, if it has not already occurred by the time I finish training, I would be thrilled with the opportunity to return to South Dakota as a fellowship-trained urologist, poised to develop a urology program within one of these large systems.”

Andrew Gomez initially planned on a career in orthopedic surgery, a good match for his undergraduate mechanical engineering degree. He now plans a career in family medicine. “There are several reasons why I changed directions. First, as a naïve first-year medical student I was drawn to the allure of surgery without much consideration of the reality of the hard work involved. I prefer to maintain a certain work-life balance, which seems challenging in such a rigorous field like surgery. I credit the Columbia-Bassett program for providing me with the information to make an informed decision regarding the future of primary care and my potential role in this field,” says Mr. Gomez.

“I hope to be a physician who is comfortable treating a wide range of diseases. There are certain ingredients that I think will lead to my satisfaction as a family physician, including building therapeutic relationships with my patients, teaching (patients or students), and integrating my background as an engineer and entrepreneur. Family medicine affords me an array of possibilities in terms of these considerations, which range from starting a clinic in another country, developing and implementing lean process technologies, or simply working as an employee at an ACO,” adds Mr. Gomez.

Photo: Jörg Meyer

A unique aspect of the Columbia-Bassett Program is the SLIM (Systems, Leadership, Integration, and Management) curriculum, which incorporates business and public health coursework to help students understand the U.S. health care system through study of care delivery, strategies for quality improvement, and cost and payment issues. “The SLIM curriculum gave us a really unique gateway to learning about health care systems management and policy from professors at the Columbia Business School and the Mailman School of Public Health, various speakers who are leaders in health care, and hands-on performance improvement projects with clinical and administrative mentors at Bassett,” says Ms. Laszkowska. “I have a strong appreciation for how empowering I found the SLIM curriculum to be. Through carrying out my own projects, I saw just how difficult and important it is to continue to refine how we deliver health care to patients. Most importantly, I realized that the scale of such efforts can vary from an individual doctor working to make their practice more efficient to an entire institution acting to try to improve patient safety and outcomes. I learned the importance of asking the right questions, and I was able to build a tool set that enables me to use data-driven, collaborative approaches to find the right answers.”

“Our SLIM curriculum exposed us to important aspects of medicine (policy, politics, business) not always taught in med school,” adds Mr. Guiney.

Adds Mr. Alberts: “The Bassett program provided me with a 30,000-foot view of the health care system that few medical students get without taking time for an MPH or MBA. My residency will include one year of dedicated research time, and I hope to use the knowledge I picked up in the Bassett SLIM curriculum and apply it to urology.”

“I’ve become interested in the arena of quality and performance improvement in hospitals so I could see that playing a role in my eventual career path as well,” says Ms. Suojanen. “I think there are huge changes to come in health care that have started to begin to take shape during these four years that make it hard for me to completely envision what the future will hold.”

For Mr. Gomez, the SLIM curriculum’s use of statistics, scientific papers, speakers, and other evidence “clearly delineated the need for a stronger and more effective primary care system in the United States. I’m encouraged to see innovative thinkers in medicine looking toward the engineering field for its wisdom in reducing undesired outcomes, implementing lean strategies for mitigating waste, and using information technology, among other examples.”

Like all P&S students, the Columbia-Bassett students completed scholarly projects, and several of the projects related to the SLIM curriculum or were carried out in Cooperstown. Mr. Alberts integrated concepts from the SLIM curriculum to study hospital readmissions among patients undergoing radical cystectomy for bladder cancer. Mr. Gomez developed a predictive model to prevent unnecessary meniscal surgery following a traumatic knee injury. Ms. Laszkowska worked on a cardiology project with two Bassett mentors to assess the relationship between chest pain perception in cardiac ischemia and sensitivity to capsaicin. Ms. Suojanen’s medical education project focused on whether aspects of communication can be taught and the ideal time for teaching the skills; members of the Columbia-Bassett Class of 2015 were study subjects.

These Columbia-Bassett students acknowledge the risk of being the first students in a new program. “I knew that choosing the Columbia-Bassett program would be a risk, as it was a new program,” says Ms. Suojanen, “but the ability to train in both a small hospital in a rural area of New York and a large academic center in the middle of NYC was an invaluable opportunity and one that deeply enriched my education and overall experience.”  

Ms. Masterson also acknowledges the uniqueness of the opportunity: “I cannot express how grateful I am to have been given an opportunity to be part of the Columbia-Bassett program, particularly the inaugural class. I think chances like this come across only once or twice in a career, and I’ll always be thankful that I said yes to this one.”

“My experience at P&S,” says Mr. Gomez, “has been a whirlwind which will require much introspection and processing long after this experience ends.”

Aside from the accolades for the Columbia-Bassett curriculum, Bassett mentors, and the experience itself, the inaugural Columbia-Bassett students reserve their strongest praise for each other and their New York City-based classmates.

Mr. Alberts: “The group of 10 that traveled to Bassett became a strong family unit. We did everything together during our major clinical year, and I anticipate we will be a group that assembles at Bassett reunions for years to come.”

Mr. Gomez: “I feel remarkably privileged to be part of a long tradition of medical students that have trained here. One major reason I chose P&S was because I wanted to be surrounded by a diverse set of talented peers. My expectations were far exceeded in this regard as I’ve had the fortune of meeting other engineering-turned-medical students, students who worked in finance, were artists, travelled the world, and many who are just incredibly smart.”

Mr. Guiney: “Looking back now, I see that nearly every aspect of my education at P&S was top-notch, but the thing that made the biggest impact was the quality of the students I learned with.”

Ms. Schwartz: “I could not have predicted how close I would get with my fellow classmates.”

Mr. Alberts realized how unique P&S is during rotations last summer. “I rotated at top institutions with students from other top medical schools. They learn the same pathology we learn at P&S, but they are not doing it in NYC at a school that encourages its students to pursue everything from rugby to theater. During my senior year of college, I was deciding between P&S and a school back in the Midwest. I am grateful I chose P&S.”

My Columbia-Bassett Experience

By Monika Laszkowska’14

Coming into medical school I was very undecided in terms of what field of medicine I wanted to pursue. The longitudinal curriculum of the Columbia-Bassett Program gave me the flexibility to thoroughly explore my interests in a range of medical fields and specialties and allowed me to make an educated, confident decision about my future career plans. Furthermore, I have strengthened my interests in both medical education (through activities like my role as the curriculum representative for my P&S class) and health care systems improvement (through the SLIM curriculum, described below), and these experiences have strengthened my desire to incorporate both into my future career plans.

The Columbia-Bassett Program exceeded my expectations. As the first class starting a new program that overhauled certain traditional approaches to medical education, we all had some trepidation; however, things have gone far better than any of us could have anticipated. I credit this to the incredibly supportive nature of the deans and faculty at both the Bassett and Columbia campuses. Everyone was really invested in ensuring that our experience went smoothly. Our deans at Bassett, Dr. Henry Weil and Dr. Walter Franck, met with us weekly to make sure all aspects of the program were meeting our needs and expectations. There was an open feedback loop and any issues that did arise (glitches in the paging system notifying us about our longitudinal patients, for example) were promptly addressed.

The longitudinal curriculum offered a unique opportunity to build strong relationships with patients and faculty alike. The Bassett community embraced our presence, and faculty proactively found ways to enhance our learning. Our preceptors got to know us well over the course of the year and could really speak to our strengths and weaknesses as we developed as clinicians. We were able to take ownership of our patients and follow them across a variety of services and specialties. The flexibility of the curriculum gave us an incredible opportunity to explore our career interests.

The SLIM curriculum (for Systems, Leadership, Integration, and Management) gave us a really unique gateway to learning about health care systems management and policy from professors at Columbia’s Business School and School of Public Health, various speakers who are leaders in health care, and hands-on performance improvement projects with clinical and administrative mentors at Bassett. This aspect of the program offered an immersion into aspects of health care that most medical students don’t have the opportunity to gain exposure to. I have a strong appreciation for how empowering I found the SLIM curriculum to be. Through carrying out my own projects, I saw just how difficult and important it is to continue to refine how we deliver health care to patients. Most importantly, I realized that the scale of such efforts can vary from an individual doctor working to make a practice more efficient to an entire institution acting to try to improve patient safety and outcomes. I learned the importance of asking the right questions, and I was able to build a tool set that enables me to use data-driven, collaborative approaches to find the right answers.

For the first year and a half of the program, we were part of the greater Columbia class for the preclinical courses such as anatomy, molecular mechanisms, and body in health and disease. We were able to learn from the accomplished Columbia faculty and develop basic clinical skills through the Foundations in Clinical Medicine curriculum. In January 2012, we made the move to Cooperstown and began our Major Clinical Year experience at Bassett. This included the longitudinal rotations and SLIM curriculum, as well as added experiences such as a humanities course, a communications lecture series, and clinical skills workshops at the Active Learning Center (our simulation lab). Like our P&S classmates, we prepared for Step 1 in January and February 2013, and then in March 2013 returned to Cooperstown to complete our family medicine rotation at one of Bassett’s satellite clinics. Finally, we continued to pursue our individual interests during the Differentiation & Integration phase, when we were able to pursue electives and research at the Columbia campus or at Bassett.

It was incredible to have access to resources at both the Bassett and Columbia campuses. The Columbia-Bassett Program had a small, personal, family-like feel within the context of a large, diverse, academic powerhouse of Columbia.

I have had a fantastic experience at P&S, and I continue to be impressed with how supportive the administration, faculty, residents, and students are in the Columbia community. My time at Columbia has given me the opportunity to work with world-renowned experts in a variety of specialties and gain exposure to cutting edge research that is helping to change how we practice medicine. I am excited as I look forward to starting my residency training and putting the skills I have acquired over the last four years into practice.

Without a doubt the most memorable part of my medical school experience has been my fellow students, both in my Columbia-Bassett class and in my P&S class as a whole. It is a humbling experience to be surrounded by so many brilliant, accomplished individuals who are at the same time so genuine, caring, and fun-loving. I am proud to call them my friends and colleagues, and I have learned some of the most important lessons about medicine (and life) from them.

Also memorable are the patient experiences I had over my whole medical school career and especially during my Major Clinical Year at Bassett. The longitudinal program’s opportunity to work for a full year in one hospital system lent itself well to some amazing student-patient relationships. From helping to deliver my first baby, to my first surgical case, to my first time helping to break the news of a new cancer diagnosis, to my first patient death: These are all experiences that made a huge impact on me during my clinical development and helped shape me as a doctor and an individual.

I pursued my scholarly project in the field of cardiology with two mentors at Bassett Hospital, Dr. Patrick McNulty and Dr. Dhananjai Menzies. My project focused on assessing the relationship between chest pain perception in cardiac ischemia and sensitivity to capsaicin. This is a clinical research project I carried out on the Bassett campus. I have had tremendous amounts of support from my mentors, the staff of the Bassett Research Institute, as well as the Scholarly Project program at P&S throughout my research experience.

I matched to an internal medicine residency at NewYork-Presbyterian/Columbia. My clinical interests lie in the fields of cardiology or gastroenterology, and I intend to subspecialize in one of these areas in the future. While I hope to have a career that is largely rooted in clinical practice, I am also very interested in health care systems improvement, medical education, and clinical research and I hope to continue to be active in these areas throughout my career.