Alexandra Hoffman, who goes by Ali, was eager to see how the science she had learned during her first two years as a medical student at Albert Einstein College of Medicine could be applied to caring for patients. Last spring, in the beginning of her third year, she began what are known as clerkships, where medical students participate on clinical teams. She got her first real exposure to inpatient care, which she loved.

Like her preclinical training, however, seeing patients hospitalized with a wide range of conditions felt very broad. So it was major shift in perspective when in April and May, she spent three weeks with the division of allergy and immunology as part of a new subspecialty experience that is a recent addition to the medicine and primary care clerkships. “Exploring medicine through a subspecialty gave me a whole new lens,” says Hoffman. “I got a sense for the first time of what it’s like to dive into a specific clinical problem that people might devote their entire career to.”

The new clerkship structure for the department of medicine, which launched in 2024, gives third-year medical students six weeks of inpatient care, three weeks of primary care, and three weeks with a subspecialty division, including critical care, infectious diseases, allergy and immunology, rheumatology, renal, endocrinology, and more.

Third-year medical student Alexandra Hoffman at her Albert Einstein College of Medicine White Coat Ceremony, with her grandfather, a rheumatologist.

“The new subspecialty medicine rotation enhances the clerkship by exposing students to diverse medical careers,” says Melissa Laudano, MD, assistant dean for clinical sciences education. “Students work both on the general medicine inpatient service where they often consult medicine subspecialists, and are embedded on subspecialty teams receiving those consultations. This provides students with a better sense of how care is provided while deepening their understanding of complex medical conditions, clinical reasoning skills, cultural competency, and empathy while caring for the Bronx community.”

Peer-to-peer learning

Each student is assigned to a subspecialty at random. Groups of students doing the subspeciality rotations at either Moses, Weiler, or Jacobi Hospitals meet together each week with their respective site directors: Ayush Sutaria, MD, assistant professor in the division of critical care, at Moses; Shilpa Vasishta, MD, assistant professor in the division of infectious diseases, at Weiler; and Perminder Gulani, MBBS, associate professor of medicine in the division of pulmonary and critical care, at Jacobi.

The small group meetings provide an opportunity for each student to share their experiences with their peers. “Each student's experience, be it in cardiology or critical care or rheumatology, is going to be very different from the others,” says Dr. Sutaria. “The goal is for each student to have a concentrated experience, while gaining exposure to other subspecialties through their peers. They teach each other.”

Students also present on a subspecialty case of interest, incorporating one piece of relevant literature that informed the care provided. “As an exercise, it very much mimics what we do as subspecialists when we’re called to consult on a case,” says Dr. Vasishta. “I tell students that reviewing literature is a big part of our work.”

Hoffman saw a patient during her time on the allergy and immunology service who turned out to be a very rare case. “We saw a really significant allergic reaction to a workplace substance that has barely been documented,” she says. “Dr. Manish Ramesh, division chief, really let me run with this.” Hoffman’s research found only one other known instance of anaphylaxis following exposure to the substance in question. She has continued to follow the patient with Dr. Ramesh and they are working to share the case study more widely.

Of her experience overall, Hoffman says, “The science I learned was fascinating and whole team made me feel at home. They pushed me to be as independent as possible, gave me confidence, and made me feel knowledgeable even as a third-year medical student.”

Walking in their shoes

The subspeciality clerkships also provide an important early exposure to how collaboration between specialties works. “When students understand what it’s like to be, for instance, a pulmonologist, and receive a call for a consult from a primary care doctor or a hospitalist, they have a better sense of what information they need to provide about a patient,” says Dr. Vasishta. “It strengthens their experience as future members of this increasingly team-based medical workforce.”

On a practical level as well, it exposes students to the day-to-day in different areas of internal medicine. Maybe rounding on hospitalized patients in the early morning doesn’t suit them. They may not realize they have the option of working in a clinic, or that some doctors round at different times of day, or perform procedures. “There are so many different versions of what a career in internal medicine can look like,” says Dr. Vasishta.

“I put emphasis on the unique things that each subspecialty offers,” says Dr. Sutaria. “If a student is on pulmonary, I send them to the robotic bronchoscopy suite to see these high-tech procedures. If they are on cardiology, I make sure they go to the echocardiography lab. We had students go on house calls with geriatrics attendings into patients' homes.”

A win-win

The new clerkship structure was designed with the medical students’ needs front and center. “Based on feedback we’ve received so far, the program is achieving our goal of giving students a wider understanding and experience of what internal medicine is, which is exactly what we were hoping for,” says Amanda Raff, MD, associate chair for undergraduate medical education in the department of medicine and the key architect of the new clerkship structure.

“Before doing this, I didn't think to seek out subspecialties within internal medicine,” says Hoffman. “This experience exposed me to more opportunities and encouraged me to explore areas of medicine I didn’t know existed.”

The subspecialty clerkships have an added benefit of providing a hands-on teaching opportunity for fellows and faculty who may not otherwise have a chance to work with medical students. “Some of these subspecialties are very complicated, and can take years of internal medicine knowledge to understand,” explains Dr. Sutaria. “It’s a great teaching exercise for our fellows to help make some of these topics accessible to our medical students.”

There are less tangible benefits as well. “Working with medical students helps me remember how amazing our field is—the interesting pathologies we see and advances in the treatments we are able to provide,” says Dr. Vasishta. “The privilege of working with patients really comes alive for me when I'm doing it with a student who is early in their clinical experience and we can reflect on it together. It humbles me and makes me feel fortunate to work in medicine.”

“It’s turned out to be a mutually beneficial arrangement,” says Dr. Raff. “The medical students are seeing and learning about medicine from a new vantage point, and our subspeciality services are really energized by their presence as well.”