Learning From Other Clerkships Through the Alliance for Clinical Education (ACE)

ACE was first formed in 1992 almost by the sheer force of one person – Dr. OJ Sahler. OJ was the first president of COMSEP. Shortly after COMSEP was formed, OJ contacted the presidents of the other national clerkship directors’ group that had a major teaching responsibility for the third-year curriculum and asked them if they were interested in sending up to 4 representatives to a meeting to discuss common issues. She chose the AAMC Annual meeting as the time because, in her own words, “…1) I had to be there on other business, 2) Brownie Anderson whom I have known from other contacts, was willing to help me find a room and 3) each president was able to find people from his/her respective group who were going to the AAMC on other business as well. Hence, our meeting at AAMC was initially totally a matter of convenience. By chance, however, I happened to read in the GEA Correspondent that the GEA was interested in reaching out more systematically to clerkship directors and I thought that what they had to say might be a good agenda item (I had no idea what we would talk about!). They agreed to attend because where else would they find representatives of all 6 groups gathered in the same room!?!” Parenthetically, Brownie did find us a room and even furnished coffee and cookies!

OJ goes on to say about the early activities of the organization, “The activities of ACE have been remarkable and include joint sessions facilitated by the GEA, a joint handbook and workshop for clerkship directors, and the joint “political” advocacy that arose out of the March COMSEP meeting.”

OJ, writing to the COMSEP Executive Board, also said, “For the purposes of the November 1992 meeting, I asked Fred McCurdy (then president-elect), Ardis Olson (because of her curriculum activities), and Jennifer Johnson (because of the clearinghouse) to join me. It was convenient for them to do so and they became the de facto COMSEP representatives to ACE.”

Early ACE Advocacy

Additional background history is important to better understand part of the “political” reference OJ made. In the early 1990’s the financing of medical student education was very much in question due to the proposed reforms in medical care proposed by the federal administration in Washington DC. So, as noted above, ACE was the “brainchild” of Dr. OJ Sahler, Professor of Pediatrics at the University of Rochester School of Medicine. One of her major concerns was the implications and implementation of the ACME-TRI Report (Educating Medical Students: Assessing Change in Medical Education – The Road to Implementation), published in 1993, which called for the interdisciplinary education of medical students. This report was published by the AAMC and was funded by the Charles Culpepper Foundation. The report’s goals were to: 1) Assess the extent of change in medical education; 2) Identify barriers to change; 3) Suggest ways to address the barriers, and 4) Create a plan of action to improve medical education. The report’s principal findings were: 1) A lack of oversight and leadership in medical education programs; 2) Limited resources and a lack of budget for medical student education; 3) Faculty inertia and a lack of incentive for teaching; and 4) A lack of evidence that proposed changes would improve medical education. The report’s recommendations included incorporating educational technology into teaching programs.

Thus, the early ‘90s backdrop in undergraduate education was that not only was it under duress but also under “fire” to produce better results. This served as a real impetus to gather all the teachers of medical students in required clinical clerkships to better deal with the “winds of change” that were swirling around in 1992. As OJ surveyed the landscape, she realized that there was no other organization like ACE and that there was power in numbers.

An Organization of Organizations Was Formed

The original 7 organizations that formed ACE included:

  • ADMSEP (Association of Directors of Medical Student Education in Psychiatry)
  • APGO (Association of Professors of Gynecology and Obstetrics)
  • ASE (Association for Surgical Education)
  • CDIM (Clerkship Directors in Internal Medicine)
  • CNCD (Consortium of Neurology Clerkship Directors)
  • COMSEP (Council on Medical Student Education in Pediatrics)
  • STFM (Society of Teachers of Family Medicine)

The guiding principles established by this original group were that each organization elects 4 representatives to ACE – term of service determined by each organization but typically three years – may be reelected, the Executive Committee composed of one member from each constituent organization – elected by the 4 representatives from each constituent organization – term of service typically three years, but can be re-elected, and the President elected by the Executive Committee – term of service three years, but may be reelected for two consecutive terms. At its inception, ACE had no by-laws, and it had no formalized mission vision and values. These would come later.

One of the first activities that ACE sponsored was a half-day workshop held at the AAMC Annual Meeting for new clerkship directors. This was held, I believe, 3 consecutive years with initial great attendance that then dwindled. The group most involved in this workshop began to discuss amongst themselves putting together a Handbook for Clerkship Directors. But no one had any money. In steps Brownie Anderson again along with Dr. Rhee Fincher (CDIM). Brownie was able to convince the AAMC to publish this Handbook and the Editor’s Note states:

“I want to express appreciation to everyone who contributed to the development of this Handbook, especially the authors who worked diligently to write a brief, yet practical guide. I particularly acknowledge Frederick Sierles, MD, Ajit Sachdeva, MD, Janis Work, PhD, and Lloyd A. Lewis, PhD for their valuable recommendations regarding the entire manuscript. I want to thank M. Brownell Anderson for facilitating publication of the handbook by the Association of American Medical Colleges and Margaret Rebecca Williams for her superb, untiring technical support.”  Handbook for Clerkship Directors (1995); Ruth-Marie (Rhee) E. Fincher, MD, Editor.

OJ Sahler was the first Chair of ACE (1992-1994). Fred McCurdy succeeded OJ in 1994-1995, Ajit Sachdeva was chair 1995-1999, Fred McCurdy became the President of ACE 1999-2004, and Lou Pangaro succeeded him in 2004.

Fred McCurdy guided ACE through developing a mission, vision and values over the years 1999 through 2001. Quoting the original version compiled in early 2001:

“The Alliance for Clinical Education’s mission is to foster collaboration across specialties to promote excellence in clinical education of medical students.

In support of its mission, the Alliance for Clinical Education will take a national leadership role in promoting:

  • the recognition of excellent medical education as the enduring core mission of medical schools with a concomitant commitment of adequate resources
  • collaboration, communication, and resource sharing among educators in different clinical disciplines, including a multidisciplinary approach to core competencies for medical students
  • innovation in medical student education based on well-designed research, especially as this applies across clinical disciplines
  • professional development of clinical medical educators 
  • service to our constituent organizations, other organizations in academic medicine, and students as a resource for information, ideas, and advocacy

The Alliance for Clinical Education uses the following values to guide all its operations:

  • Collaboration
  • Open Communication
  • Trust 
  • Commitment to Personal/Professional Development 
  • Innovation
  • Outcomes Focus”

Dr. McCurdy, also began the process of creating a set of By-laws. All the ACE constituent organizations formally ratified these in January 2007.

Additional ACE Activities

Beyond publishing a very popular Clerkship Director’s Handbook, ACE has also weighed in on managed care (Brodkey AC, Sierles FS, Spertus IL, Weiner CL, McCurdy FA. Clerkship directors’ perceptions of the effects of managed care on medical students’ education. Acad Med. 2002;77(11):1112-1120. doi:10.1097/00001888-200211000-00013), and the impact of pharmaceutical “detailing” on Medical Students (Sierles FS, Brodkey AC, Cleary LM, MCCURDY FA, et.al. Medical Students’ Exposure to and Attitudes About Drug Company Interactions. JAMA, 2005; 294 (9): 1034-1042.) as just two examples of addressing national issues that might negatively impact the third-year medical student experience. It has also opined on the role of the clerkship director in the larger academic enterprise (Pangaro L, Bachicha J, Brodkey A, et al. Expectations of and for clerkship directors: a collaborative statement from the Alliance for Clinical Education. Teach Learn Med. 2003;15(3):217-222. doi:10.1207/S15328015TLM1503_12.).

Fred McCurdy, M.D., Ph.D., MBA
Past President of ACE