Serving patients with unmet health needs is taking on a new meaning for medical students as they provide care for urban and rural patients both in patients’ homes and in their communities. The experiences also are providing clarity about the social determinants of health and the importance of continuity of care as students become more attuned to their patients’ needs.
The immersions into the clinics and greater community are part of the schools’ work with the AMA’s Accelerating Change in Medical Education Consortium. The consortium, working to modernize and reshape the way physicians are trained, brings leaders from schools together to share ideas and experiences with new programs that are designed to improve competency, leadership and patient care through innovations that bridge the curriculum gap between medical school and practice.
Students from the consortium schools recently came together at University of California, Davis, School of Medicine to share their experiences and gain insights from experts that they can put into practice throughout their careers.
Students at Florida International University Herbert Wertheim College of Medicine are embedded directly into underserved households in Miami-Dade County.
Students very early on see first-hand the challenges that some patients face in taking care of their health, and they gain skills to help the whole patient, said Onelia Lage, MD, FIU HWCOM’s chief of education and faculty development in the Department of Humanities Health and Society.
“They learn to address the social determinants of health for households, participate in health education, provide clinical monitoring of blood pressure, medication reconciliation, vital signs … and address social, behavioral, educational and legal needs,” she said.
The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP™) introduces first-year medical students during the NHELP orientation and the community practicum to the school’s community outreach team, which has relationships with more than 160 community partners. During their second, third and fourth years, students are part of an interprofessional team that includes at least one of the following: nursing, social work and physician assistant students. They go into households together to take care of individual families.
“Working with an interprofessional group in their preclinical years aims to prepare students to more effectively work with interprofessional teams later on,” Dr. Lage said.
The program has been teaching students this way for a decade.
Students say that they have become more knowledgeable about cultural differences, more comfortable working with interprofessional students, and more empathetic and sensitive to households’ needs, Dr. Lage said.
During the first week of medical school, students across University of Washington School of Medicine’s six regional campuses in five states embed themselves in a primary care setting. More than 250 preceptors in areas such as family medicine, internal medicine and pediatrics are helping the students with the hands-on learning. The change in the medical school curriculum took place in the fall of 2015.
“From the students’ perspective, it is probably their favorite part of the new curriculum,” said Michael J. Ryan, MD, the medical school’s associate dean for curriculum. “It makes the basic science they are learning stick much better because they are seeing how the science works [with real patients].”
It also reminds people why they went to medical school. “As they get burnt out on basic science, students can say ‘Yes. This is why I am in medical school,’ ” Dr. Ryan said.
For many students, working in a primary care setting reinforces the reasons they usually say they chose to go to medical school in the first place. The foundational science course can be challenging; seeing patients throughout the foundations phase makes the students say, “’Yes, this is why I am in medical school,’” he said.
The embedding is often in primary care offices in smaller rural communities, and students are there long enough to gain an appreciation for the continuity of care. For example, medical students are able to see a patient throughout the various stages of a pregnancy or an illness. And the students don’t just shadow a physician. They are expected to take patient histories and explore what brought the patient into the office.
“We are hearing that in their first year, some students have more confidence in talking to and assessing patients than previous students had,” Dr. Ryan said.
Going forward, students also will get hands-on experiences to learn about the health system, health systems science, and patient safety and quality initiatives.
These schools aren’t the only ones with innovative programs that embed medical students into patient care in their communities. Read more about how three other schools in the consortium are giving students this hands-on experience.
Additionally, Consortium founding members University of California, Davis, School of Medicine; Penn State College of Medicine; and Vanderbilt University School of Medicine, along with Morehouse School of Medicine, which joined the consortium in January, also have programs aimed at placing students in underserved communities so they can help patients and gain experience in the community.
You also can read more about consortium work in these articles: