By Diane Duke Williams
February 9, 2001
Kate Carlson, a student in the new Practice of Medicine course, gained valuable insight into her patient's life when she visited her home.
She learned that the woman lives with her mother, who donated a kidney to save her life. Her sister, who helps care for both of them, lives in the house, too. Carlson also discovered her patient's coping mechanism --her job as a teacher.
"You see them more as a person and how they're coping, not just as a patient in the hospital," Carlson said. "It gave me a better understanding of what it's like to be ill."
Students in Practice of Medicine, a required course for all first-year medical students, visit a patient at home and also spend three half-days shadowing a primary-care physician. These clinical experiences are new to the first-year curriculum.
"Students are privileged to interact with patients virtually from Day One, and both students and patients find this a valuable experience," said Stephen S. Lefrak, M.D., professor of medicine, assistant dean for the Humanities Program in Medicine and one of the course's leaders.
The class is the first part of a new three-year clinical curriculum about the interfaces among a doctor, a patient and society. Practice of Medicine incorporates and expands upon material previously taught in the Introduction to Clinical Medicine I, Medicine and Human Values I, Biostatistics and Epidemiology and Clinical Skills courses.
"We needed to teach students that taking care of a patient goes beyond the pathophysiology of disease," said Tom Gallagher, M.D., assistant professor of medicine and course director. "They need to understand how the illness fits into the patient's family or social support network and how to convince them to take their medications. We need to teach them to provide compassionate care."
Students in Practice of Medicine learn to interview and examine a patient, understand that patient's experience of illness, develop a diagnosis and involve the patient in the treatment plan. They also learn about ethics, health promotion and disease prevention, and epidemiology.
Additionally, the course uses a new problem-based learning style that teaches students how the course's different content areas relate to each other, how to synthesize material and how to gather resources on their own.
"Doctors do need to think about these issues simultaneously," Gallagher said. "For example, they'll learn how doctor/patient communication relates to health promotion."
Practice of Medicine also uses standardized patients --individuals trained to present the same scenario to each student and to observe the students' communication and physical examination skills --to assess the students' clinical abilities.
"This is important," said Alison J. Whelan, M.D., assistant professor of medicine, associate dean for medical student education and one of the course's organizers. "We as a profession need to be able to assure the public that we are training skilled, compassionate physicians. We also need for our students to be confident of their clinical skills."
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