Monday, 4 March 2013

For the Good of the Patient

This week's post is from guest blogger Anita Mathews, who writes about the value of real-world problem solving in medical education.

The rumors passed down through the ranks of pre-medical students from year to year are terribly daunting, and thankfully, many of them are untrue. There is, for instance, the notion that the courses one takes prior to entering medical school are tedious and far-removed from the type of material one will study in preparation for actually becoming a doctor. During the spring of my senior year, I found my own happy exception in the form of a class called Emergency Medical Systems, taught by two physicians who worked at local hospitals.

In addition to attending lectures and completing reading assignments, students were required to shadow doctors in local emergency departments as a core component of understanding the role of health care providers and the needs of patients. Our final project challenged us to draw from what we had witnessed in the hospital and create tools for patients to ensure that they cared for their injuries properly upon being discharged from the ED. Our instructors emphasized that, in devising these products, we should be cognizant of the low level of literacy among emergency room patients and come up with something simple and interactive.

I relished the opportunity the instructors for this course afforded us; rather than sit behind a desk and take a final exam, we were asked to exercise our capacity for creativity and use our personal observations to find feasible solutions for real people’s problems. Useful and usable hospital discharge instructions for patients could reduce hospital readmittance rates, improve outcomes, and prevent unnecessary expenses. It was a privilege and a valuable learning experience to pitch ideas with that kind of potential.

The course’s culminating symposium showcased a range of innovative ideas, including comic strips, instructional videos, board games, and stuffed toys. The projects were evaluated for cost effectiveness and execution in the hopes that the best ideas and demos could become real items used in the EDs where our course instructors worked as physicians. It was evident that many of the students chose to create care instructions based on the experiences they had had while shadowing at Rhode Island Hospital or Hasbro Children’s Hospital. Those that had seen Spanish-speaking patients created items that featured bilingual instructions, while others that had seen very young patients designed kid-friendly products that would put children at ease in frightening or painful situations.

Essentially, the students addressed the challenges that were unique to providing medical care within the state of Rhode Island -- more specifically, in the area around our university. Had we been asked to create hospital discharge instructions for medical centers elsewhere, the possibilities for identifying a problem and designing its solution would have been endless. Effective care guidelines following a visit to the ED could vary greatly in medium, depending on location of the hospital and its resources, as well as the range in socioeconomic status of patients served. The most common types of injuries (which might differ between a conflict zone and a rural setting, for example) would also have to be taken into account. I imagine that remotely creating a product for a hospital no students in our class had ever visited would have required more extensive research and perhaps the chance to learn more about the delivery of emergency care in various contexts.      

This final assignment reflects a growing trend in medical education toward placing team-based problem solving at the heart of the curriculum. At many medical schools across the country, students in their pre-clinical years are working together to determine the diagnosis and appropriate treatment of a practice patient’s case. Rather than relying solely on lectures, medical educators are incorporating team-based learning (TBL) to encourage students to learn through application and simulation of the types of challenges they will see later on. Schools are finding that by pairing traditional course formats with TBL, they are able to cater to a wide variety of learning styles and engage students more thoroughly. Then, once it is time to go from the classroom to the clinical setting, students who have dealt with real cases will be able to make the transition with a bit more confidence.

For young people who hope to one day shape the health care system, these opportunities to take a practical approach to acquiring scientific knowledge are invaluable. In a field that requires both mastering an ever-growing knowledge base and maintaining a finely-tuned sense of empathy, there’s no such thing as too much practice. And of course, what’s good for the doctor-in-training is bound to be good for the patient.

Anita Mathews will be a first-year medical student in August 2013. Since graduating from Brown University with a bachelor’s of neuroscience last year, she has worked as a Health Policy Fellow at a think tank in Washington, D.C., contributing to public health op-eds for the Huffington Post.

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