Using actors to help train medical students

Milwaukee NBC affiliate TMJ4 ran a story this week about the STAR program at the Medical College of Wisconsin, which uses local actors to help medical students prepare for future patients. The use of standardized patients isn't new, but it is nice to see a community perspective on a very effective and memorable medical student teaching tool

New ways to interview potential future doctors

The New York Times had an article about new techniques that medical schools are using to interview potential medical students and future doctors. Rather than depending exclusively on test scores, grades and a single interview, some medical schools are using several smaller interviews, where potential students are asked to grapple with some of the issues facing the practice of medicine, including ethical issues and issues with insurance. The idea is to identify students with strong communication and interpersonal skills, skills which will be important to navigating the health care system. While grades are an important indicators of whether students will be able to handle the workload of a career in medicine, communication skills are an important indicator of how well the students will be able to provide care as doctors.

Worry about aging doctors

The New York Times had an article earlier this week about aging physicians and concerns about their abilities. It is a delicate social and communication task to talk to someone who has dedicated their life to a career that it may be time to give it up. Hospitals and governing bodies are wondering if the solution is to require reaccreditation or some other testing once physicians reach a certain age. But requirements for accreditation among physicians are not uniform and are difficult to enforce with any meaning. But whether testing is required or not, fellow physicians may find themselves in the position of having to discuss declining abilities with another physician. It is not an east conversation, but an important one.

Teaching with patients, from the beginning

The New York Times had an article today about a medical school program that is turning the traditional medical student schedule on its head. New York University is now exposing students to patients from their very first day as medical students, rather than waiting until they are third year students as many traditional programs do.

NYU is not the first program to introduce a patient element in the first year of medical school. But such efforts point to medical schools' awareness that the process of medical education can be emotionally draining. Students who lose sight of why they are training to be doctors may find themselves experiencing "empathy erosion." Patient contact from the beginning helps these physicians in training remember they are learning not to treat diseases, but to treat patients.

The role of simulated patients in medical education

Dr. Pauline Chen's Doctor and Patient column last week focused on the role of simulated patients in medical education. The article sheds light on a practice that few outside medical education get to see. The simulated patients and situations can be quite complex and allow medical educators and students to practice procedures in a safe, standardized environment. Standardization is also important in assuring that students are trained in the same way, creating an environment where best practices can be reinforced from the beginning of a student's education.

Of course, simulated patients and medical scenarios can only go so far. There is absolutely no substitute for real-life experience. But students and teachers are finding that the simulated patients can provide a valuable place to start gaining that experience.

Measuring what it takes to be a good doctor

Dr. Pauline Chen's Doctor and Patient column in last week's New York Times explores the tests that act as gatekeepers for those who would pursue a career in medicine. The tests are used, in part, to determine who has what it takes to be a doctor. But do these test miss some key component of personality when it comes to measuring who will be a great doctor? Or is knowing the right answers on a test more important than any measure of personality?

Medical students behaving poorly

Several media outlets reported on a report this week from the Journal of the American Medical Association about medical students behaving poorly online. With the increased use of social media web sites, more schools are reporting incidents of poor behavior, including profane language, drunken behaviors, and sexually suggestive material. But few medical schools have policies of professionalism that extend to students' presence online. The report shows that medical schools have much work to do to address emerging technologies and work on ways to teach future doctors how to navigate the online social media world in a professional and appropriate manner.

Medical students experience the ills of the health system firsthand

The New York Times had an article today about how medical students at the University of Washington spent their summer in underserved rural areas and clinics, where they learned firsthand about the ills of the American health care system. The students not only learned about how busy these clinics are, but also about the realities of reimbursements, matching prescriptions to Wal-Mart's $4 generic list, and ordering extra tests as protection against lawsuits.

The education the University of Washington medical students received working in those clinics cannot be found in any textbook or lecture. Seeing how the problems in the health care system affect real patients has the potential to open eyes and spur these young soon-to-be doctors to action, whether that action be advocacy for their individuals or advocacy on a policy level. And seeing how the health system affects patients will help prepare physicians to communicate and empathize with their patients as they navigate their way through the system and to good health.

Experiencing a patient's perspective firsthand

The New York Times featured an article today about an innovative geriatric education program, in which medical students have the opportunity to experience life in a nursing home. Medical students at the University of New England are given a diagnosis that an elderly patient might have and spend two weeks living as a patient with that diagnosis, including medical exams, being assisted in and out of bed, and passing the time with other nursing home residents. The goal of the program is that the two week experience better equips future geriatric doctors to interact with and understand their elderly patients. When clinicians can empathize with their patient's situation and actions, they will be better able to communicate with their patients about their medical and quality of life needs.

Nurses and physicians learning from each other

I enjoyed the article yesterday from Registered Nurse Theresa Brown in The New York Times Well column. She examines the relationship between nurses and physicians, and how both learn from each other. Nurses learn from doctors and younger doctors often learn from the experience and guidance of nurses. I thought the final quote was particularly pointed: "There’s always more to learn, and no matter how hard any of us try, there’s rarely enough time for one person to learn it all."

More on pharmaceutical companies and physicians

The New York Times had an article today about an Institute of Medicine report that advises stopping the flow of gifts from pharmaceutical companies to physicians. While pharmaceutical companies have voluntarily stopped giving small gifts, such as pens and notepads, earlier this year, but the IOM report goes even further, recommending the end of industry-sponsored medical education courses. The recommendation to end industry-sponsored education courses is the most controversial, because many physicians and the companies argue that the courses provide a valuable and necessary service, to educate physicians about rapidly changing medical advances. But others warn about the dangers of bias and influence that pharmaceutical companies wield.

who should be a doctor?

The New York Times reported on a case from Sweden that raises the question of who should be a doctor, or who shouldn't be a doctor. The questions arise from several cases in Sweden of people with criminal backgrounds getting into top medical schools. Because medical schools in Sweden are not allowed to conduct background checks, it raises questions or where and when they can limit who practices medicine.

You can find the article here.

What do you think? How should Sweden approach it?

How one case changed medical education

It can be easy to forget the many of the rules and regulations in place in medical education and medical research were put in place because of specific cases. Real people are behind the push for greater regulation, oversight and safety. And sometimes it can be one case that is the catalyst for a major change. Such is a case of Libby Zion, who died 25 years ago this week. Her death at New York Hospital while under the supervision of harried residents with little or no sleep lead to reforms in work hours and supervision rules for medical residents all over the country. Dr. Barron Lerner offers a compelling account of the case and the rules put in place since then here.

Dr. Pauline Chen examines some of the implications and ethical dilemmas raised by the hour restrictions. Among the consequences are errors and problems with patient hand-offs, when one shift of physicians briefs an oncoming shift and the ethical dilemmas when residents are faced with the prospect of leaving a patient they are compelled to stay with and being in violation of, or even lying about, their hours in the hospital. You can find the article here.

pharmaceutical companies and medical education

The New York Times Business section published an interesting article today about a group of medical students and faculty at Harvard Medical School pushing for greater disclosure of the relationship between pharmaceutical companies and faculty teachers. The article and the comments on the NYT web site raise an interesting discussion. Those who advocate full disclosure and even the removal of pharmaceutical money and interest in medical schools content that medical education must be objective and cannot be so if faculty members are paid by pharmaceutical companies. Others contend that pharmaceutical money, used responsibly, is absolutely necessary to support important medical research and innovation that is being conducted on medical school campuses across the country.

What do you think? How can pharmaceutical money be used by medical schools responsibly? Is it time to get pharmaceutical companies out of medical schools? Is that even possible?

positive reinforcement in medical education

Dr. Pauline Chen writes in her column in today's New York Times about positive reinforcement in medical education. tI's easy for Dr. Chen and any other doctor to come up with stories of abuse and yelling and negative reinforcement directed at medical students and residents by attending physicians. Is the approach detrimental? Is it necessary? Medicals students are learning life and death procedures. And if someone is making a potentially deadly mistake, it certainly needs to be corrected immediately. But is there a better way correct mistakes and teach students along the way?

You can find the article here: http://www.nytimes.com/2008/11/07/health/chen11-06.html?partner=permalink&exprod=permalink

And the discussion here: http://well.blogs.nytimes.com/2008/11/06/no-praise-for-doctors-in-training/

burnout in medical education

The New York Times published an article yesterday about burnout and suicidal ideation among medical students. No one is surprised that medical school is hard. That’s perhaps an understatement. But combine the massive amount of information you are supposed to absorb with an ultra-competitive environment, and the thought that complete failure is just one slip-up away, and you have a group of students ripe for complete burnout or worse. The other implication of this is that such completely burned out students lose the ability or desire to empathize or effectively communicate with their patients. They are just trying to get through the day.

The question is whether anything can be done about this. Medical school is hard. There is a vast amount of information you simply have to learn in a limited period of time. Practicing medicine is hard. There are a million decision that need to be made, many of them a matter of life or death. There is nothing you can do to change that. But can or should medical school try to change or soften the environment in which the students learn?

The comments on this article were varied; everything from those who exhort students saying “Medical school is hard. Deal with it, quit whining, or find another profession,” to those who believe the model for how medical students and residents are educated must be completely turned on its head. Is it a matter of screening incoming medical students better to measure who will be able to handle the high-pressure environment or is it a matter of monitoring students mental health better before the stress gets dangerously high? But if such burnout impacts the students’ ability to ultimately practice medicine, most would agree that something needs to be done.

You can find the article here: http://www.nytimes.com/2008/10/31/health/chen10-30.html?partner=permalink&exprod=permalink

And the comments here: http://well.blogs.nytimes.com/2008/10/30/the-misery-of-the-med-student/

Literature and medicine

The New York Times published a compelling article today about the growing use of literature courses in medical school and residency programs. The courses are intended to help physicians grow and foster empathy for patients. And there is growing research that the programs work.

You can find the article here:http://www.nytimes.com/2008/10/24/health/chen10-23.html?partner=permalink&exprod=permalink

And the comments here: http://well.blogs.nytimes.com/2008/10/23/combining-literature-and-medicine/

One of the most compelling comments was that these courses are indeed valuable, but they should be taught by literature professors, not medical doctors. But some of the doctors who commented on the article disagreed, saying it was more important to emphasis the relevance to the patient narrative rather than literary technique. Like the literature professor, I have sometimes wondered about the fact that M.D.s rather than communication professors teach medical students communication skills. It is not just that literature professors or communication professors hold specialized knowledge about their topic, which they certainly do. It is about the fact that professors from outside the medical field bring a new perspective and push medical students to get beyond thinking like doctors and get them to think as members of the human community. Senior physicians can certainly guide young physicians in how to pull all they have learned together in the patient setting. It seems that if we want a doctor that is technically astute and also expressive and empathetic, there has to be many teachers and many different kinds of textbooks to make that happen.

Monday round-up

Three interesting articles in the wide world of mass media that I just couldn't pass up. The first two are from my local newspaper, The Milwaukee Journal-Sentinel.

The first article is about a fourth grade teacher who took her own illness as a chance to teach her students about medicine. Their lessons included a trip the hospital and a surgical suite and visits from a surgeon, a nurse, an anesthesiologist and a surgical technician who explained their jobs and answered all their students questions. Students learned about robotic surgery techniques and all the hard work it takes to become a doctor. And in the process, the students also learned about the complexity of keeping people healthy.

You can find the first article here: http://www.jsonline.com/story/index.aspx?id=761844.

The second article from my hometown paper is about a program at the University of Wisconsin School of Medicine to help first year medical students learn about their future patients by partnering them to learn about and from older adults. Students learn that the realities of old age do not always fit the stereotypes and that health issues encompass far more than a list of symptoms. Everyone hopes the students will carry these lessons with them as they grow in their medical education and face the hard realities of ever-shortening visit times.

You can find the second article here: http://www.jsonline.com/story/index.aspx?id=761843.

And finally, in entertainment new, the American Medical Association is furious about the "gratuitous depictions of smoking" in the new movies The Incredible Hulk. Apparently the bad guy is almost never seen without a cigar in his mouth. The physicians' group is worried about a movie marketed toward children with any references to tobacco use.

You can find the final article here: http://www.nytimes.com/2008/06/16/business/media/16smoke.html?ex=1371268800&en=da83254074d41053&ei=5124&partner=permalink&exprod=permalink.

two interesting articles

Yesterday evening I was occupied at an Association of Clinical Research Professionals meeting so I didn't get a chance to post this interesting article from CNN about whether the Tuskegee syphilis trial still has repercussions for African Americans participation in clinical trials today. It is an interesting article that examines whether African Americans distrust clinical trials, or if they do not have equal access to opportunities to participate in clinical trials. You can find the article here: http://www.cnn.com/2008/HEALTH/03/17/clinical.trials.ap/index.html.

Today's New York Times ran an article today on trends in medical education, specifically the trend towards specialization in the highly competitive fields of dermatology and plastic surgery. While dermatology was once derided by other medical specialties, new research is drawing in more medical students and residents. Also enticing is the promise of high pay and stable hours as compared to other medical professions. But this has implications for medical care in that fewer doctors are specializing in primary and preventative care, which have longer hours and lower pay. The article explores these issues here: http://www.nytimes.com/2008/03/19/fashion/19beauty.html?ex=1363665600&en=6af29d977d525093&ei=5124&partner=permalink&exprod=permalink

People will talk

Today I had the opportunity to sit in on a Medicine and Humanities class at MCW. The topic of the class was the Carey Grant movie People Will Talk http://www.imdb.com/title/tt0043915/ and the image of the ideal doctor. Fourth year medical students discussed how an ideal doctor behaves and how and when a doctor may decide to cross ordinary boundaries for the sake of caring for the patient. It was interesting to watch the student cringe with some of Dr. Praetorious' actions, but at the same time admire the heart behind those actions.

Every doctor who seeks to practice with compassion and empathy may have to risk crossing boundaries, and even maybe making some people squirm, to provide the best care possible. And doctors can learn a little bit here and there from watching the example of others.