Should medical students practice patient-centered care?

Miller sees her doctor
In this 2011 file photo, Mary Miller visits with Dr. Elizabeth Seaquist at the University of Minnesota.
MPR Photo/Lorna Benson

As hospitals and clinics try to find ways to provide more patient-centered care, a few medical schools are using training programs that help instill the importance of the practice in future doctors.

The University of Minnesota has had such a program for more than four decades. The medical school sends a group of students to rural communities for nine months during their third year of school through the Rural Physician Associate Program. Now medical schools worldwide are interested in the model.

This year-long embedding of medical students in communities isn't common, said David Hirsh, director and co-founder of the Harvard Medical School-Cambridge Integrated Clerkship at Cambridge Health Alliance, on The Daily Circuit Thursday.

"The first couple years of medical school at most of the medical schools in the U.S. and abroad, people do basic science training," he said. "The hope is that the basic science would be foundational for research careers or careers where you'll do clinical medicine. After those two years then to get the clinical medicine to come to life, the students do these traditional block rotations."

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Kathleen Brooks, director of the University's program, said traditional clerkships during a student's third year of medical school involve meeting patients later in their diagnosis. The patient has likely already been seen by three or four people and had testing done.

"In this model, when students have the opportunity to see the patient on the front end of things, they may be the first person the patient is seeing and so they have an opportunity to see things at the very beginning without having information handed to them and to establish a relationship with that patient that they can carry forth," she said on The Daily Circuit.

Chris in Brainerd called in during the show to talk about his experience. He went through the University's program in Cambridge and has been practicing medicine for two years.

"It was by far the most valuable part of my medical experience," he said. "You see people in a community. I had seen people in clinic and then saw them in Target, and then saw them in surgery and participated in their surgery and then maybe saw their dad in the nursing home. For me as a family physician, the opportunity to take care of a family in all of those settings across a longer period of time was invaluable."

But Randall in Bemidji said he didn't find that first contact as valuable to his practice in osteopathy.

"I found that the training that I received that was closer to the hospital was much more important for my overall understanding of the chronic disease state than the initial interviews with patients," he said.

Hirsh said these patient-centered programs don't take away time from the training with chronic illness.

"It would be unacceptable frankly to not have intense training in acute environments in big hospitals in places where patients come in with the most severe health care needs," he said. "But our program does not in any way get rid of that. It's a third year core training where you have the opportunity to follow patients throughout an entire year, not just snapshots... You get first contact but you also get repeated contact... Of course, without a doubt, they must then return to places where they can see acuity and severe disease and things that are only found in the hospital."

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