News

Colo. Medical Students Taught Proper Bedside Manner Along With Medicine

Jakob Rodgers

05/10/2016

May 09--Michael Cookson knows being a doctor means spending time in a car.

He expects to zigzag across Colorado Springs this year, seeing patients in different clinics throughout each day.

And when he greets them, he knows his bedside manner will be just as important as his diagnosis.

He's a step ahead of many other doctors-in-training. It's rare to get such practical information in medical school.

For decades, U.S. universities have taught medical students using the same model -- one that a growing number of experts say is outdated and a poor fit for today's health care industry. Studies show some students graduate medical school burned out and ill-prepared to be doctors -- leaving patients at risk of lower-quality care.

Aiming to buck that trend, leaders running the new University of Colorado School of Medicine's branch campus in Colorado Springs are employing a different brand of training for third-year students -- one that teaches compassion along with diagnosis and treatment. It's aimed at creating better doctors.

Their work offers the first hints of broader curriculum adjustments at the University of Colorado School of Medicine.

Though just days into the program, Cookson, one of 22 third-year medical students in Colorado Springs, is optimistic.

"At the end of the drive (to a clinic or office), there's always this thought that you're going to see a patient that you saw a couple weeks before," Cookson said. "It's a motivation to get there, instead of just going through the routine."

He wasn't alone. Every student The Gazette spoke to -- roughly a third of the class -- voiced excitement about training under the new model. Many said it should allow for more one-on-one training with doctors.

"It gives you a real picture of what medicine is going to be like," said student Kim Cabral.

So far in Colorado, much of the effort to revise curriculum and training has focused on students' third year, when they transition from the classroom to the hospital.

Under a traditional model, students learn specialties -- such as pediatrics and surgery -- in six-week blocks. They train in hospitals, and rarely revisit specialties after finishing a six-week block.

The old format worked well on two fronts: helping doctors diagnose diseases and understanding what treatments work best.

But that only encompassed half a doctor's job, said Dr. Erik Wallace, associate dean for CU's Colorado Springs branch. He realized as much during his own medical school training.

"I did not learn how to deal with complicated people or conflict situations," Wallace said. "I didn't learn about quality improvement. I didn't learn about teamwork."

The newer teaching model aims to offer students a more "real world" experience, Wallace said.

Students will still undergo several blocks of intense training, but those courses are shortened to roughly a week.

The following 10 months are spent in outpatient settings, such as a family practitioner's office. Students will still do specialty work -- including stints in psychology and neurology offices -- but only for a few hours each day.

Meanwhile, they will spend the bulk of their time treating the same core group of patients. That means a student working with a specialist, such as a psychiatrist, likely will see the same patients each time he or she works at the office.

The goal: Allow students to learn how each patient's overall health evolves over time -- all while developing deeper relationships with them.

Experts say the model appears to engender a greater sense of empathy and compassion in doctors -- qualities that take a back seat under the traditional medical school model.

"You get to see health care from the patient's perspective," Wallace said. "You get to see what their experience is like dealing with a particular illness, dealing with navigating a complex health care system and the struggles and challenges they face with doing that."

For decades, this teaching model failed to extend far beyond the University of Minnesota, which began a similar program in the 1970s. Only in the last 10 years have a growing number of medical schools across the nation started to implement it.

As of 2014, 37 schools used some variation of the longitudinal integrated clerkship model, said Lisa Howley, the Association of American Medical Colleges' senior director of education affairs.

The CU School of Medicine piloted the program two years ago using eight students who trained at Denver Health.

Brooke Bredbeck, 26, said she oversaw 30 to 40 patients for a year as one of the first students to train under the new model in Denver.

She treated a woman who was three months pregnant, then helped deliver the baby six months later. She treated patients when they walked into her clinic, sat in on pre-surgical consults, scrubbed in on surgeries and saw patients for follow-up appointments.

One day, she noticed one of her routine patients less lucid than normal -- simply put, "she wasn't right." She helped the patient fill out admissions paperwork -- a rarity for medical school students -- and admitted the person to the hospital.

"It really encourages the ownership of patients that, I think, medicine strives for but is having more and more difficulty holding onto -- just because we're super specializing in everything now," Bredbeck said.

Her experience appears far from unique.

A 2012 study found that Harvard Medical School students enrolled in a similar program had better relationships with their patients and saw them more often before and after surgeries. The students believed they made a difference in the health of their patients -- all while receiving more one-on-one mentoring and feedback on their work.

Students at Denver Health fared similarly well, said Dr. Jennifer Adams, who oversees the Denver Health program.

She acknowledged that her students chose to work in the new program -- meaning they might have been more motivated from the get-go, and less apt to burn out. Yet there is no denying the results, she said.

Howley said the newer training model has its limitations. Each student learns differently -- meaning the more traditional model may work better for some people.

And the new model can be complex -- requiring a sophisticated organizational structure that takes more time and administrative resources than a traditional program. Students are paired with a range of doctors across an entire community.

Roughly 250 doctors across the Pikes Peak region, from Pueblo to the Air Force Academy, have signed on to help train students. Often, students must be at one clinic in the morning and miles away at another in the afternoon.

"To keep track of that -- and then you start adding that they've got an exam on this day, and our preceptor is on vacation that day -- our coordinator works incredibly hard to manage the schedule of eight students" in Denver, Adams said.

Cookson, a 2007 Palmer High School graduate and an aspiring pediatrician, sees only benefits.

"We get to be someone's doctor, versus just someone's medical student."

Contact Jakob Rodgers: 476-1654

Twitter: @jakobrodgers