PHILADELPHIA - Medical students seldom learn much about the real-life problems (hunger, joblessness, addiction) their patients face outside the clinic walls. Yet, these problems are at the root of poor health in many low-income communities. A new article published today in the Journal of Health Care for the Poor and Underserved describes a new approach to educating medical students about the real world.
The course, developed by the Perelman School of Medicine at the University of Pennsylvania, apprentices medical students to community health workers (CHWs) in inner city Philadelphia. CHWs are trusted laypeople who come from the local community, hired and trained by healthcare organizations to support high-risk patients.
By pairing up with community health workers, students had the opportunity to understand life from a different perspective. Most students had not experienced poverty or trauma in their own lives. The course also helped students to overcome implicit bias and discrimination, which often permeates healthcare experiences.
"Thirty-year-old, uninsured, and taking street Xanax. You automatically think . . . difficult patient," explained one student. "She had little dreads and they were dyed red. And the community health worker loved it. She was like 'oh my god, your hair is so cute!' Then the patient got this big smile on her face and was so willing to talk to us. My whole impression of her changed from this really difficult patient to just a sweetheart."
The Institute of Medicine and the Association of American Medical Colleges recently recommended medical schools should train students in skills related to community engagement, including the "cultural humility" needed to deal non-judgmentally with patients from very different walks of life. So far, relatively few med school programs aim to provide that training. When they do, it is often through lectures and reading assignments more than hands-on experience.
Penn's early experience with this teaching experiment has been so promising that the course is now a permanent part of the curriculum, and is being expanded for nursing and social work students. The Penn Center for Community Health Workers is building on this course to develop online cultural competency training for students and even practicing clinicians.
"In medical school, you learn about antibiotics and MRIs. There is a lot more to health than that," said lead author Shreya Kangovi, MD, MS, director of the Penn Center for Community Health Workers. "Unless we train our future healthcare professionals to understand what life and health are like for real people, we'll be failing them."
The article reports that in interviews, participating students indicated that the rotation generally met its goal of imparting community engagement skills. Students showed a better understanding of the life circumstances - from homelessness to the difficulty of getting a taxi in inner-city neighborhoods - that affected patients' health care experiences. They also seemed to develop more confidence and competence at overcoming those challenges, as well as a greater appreciation for what community health workers do. To date, 60 students have participated in the rotation.
Kangovi and colleagues hope that the new rotation will serve as a model for other teaching hospitals that want to prepare students to care for low-income patient populations.
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The other co-authors of the paper were Tamala Carter, Robyn A. Smith, and Horace M. DeLisser, all of Penn.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $7.8 billion enterprise.
The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $405 million awarded in the 2017 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; Penn Wissahickon Hospice; and Pennsylvania Hospital - the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine, and Princeton House Behavioral Health, a leading provider of highly skilled and compassionate behavioral healthcare.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2017, Penn Medicine provided $500 million to benefit our community.
Journal
Journal of Health Care for the Poor and Underserved