As patients, we think of working with medical students as a good deed, a necessary evil to improve the future doctors of America. You spare the extra time, discuss your mother’s sister’s medical history, a detailed account of your drinking (not quite) habit, and succumb to a physical encounter rivaling the awkwardness of a junior high date.
But medical students are changing. Today’s students are starting medical school with more experience in health care (think paramedics, nurses, or social workers). Others have taught in underserved communities or worked internationally in global health. No longer wooed by the paycheck, today’s students take extensive loans and delay adult life (and income) until beyond age 30.
Today’s medical student seems more committed than ever to the profession of medicine. But, in addition to what they bring to the table from their life experiences, today’s students are better prepared to actually practice medicine. Medical students now learn not just anatomy and physiology, tedious biochemistry and stomach-lurching pathology, they take courses in communication, professionalism, and ethics. They begin interviewing patients and practicing physical exams in the very first days of medical school. Today’s students are learning to provide not only diagnostic acumen and evidence-based treatment, but exceptional service that can contribute meaningfully to the overall care of patients.
The hospitals in which I work and teach are doing something even more. Traditionally third year medical students do clinical immersion rotations or clerkships in specialties like surgery, internal medicine, and pediatrics. In the last decade at UCSF and Kaiser Permanente Oakland, we’ve worked to redesign these clinical clerkships, putting patients at the center of the learning experience. In longitudinal integrated clerkships, or LICs, students simultaneously learn all specialties under the tutelage of one physician per specialty. Generally 6 to 12 months in length, the LIC requires that students pick up a cohort of patients for whom they will care for and learn from over the course of the LIC.
LIC students are meeting patients in the hospital or in clinic and following them over time, watching their illnesses improve or progress. They meet patients with newly diagnosed breast cancer, attend their surgeries, their visits with cancer doctors and chemotherapy appointments, doing their best to explain the treatment and prognosis. Students work with pregnant women through the course of their pregnancies, help deliver their babies, then care for the infants with their pediatric preceptors. Students do home visits, arrange follow up appointments, call patients at home, counsel them on weight loss, advocate for social services and encourage smoking cessation.
Students have tremendously powerful experiences from LICs. Research demonstrates that students in LICs do as well on tests and receive the same grades as peers in traditional clerkships. But something fascinating is happening as well. Students in LICs are leaving as more empathetic and more patient-centered physicians.
Recently a patient’s son asked me if they could write a letter for a student’s application to residency. “Their” student, a future OB/GYN, had visited their father daily in the hospital over a month when he suffered a gut obstruction from widely metastatic colon cancer, requiring extensive surgeries. The student found time to attend meetings with doctors in the hospital and was present when their father suffered a cardiac arrest in the ICU. She helped counsel the family about palliative care options. She visited his room after his death and cried with the family, then attended his funeral. How useful a letter like that would be, among the gray words of gray haired professors.
This experience, played out over months of my student’s life, will never leave her. She played a meaningful role in patient care and provided exceptional service. Her involvement will be remembered by the patient’s family forever. It is no wonder that she will be more empathetic and patient-centered in her future practice.
Today’s medical students are contributing, advocating, translating and serving. They can both clinically reason and help a patient tell their story — across time and specialties — while catching errors, making requests and helping their patients persevere.
So here’s what I suggest: Catch your doctor by surprise and ask if she has a medical student that can work with you. They make take a little extra time caring for you, but it will be worth your while.
Lindsay Mazotti is an internal medicine physician.
