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Join Nicole Cifra, an adolescent medicine physician, as we delve into the often-underestimated but invaluable role of medical students in patient care. Nicole shares her personal journey, experiences, and insights, shedding light on how medical students play a crucial part in health care teams. Discover the untold stories and learn how these future health care professionals contribute significantly to patient well-being.

Nicole Cifra is an adolescent medicine physician.

She discusses the KevinMD article, “The surprising impact of medical students on patients.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Nicole Cifra. She’s an adolescent medicine physician. Her KevinMD article is titled “The surprising impact of medical students on patients.” Nicole, welcome to the show.

Nicole Cifra: Thank you so much for having me.

Kevin Pho: So we’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Nicole Cifra: I’ve always had a place in my heart for adolescents. Initially, when I went to medical school, I thought I would be a primary care pediatrician who just didn’t mind teenagers. But as I progressed through my training, really as a medical student, I learned about the field of adolescent medicine as a subspecialty, and I was really drawn to it. I just love the people I work with. I love my mentors. I feel like it’s such a great, tight-knit group of folks, and I love our patients, the impact we can have on them, and just being witness to their journey into adulthood. My main area of interest, which has been a long-standing one, is eating disorders and malnutrition, and that actually makes up the majority of my clinical time.

Kevin Pho: So tell us about some of the typical cases you would see in adolescent medicine. You specialize in eating disorders, so tell us about some typical challenges you face and typical cases you see.

Nicole Cifra: It’s really interesting, because I think the COVID pandemic has really highlighted a lot of these issues and increased both our volume and the degree to which our patients are suffering. I practice in the inpatient and the outpatient settings, and we work on a multidisciplinary team. I have a lot of great colleagues I love working with, including dietitians and psychologists. We see patients from their initial assessment, making the diagnosis of an eating disorder and helping educate families about it, and then through their journey of getting back to life, which is a really cool part of my job. So it’s neat to work in a few different settings, meet a lot of different people and help kids get back to their lives.

Kevin Pho: All right. Your KevinMD article is about the surprising impact of medical students on patients. How did your article come together?

Nicole Cifra: As I was reflecting on my journey as a medical student, and on how my view of medical students has changed since graduating from that role and becoming a resident, then a fellow and now an attending, I could really reflect on and appreciate how my view of medical students has evolved. I remember, when I was a medical student, feeling like what you did didn’t matter, that you were in the way or didn’t have much value to add to the team. But as I’ve stepped away from that role and worked with so many amazing medical students and learners of all levels, I’ve really come to appreciate what an impact medical students can have on patients and on their teams. I think it took stepping away from that role and seeing it from the outside for me to truly appreciate how much of an impact medical students can have.

Kevin Pho: So talk more about that evolution of your perspective, from being a medical student yourself through training, fellowship and becoming an attending.

Nicole Cifra: I think especially as a resident, you feel like you’re being pulled in a lot of different directions, doing a million things. It’s a little bit sad in some ways, because you feel like you don’t have as much time to get to know your patients as you might want, because you have so many tasks to complete. I remember really struggling with that as a resident. I felt like I wasn’t as present for patients as I wanted to be. And I found that the medical students on my team, and I mention one specific situation in the article that really stuck out to me, really filled that role: getting to know patients, learning from them, helping them feel heard and walking with them through the process, over a span of time that just isn’t feasible for residents, or even attendings. I really came to appreciate that and see the value of it as a unique offering on the health care team.

Kevin Pho: Now, for those who aren’t familiar with how a typical teaching team works, what is the role of a medical student?

Nicole Cifra: Oftentimes, medical students will follow a few patients on the team. Depending on the type of inpatient team you’re on, you can have between 12 and 20 patients, sometimes even more, and medical students will usually pick three or four of those patients to follow, and those become the patients they get to know the best. So they’re not following everyone on the team, the way residents or attendings might, but they really focus in on those few patients: They present them on rounds, learn about their diagnoses and medical history, and get to know them as people.

Kevin Pho: And when patients develop this deeper relationship with a medical student than they would with, say, the attending or the fellow, what impact does that deeper relationship have on the patients on the wards?

Nicole Cifra: I think the biggest thing I have noticed is that it gives them an opportunity to really feel heard and to process a lot of what they’re going through. I’ve been on teams where we’ve learned things about patients through really long, deep conversations that medical students have had with them. Building that rapport leads patients to bring up things that are helpful to know and that may not otherwise have come to the surface, and that really helps the team meet their needs in a better way.

Kevin Pho: So now that you’re an attending and you’ve reflected back on your experience as a medical student, what kind of role do medical students have on your team? Has the way you teach or interact with medical students also evolved over time?

Nicole Cifra: Yes, and I think that gets to the heart of my article: You never know what can be brought up, to whom, and how helpful that information may be. So when I’m listening to medical students present in the outpatient setting, for example, I’ve learned to appreciate being really attentive to what they’re saying. It’s kind of the joke that patients will bring something up to a medical student and not to an attending, or vice versa. They may give a different story as they think about things, or based on how the questions are asked. So I’ve really learned to pay attention and focus on the history that our med students are giving, because it may include something I might not have gotten in talking with the patients.

Kevin Pho: Now, specifically in adolescent medicine, the medical students are likely closest in age to a lot of the patients your team is seeing. Talk more about that dynamic.

Nicole Cifra: I know, it’s a really interesting dynamic, and it makes me think a little about why I got interested in adolescent medicine. As a medical student, I was learning about the things adolescents deal with while I was in my early 20s, really within that adolescent age group myself. And especially as the world has changed, with the way we use science and technology and social media, being a teen or a young adult now is not the same as when I was an adolescent or young adult. Medical students who are closer to that age range may have a different appreciation for the things patients are going through or dealing with.

Kevin Pho: Now, give some advice to the medical students who may be listening to you on this podcast who may feel exactly the way you did, like they’re getting in the way, maybe with some imposter syndrome. Give them some perspective, after your reflections, on the role they play and its importance on the medical team.

Nicole Cifra: That’s a great question. The main thing I want medical students, or really learners at any level, to take away from this is that you are a valued member of the team, and you can make a huge difference in a patient’s experience. That’s a real privilege, and I would encourage people not to lose sight of it. I would encourage people to really get to know the patients they’re working with and spend time with them, because oftentimes that’s the time in your training when you have the most freedom to really get to know people and learn from their lived experience what living with a disease or condition may be like. I think that’s a really important part of learning that you can maximize at that stage of your training.

Kevin Pho: Do you ever encounter patients or families who are hesitant to talk to medical students, who say things like, “I only want to talk to the doctor”?

Nicole Cifra: I think that’s more rare than I anticipated as a medical student. As an attending, it hasn’t come up that much, though I have gotten it in some situations. And this is in the literature, too: Having medical students on a team can actually lead to improved outcomes. Obviously, we would respect the wishes of patients and their families if there’s something they’re not comfortable with, but that’s something I always think of in those situations: how medical students can impact care for the better.

Kevin Pho: We’re talking to Nicole Cifra. She’s an adolescent medicine physician. Her KevinMD article is titled “The surprising impact of medical students on patients.” Nicole, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Nicole Cifra: No matter what your role is on the team, you matter as a team member, and you have something important to say. And thinking about being a patient as well, you never know whom you’re going to connect with the most. In a lot of cases, that may be an attending, a resident or a medical student, and I think that at any stage of your clinical training or journey, you can have those really meaningful relationships, and they’re so valuable and so meaningful.

Kevin Pho: Nicole, thank you so much for sharing your time and perspective, and thanks again for coming on the show.

Nicole Cifra: Thank you so much for having me.