Future doctors take to the streets to address problems at the root of poor health
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.
