Republished from fyi - the University of Iowa's faculty staff newsletter
On a September afternoon, Mike Blaser arrived early for an appointment in the University of Iowa Medical Education and Research Facility. He killed time by engaging in typical waiting-room banter for this time of year: football talk.
He discussed the Iowa Hawkeyes’ chance for success in 2009 before touching on the rival team from Ames, his admiration for Iowa’s coaches over the years, and the numerous times he’s enjoyed a game in historic Kinnick Stadium.
Soon enough, it was time for Blaser to enter an exam room. It wasn’t long before Dorlyne Henry, a third-year medical student in the UI Carver College of Medicine, joined him. Henry ran through a basic exam with Blaser, peppering her conversation with a mix of health history inquiries and “get to know you” questions.
Once the exam was over, Henry thanked Blaser for his time and asked, “Do you have any suggestions for me?”
“You did what I wanted to see: you were calm, you kept your composure,” Blaser replied. “Some people don’t keep it together.”
Blaser, who has cerebral palsy, was playing the role of patient as part of a series of simulated clinical exams, an experiential training program funded by the Iowa Department of Public Health and facilitated by the Carver College of Medicine and the UI Center for Disabilities and Development.
The thrust of these simulations is to give medical students greater confidence when communicating with patients with disabilities or their family members.
“About one in five people in the United States has a significant disability—something that affects mobility, daily activities, cognitive ability, memory function, or emotions,” says Scott Lindgren, professor of pediatrics in the Carver College of Medicine who oversees the simulation project. “If you live long enough, you’ll have one or several of these disabilities.
“Patients with disabilities are not just a small fraction of the population,” he continues. “We want our medical students to be comfortable communicating in all situations—patients with disabilities comprise one very important group.”
These clinical simulations began for third-year med students in the spring of 2007, and recently have become part of the physician assistant and nurse practitioner training as well. Lindgren coordinates a panel discussion and demonstration on communicating with people with disabilities for first-year students, and he thought that smaller, more hands-on experiences would also benefit medical students.
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"Our volunteers have been wonderful. They are not just simulated patients; they also take on the role of teacher, as they are teaching our med students how to interact."
—Scott Lindgren,
professor of pediatrics |
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A small grant from the College of Medicine Educational Development Fund provided the program’s startup money. Once the program was established, funding was obtained from a grant from the Centers for Disease Control and Prevention to the Office of Disability and Health at the Iowa Department of Public Health.
The simulation sessions, which are offered 16 times per year for medical students, are part of the pediatric clerkship, a six-week rotation that all students attend. Both adults and children with physical and/or neurodevelopmental disabilities serve as patients for the simulated exams.
Patients voiced the need for improved communication from their medical providers. “This program was inspired by concerns from people with disabilities—they were not always having great experiences when getting medical care,” Lindgren says. “They wanted this to be better addressed in the early part of medical training.”
Finding people with disabilities to play the role of the patient has not been difficult—typical schedule conflicts such as work or school activities are much bigger hurdles than reticence on the patient’s part.
“Our volunteers have been wonderful,” Lindgren says. “They are not just simulated patients; they also take on the role of teacher, as they are teaching our med students how to interact.”
Some volunteers say the simulations improve their attitudes toward receiving medical care.
“Sometimes it can be a challenge to share information,” Blaser says. “If the physician is comfortable with the patient, the patient will be comfortable as well. That makes me more willing to be someone’s patient.”
Finding a comfort level with the patient—and in the case of young patients, their parents—can lead to more efficient care, Lindgren says. “Parents often are the experts on their own children’s health.”
Jeffrey Cagley, a student who recently participated in the simulation, echoes Lindgren’s sentiment. “Sometimes the parent is the sole means of communication between a child with disabilities and the world at large,” he says. “The parent knows things, sees things that we might not recognize. Bottom line: trust them.”
Lindgren says he feared that students might not find learning to communicate with patients with disabilities as exciting as the biological side of med school, but the simulations have brought out the students’ enthusiasm.
“This simulation is but one brief period, about an hour and a half of a student’s life, but it’s one of those things that a student can build on,” Lindgren adds. “It gives them the tools to master a variety of challenging clinical experiences.”
Student feedback following the simulations is clear: the students are gaining confidence.
“The student’s worry heading into these situations is that communication with the patient will be difficult or unusual—that’s one of the things we’re working to eliminate,” Lindgren says. “Following the sessions, the students say they are more confident and have a better idea of how to make patients feel comfortable.
“The best thing we hear when we talk with our students is that this experience isn’t a problem—it’s like dealing with any other patient. That’s what we want them to realize.”
by Christopher Clair
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