Learning Opportunities Call Upon Patient Perspectives

On August 21, 2017, these 176 students — some who know each other, and many who don’t — chatter away or anxiously pick at breakfast snacks. Student services staff greet them, and — as time passes — some students get more anxious and begin fidgeting with their phones.

Then, at 8 a.m., it’s time to start medical school. The lecture hall is in the Health Sciences Learning Center, which will be their home away from home for most of the next four years when they are in Madison.

The students stream into the hall and take their seats. As the lights dim, many expect to see an experienced doctor — someone who is a gifted lecturer with a mile-long curriculum vitae, sharing a well-crafted PowerPoint presentation. Instead, when the stage lights come back on, the students are surprised to see a soft-spoken, 9-year-old boy.

His name is Jack Christensen.

Next, the students view a video that describes his journey: the struggle he and his family have endured since Christensen was diagnosed with type 1 diabetes at age 4.

As the classroom lights brighten, a young voice makes a simple statement.

“My name is Jack, and I am the face of type 1 diabetes, and today you will hear my story,” he said, before walking away from the podium, which is nearly tall enough to hide the top of his head full of straight brown hair.

At this stage of the students’ learning, this 9-year-old boy may have more significance than that of a health care professional with nine years of experience.

Christensen is an example of the patients they will learn from, because — while just a boy — he has lived through the types of hardships and treatments many of the students may never personally experience. But they will be charged with doing their best to make people like Christensen well.

“It’s easy to get caught up in the first day — all of the logistics and finding our place in this school,” shares Olivia Rater, a first-year medical student. “Faces of Patients was a way for us to refocus that energy and remind us why we started along this path.”

The Human Element

The innovative Faces of Patients program has been a part of the School of Medicine and Public Health curriculum for more than 10 years, and it has existed as the first learning activity of the curriculum since 2006, when the UW Medical School — as it was called until late 2005 — transformed into the nation’s first integrated school of medicine and public health.

Faces of Patients has two parts. Initially, the entire first-year student body gathers in a lecture hall to hear brief introductions by the many people who have volunteered to share their stories about living with particular medical conditions. Then, the medical students and volunteers break into small groups, so each group of students can interact on a more personal level with the patients and/or family members.

The program was the brainchild of Jane Crone, NP, MEd, MS, in 2005, when Christie Seibert, MD, now the associate dean for medical student education and services, asked Crone to devise a new, impactful orientation that would be different from programs at other medical schools.

When Crone began researching the subject, she learned that most medical schools’ orientation programs were based on academic preparedness and navigating the system. But she thought the focus should be elsewhere — on the patient.

Crone found Seibert’s initial request a bit daunting, but the solution came to her through an experience, similar to the encounters medical students would have.

When Crone was developing the program in collaboration with Elizabeth Tuschen, administrative program specialist, Crone was called to the bedside of her younger sister, who had just received a diagnosis of multiple sclerosis at a Chicago hospital.

“The doctor came into the room, sat down, put his feet up on a hand rail, and said, ‘I have all day to listen to you,’” she repeats.

His attitude resonated with Crone, who has learned from personal and professional experiences that patients want a positive connection with their doctors and nurses. A nurse practitioner at UW Health with 40 years of nursing experience, Crone has worked with the UW School of Medicine and Public Health’s curriculum for 17 years.

Research supports her idea to create Faces of Patients. For example, a 2010 study, “Doctor-Patient Communication: A Review,” published in The Oschsner Journal, outlined numerous studies and concluded, in part, that doctor-patient communication is a major part of health care.

According to the study, “most complaints about doctors are related to issues of communication, not clinical competency,” and “patients want doctors who can skillfully diagnose and treat their sicknesses, as well as communicate with them effectively.”

Crone says the impact that Faces of Patients has had on medical students gives her a sense of pride, adding that she often hears comments like, “I’ve never forgotten that first day,” when she runs into former students, often years later.

Fast forward to 2016, when the School of Medicine and Public Health implemented its ForWard curriculum, and Faces of Patients continues to be a critical part of the curriculum under the guidance of Scott Mead, MD ’02 (PG ’05), clinical associate professor, Department of Medicine. He is the curriculum thread director of ethics, health information technology, interpersonal and communication skills, patient care, professionalism and lifelong learning.

Taking It a Step Further

Virginia Snyder, PhD, PA-C, director of the US School of Medicine and Public Health’s Physician Assistant (PA) Program, recalls thinking, “Why aren’t our students doing a program like the Faces of Patients? It’s so powerful!”

With Crone’s help, the PA Program launched Faces of Patients in 2009. Responding to demand, program leaders now hold these patient-centered learning sessions once every year, when both first-and second-year students can attend.

In addition to the Faces of Patients program, in 2012, Snyder and her team added sessions of a similar format into the curriculum for PA students. Called Cases of Patients and held twice each semester, these are somewhat of a sequel to Faces of Patients. Fourteen patient cases about different medical conditions or study areas are longitudinally integrated into PA education, Snyder explains. Patients, families, and health care providers uniquely cover a particular area of focus, often spending one to two hours with students and PA faculty.

“Our students constantly want to see and hear from more patients. Cases of Patients allows them to delve deeper into one patient and/or family story,” she says.

In addition to learning to improve patient communication skills, this experience allows PA students to remember the value of the patient-provider relationship when they start interacting with patients in their training. Cases of Patients encourages PA students to explore psychosocial, cultural and emotional experiences with the patients and/or families.

In October 2017, the PA Program expanded its patient-centered curriculum to include students from the UW School of Nursing and UW School of Medicine and Public Health Master of Public Health Program. Cases of Patients is the first program of its type to include multiple parts of the care team. Like its model, these interprofessional sessions include patient presentations, followed by small-group discussions and sharing with the larger group. They allow students to learn about roles and responsibilities of other disciplines and how each approaches care of patients or populations within the content area.

During the fall 2017 Cases of Patients, students met with the parents of a young woman from Mukwonago, Wisconsin, who died suddenly from a meningitis infection.

Bob Werner told the story of his daughter, Becky Werner, who was perfectly healthy on February 23, 2004, and two days later, she was gone, at age 20. He explained that when he and his wife, Dee, took Becky to the emergency room, doctors initially couldn’t determine what was wrong, and nobody was telling them anything about their daughter.

That night, Becky Werner was transferred to the intensive care unit, and symptoms of the infection started to show. By 9 p.m. on February 25, her heart stopped.

Reflecting on Bob Werner’s presentation, nursing student Amanda Schmoeger says, “What struck me most was the ‘whirlwind’ and the speed of what the family went through with their daughter’s sickness.”

Meeting with the patient’s family gave Schmoeger a perspective she has applied to clinical work during her training because, she realizes, often a nurse’s first priority is the patient, and the family members — who may be scared — can be overlooked.

“I continually ask family members if they need water, a break, etc., because I feel, by offering these things, it shows them that we care for the family as a whole while they are going through a difficult experience,” she says. “Many times, the family members don’t want anything, but a few times, they have said to me, ‘Thank you so much for asking. You are the first one who has done that.’”

Cases of Patients has been so successful that — as part of the grant that funds it — Snyder and her team have developed a lesson plan and materials so they can share the curriculum with other physician assistant programs throughout the United States. Her team also has presented the program at two national physician assistant education forums.

Giving Back

In addition to Christensen, this year’s Faces of Patients program included volunteers who shared their experiences with epilepsy, obesity, domestic violence and life as a transgender person. Many volunteers — including Christensen — return year after year to help the students.

Jess Christensen, Jack’s mother, believes it’s important to keep the patient in the forefront of medical education, which is why her family has been working with students through the Faces of Patients program since Jack Christensen was 4 years old.

“The short answer is (we want) to increase awareness and education about this often-misunderstood disease,” Jess Christensen shares. “Our hope is that when these students become doctors, they will remember Jack’s story.”

Faces of Patients has had a profound impact on students, says Gwen McIntosh, MD ’96, MPH, associate dean for students at the UW School of Medicine and Public Health and a pediatrician at UW Health.

“From Day 1 of medical school, we link the educational experience directly to patient care. This message can be lost in the detail of basic science and pathophysiology if there is no intention to bring their learning back to focus on the patient,” she notes, adding that the program also has had an impact on her.

“It always reminds me of the privilege physicians are permitted in caring for people during vulnerable times in their lives,” McIntosh reflects. “The patients on the panel do an excellent job highlighting how important it is for physicians to provide clear communication and human compassion.”

Jack Christensen, in particular, made an impression on Rater, who spent four years as a playroom volunteer at Phoenix Children’s Hospital before she enrolled at the UW School of Medicine and Public Health.

“Kids like Jack are a big part of the reason I went into medicine,” she shares. “Children have such resilience in the face of adversity. They have this inspiring ability to maintain a positive outlook when faced with serious medical conditions, and Little Jack brought me back to that on Day 1.”