Making a diagnosis and suggesting treatment options would seem beyond the wherewithal of first-year medical students. Yet this fall, just days after donning their white coats and still in their medical school orientation, students had a chance to figure out why an otherwise healthy young woman collapsed while shopping. The “patient” lying on a gurney in an examination room was actually Sim-Man, a mannequin wired to “present” symptoms of various ailments and even “talk” to students.
When the three students in the room asked about symptoms, the “patient’s” answers came from Leigh V. Evans, M.D., assistant professor of surgery (emergency medicine), speaking through a microphone from an adjacent control booth. Nausea, some spotting, and abdominal pain were her answers. “Are you pregnant?” a student asked, unearthing the key to the diagnosis.
An ultrasound revealed an ectopic pregnancy, then Kelly Dodge, M.D., assistant professor of surgery (emergency medicine), playing the role of a nurse, pointed to a black mass on the image. “What do you think it is?” The students correctly surmised that it showed massive bleeding, leading to a request for an ob/gyn consult and a recommendation of a blood transfusion, with surgery a distinct possibility.
The session with Sim-Man was part of the new Hospital Immersion Program (HIP), four days of interactions with clinicians at Yale-New Haven Hospital and the School of Medicine. The program is the brainchild of Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, associate dean for student affairs. She wanted to emphasize that, despite similarities—students still attend lectures in a big hall, wear jeans, and carry backpacks—the first days of medical school are not like college.
“There isn’t anything that says to you, ‘This is different. You are now starting on your journey to become a physician,’ ” she said, adding that it’s not until the third year of medical school that students see patients as part of a medical team. “I have always wanted to take that experience and move it up front to the first year.”
Until this year students could choose between two orientation programs, a three-and-a-half-day backpacking trip on the Appalachian Trail, or an introduction to community service opportunities in New Haven. This year 27 students chose HIP and the chance to accompany attendings, residents, third-year medical students, nurses, social workers, physical therapists, and nutritionists on their rounds. During rounds the students observed how such disciplines as radiology, pathology, and microbiology support patient care and medical decision making. In pairs, the students joined clinical teams in medicine or surgery.
Each element of the program addressed at least one of three themes; teamwork and communication, the experience of illness of the patient in the hospital, and who and what is involved in medical decision making. The program’s seven goals, Angoff said, were to encourage students to recognize the centrality of the patient in medical practice; to promote early professional identification; to stress the importance of the basic sciences essential to clinical decision-making; to showcase the importance of teamwork, communication, and collaboration in the practice of medicine; to introduce students to the complex culture of the hospital; to promote self-reflection as a life-long habit that enhances learning; and to model mentorship as a virtue and professional duty.
Within HIP students were assigned to either surgery or internal medicine and rounded for about two hours a day with teams that included an attending, residents, and third-year medical students. The students were asked to keep daily journals about their experience, and at the end of each day a faculty moderator led a debriefing session. Students also had fourth-year medical students as guides, and, in pairs, spent time talking with a patient in the hospital.
“Rounding was the most valuable thing,” said first-year Katherine Davis. She was able to follow clinicians and patients over several days, she said. She could observe the interactions among the medical teams, including nurses, chaplains, and social workers. “You see how integral every position is to treatment.”
“To be able to round with a medical team—no longer as a pre-medical student, but as a white-coat-donning medical student—was a surreal and highly beneficial experience,” said Roger Kim. “We were treated as adults and as young physicians rather than pesky, nosy students. Spending significant amounts of time in the hospital also put into perspective what it means to be a physician, to be a medical student, and to wear a white coat and stethoscope.”