College of Osteopathic Medicine of the Pacific (COMP) student Kenneth Chang, DO ’18, recently sat in the lobby of WesternU’s Patient Care Center and talked with Chino resident Angel Gomez. He asked Gomez about his medications, his blood pressure readings, and whether he’s drinking enough water every day.
"He’s helping me a lot. He’s a good man," Gomez said. "He’s going to be a good doctor."
The student doctor and patient are part of the Longitudinal Chronic Care Course (LC3), a pilot program at COMP. Chang will take care of Gomez throughout his time as a COMP student.
"I feel that regardless of what medical specialty one wants to go into, we can’t forget about the art of medicine," Chang said. "Medical school is very challenging with the huge amount of material that we are supposed to digest, but knowing that I’m doing something for my patient is motivating me to rise to those challenges."
Chang attends Gomez’s appointments at WesternU’s Western Diabetes Institute (WDI) and with outside providers, and they also talk by phone at least once a week.
"We wanted each student to get to know a patient very well," said Edward Barnes, MD, FACP, COMP Assistant Dean of Longitudinal & Experiential Learning. "They begin to see through their patient’s eyes what it’s like to live with chronic diseases every day."
Barnes started the LC3 program a year ago with about 35 students in the COMP Class of 2017. An additional 50 students in the new COMP Class of 2018 joined the program this year. Students are paired with a Western Diabetes Institute patient and will follow the patient throughout their four years. COMP-Northwest in Lebanon, Oregon is also implementing the program on a smaller scale, with about 10 students pairing up with nursing home patients of Assistant Professor Derrick Sorweide, DO.
Longitudinal tracks harken back to the way doctors were trained in apprenticeships. An apprentice physician would work with a physician and follow patients over a longer period of time.
Medical school is now arranged in sequenced blocks of education. Students complete a course, get a grade, then start a new course.
"What these longitudinal tracks allow us to do is what we call integrated blocks, where they’re all connected without ending," Barnes said. "The goal is to get them through seven years, including residency. That’s how long their training actually is. I think it’s important so they get the long view of being a physician rather than dropping into this rotation, coming out of that rotation, stopping that course. I didn’t get that view until I actually got into practice."
Barnes arrived at WesternU more than four years ago. He has now seen patients at WDI for that length of time.
"I understand them better than anyone else. I know their history. I know what medicines they don’t or do take. It makes it that much better and valuable to be able take care of patients," he said. "That’s why I think it’s important to do things over a longer term rather than in this piecemeal way. I do understand the importance of gaining that foundational knowledge, but why can’t we do both?"
"Albert Einstein said, ‘It’s not that I’m so smart. It’s just that I stay with problems longer.’
"The longer they stay with these questions, the better they’ll be able to find innovative, unique solutions to taking care of patients," Barnes continued. "We need to train them to think, to understand processes, and be able to manipulate the knowledge they’ve received in their education to then make these big decisions that we’re going to have to make in health care. They’re going to live in a totally different world of medicine than I’ve even had to deal with."
LC3 is a humanities course for medical school, Barnes said. Students learn about professionalism, accountability and empathy. They serve as a care coordinator and engage the patient during their health care appointments and in between appointments. Students will make home visits, go to lunch with their patients, and engage with them in their everyday lives. They are not expected to provide medical care in their first year. Their primary objective is to gain the communication skills, social skills and time management skills necessary to become an effective clinician who manages chronic disease.
The Course Construction Committee continues to make adjustments as the program develops, Barnes said. One lesson from the first year was that some students were too focused on attending appointments. He had to remind them that they serve as the communication in between appointments. This is due to the prevailing mindset in the U.S. that your health care is based on your appointments, not what you’re doing at home, Barnes said.
"We’re trying to switch that paradigm to reach into folks’ homes to give the best care," he said. "At WDI, we have several blood pressure cuffs that patients can take home and use themselves. We have the insulin titration team that calls them to make sure they’re getting their blood sugar list, giving them changes over the phone so they know what they have to do about their diabetes every day. We also have a core collaborative therapeutic alliance (CoreCTA) that coordinates the patient’s care and serves as health care coaches for the patients. Our LC3 students serve as members of the CoreCTA, viewing things from the patient’s perspective."
In the fourth year, each student will complete a capstone project as an expression of their experience. It could be an essay, a video, music, a song — whatever their form of expression is about their experience with their patient.
"They’re all going to have different experiences," Barnes said. "Some are going to be very close to their patient, some not as close. Some of their patients are going to pass away. Some are going to get a lot healthier. This is a way for them to share the spectrum with each other."
Second-year COMP student Elysia Chin said she volunteered for the LC3 program because she has an interest in geriatrics, and the course provides a unique opportunity to develop a long-term relationship with a patient. She met her patient in spring 2014.
"I feel like my relationship with my patient is a lot closer than one might expect for such a short amount of time," Chin said. "Every week for a month I drove to her assisted living facility. I took her blood pressure, kept track of her meals, and was very interactive with her. I had a chance to meet with the people she’s close to at her assisted living. It’s creating connections with her and her support team, not just with her. I met the manager at the assisted living. I met her daughter. That really helps our relationship."
The home visits were vital to building their relationship, Chin said. Patients form a professional relationship with student doctors at appointments.
"Making an effort to see her outside of appointments makes a huge difference in the relationship," Chin said. "Most important was, her spirits were higher. She said she feels a lot happier, knowing that someone cares. That really makes a difference in them wanting to improve their health."
Chang has also built a strong relationship with his patient. He was invited to a birthday party for Gomez’s grandchildren, where he met most of his patient’s family.
Medical students sometimes get a little too focused on studying, taking exams, and the hurdles that they have to go through, Chang said. But working with his patient has opened his eyes to new perspectives.
"I like Mr. Gomez because he has such a positive attitude about life," Chang said. "Sometimes we get so caught up in ourselves that we don’t think about what the patient is going through. He has to see multiple providers, check his blood sugars and blood pressure daily, and take care of his own numerous medical conditions and family members. Yet, whenever we talk on the phone, he always encourages me and makes my day better."