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Q&A: Using Medical Students as Patient Navigators

IMPORTED: __media_EE4C46D325A14349B152429AD43A2897.jpg Terry Wolpaw, M.D., vice dean for educational affairs at Penn State College of Medicine in Hershey, Penn., is overseeing revisions to the school’s curriculum that are designed to help students better understand the way existing models of care, socioeconomic determinants of health, and payment models affect treatment outcomes. A key part of this is having first-year students serve as patient navigators for a year. Quality Matters asked Wolpaw about the program, which starts in August.

Quality Matters: Where did the idea of using incoming students as navigators come from?

Wolpaw: We realized that our students came into medical school on day one with huge hearts and really smart minds, but they didn’t have the skills to be doctors at that point, nor would they for quite a while. We felt like we really weren’t taking advantage of the strengths they brought with them as they entered medical school. Then it hit us while reading about the benefits of patient navigators that our students could take on that role right away. It would be a great way to help them better understand the health care system by seeing it through the lens of patients. In many ways it is the opposite of what we typically do, which is put students in the classroom and then immerse them into the health care system later. Our goal was to immerse them in the system at the start so they will be able to use their patient-centered perspectives to give breadth and depth to what they are seeing in the classroom.

Quality Matters: How will they get training to do this?

Wolpaw: We created a patient navigation curriculum that will run concurrently with their early navigation experiences to help students acquire skills in relationship building, teamwork, and care coordination because they need some understanding of how health care systems work. 

Quality Matters: Can you give us an example of the role they will play?

Wolpaw: Right now, we’re looking at how they can participate in chronic disease programs such as heart failure clinics or hot spotter programs for patients who have multiple admissions or emergency department visits. Navigators can assist patients in accessing services that help them stay healthy and at home. The plan is for students to connect with and understand patients’ needs in many ways, including through home visits. There’s been a lot of interest in our medical student navigator program from the Pennsylvania Department of Health and the insurer Highmark Blue Shield because the possibilities for improved health care and illness management are enormous.

Quality Matters: Will they be rotating through other types of clinics?

Wolpaw: An individual student will commit to one site.  We like the continuity and relationship-building that comes from a student working in one location and seeing patients over a longer period of time. We are looking at about 20 different sites right now. We have a five-year grant from the American Medical Association so the program will continue to evolve. Our plan is that students will form learning teams and share their navigator experiences with each other.

Quality Matters: I imagine having an affiliation with your health system greatly facilitates this. How might medical schools without such affiliations make such a program work?

Wolpaw: There are definitely other ways to help students experience a patient’s perspective. Students at Penn State are required to do a patient project in their first year of medical school. They are paired with a patient who has some ongoing health issue— a chronic disease is typical. The student’s job is not so much to learn about the disease, but mostly to try to understand the way this disease has affected a  person’s life. So students make a certain number of home visits and clinic visits and then they have to produce a reflective paper, a video, or a piece of poetry. They can choose the modality. We want them to see that this person is with the doctor for only a few minutes of a lifetime, but the chronic disease is with them all the time.  It’s important to learn about all those other minutes between doctor visits.

Quality Matters: You’ve said you’re hoping the experience will enhance the students’ sense of agency; that is, that it will give them an opportunity to see where changes are needed and then make them. Could you give us a few examples of things you’d expect they’d tackle?

Wolpaw: We expect that our students will reflect on a patient’s journey through the health care system, identify barriers, propose plans to health systems leaders to change those barriers, and help implement the plans.  We believe in the power of our students and know that, given the opportunity, they will make a difference.

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