Medical Students See All Aspects of Community Health Care Firsthand

UA medical students in Phoenix take part in a curricular experience that allows them to observe patients and procedures, such as open-heart surgery, a colonoscopy and an autopsy.

The study of medicine often goes far beyond the multitude of science classes and lectures – more than most people realize. In fact, the study of medicine at The University of Arizona College of Medicine – Phoenix in partnership with Arizona State University is taking a decidedly hands-on approach.

This part of the curriculum is called the "Capstone Experience." For example, during several days earlier this semester, second-year students at the Phoenix campus barely touched a textbook or a laptop; instead they observed patients at both the beginning and end of life, firsthand.

"This experience helps with the other aspects of practicing medicine," said second-year student Brian Geyer. "You learn that you need to build trust with your patients, you need to respect your patient's autonomy, let them make their own decisions, you need to give them the tools and educate them. This is so valuable."

Geyer is referring to his experience at a homeless pediatric clinic during the "Capstone" week that wraps up a block of study and gives students the real-world view to complement the traditional classroom lectures.

"What you are doing is really just treating the effects of one bad decision," Geyer said. "You experience this kind of ‘teachable moment' – when you can show someone immediately the consequences of their actions. You're teaching them, educating them about the consequences of their health behaviors."

Within the curriculum of the Phoenix expansion of the four-decade-old UA College of Medicine in Tucson, are blocks of study. Each block teaches a system or area of medicine. Second-year students during the winter studied the beginning and the end of the lifecycle – obstetrics, pediatrics and geriatrics.

At the end of each block, students spend a week in the community experiencing firsthand what was just learned.

During their first year and a half, the inaugural class of medical students in Phoenix saw an open-heart surgery, a colonoscopy and an autopsy. At the end of the recent winter block, students spent time in a labor-and-delivery ward, a homeless pediatric clinic and with chaplains, social workers and nurses from Hospice of the Valley.

For "instructors" like Dr. Randy Christensen, who for the last eight years has worked thousands of hours taking care of homeless youth and runaways out of a converted recreational vehicle, the time spent with the students is just as important.

"They are going to see anything and everything here," Christensen said during an afternoon clinic as part of the Capstone week. "But it is rewarding because you are doing stuff, but it is also rewarding because you see a lot of pathology very quickly. It's just amazing how much stuff you can see. It's sort of in your face and you're, like, ‘Oh my gosh.' But it's always better to learn the abnormal right away."

Nurse Kim Williams, at a clinic housed at an east Phoenix shelter, knows the students only will spend a short time in the grand scheme of their schooling in these real-world experience settings, so the lessons are important.

"You don't learn this in nursing school or, I assume, medical school," Williams said during a clinic visit by the second-year students. "This is where you learn that hugs are important and taking the extra time is important and showing them some respect."

That registered on another student.

"This is the kind of medicine I want to practice – fun, creative and responding to a real need," said second-year student Alicia Bond.

Also during the community experience week students spent time with chaplains, social workers, counselors and nurses from Hospice of the Valley, the largest organization in Arizona that handles end-of-life cases.

Although second-year student Greg Burnett questioned being paired up with one of the chaplains, it didn't take long for him to realize how he may need to relay information on these kinds of services someday.

"One great thing about our curriculum is that we really do focus on overall patient well-being, their mental/spiritual/emotional health as well as their physical health," Burnett said. "I hope we retain this stuff and can be better docs when we begin practicing."

Burnett spent the morning with the Rev. Peggy Roberts, a Hospice of the Valley chaplain, seeing patients who are in various stages of their final days, including a 105-year-old woman.

"I guess that I would hope that he remembers that for every person dealing with end-of-life issues, it is a unique personal journey," Roberts said. "And they should be cared for in a unique manner."

She adds, "Yes, he's being trained medically for the biological end of life, but there is so much more to caring for a patient and their family, to support them, holistically."