Today we’re living longer than ever before. One of the reasons is medical technology — new drugs to cure once incurable diseases, surgical techniques to repair previously irreparable damage, and non-invasive approaches remove tumors that would have been fatal a generation ago.
Along with those added years has come a growing concern about end-of-life care. Medical technology can extend life, but at what point does it result in reducing quality of life? Many people fear an existence marked by chronic pain and unwanted or unwarranted treatments that unnecessarily prolong life. The curriculum of UNLV’s new School of Medicine is designed to ensure future doctors are ready to help patients and their families deal with these concerns.
Relationships Matter Most
From the beginning of their training, UNLV Medical School students will interact with real people and families. This starts with a requirement of all first-year students become certified emergency medical technicians. It’s supplemented in the first six weeks of their education with a visit to the Nathan Adelson Hospice, where students will observe how medical professionals provide compassionate care to their patients.
Infusing the curriculum with such experiences enhances the personal development of students, said Dr. Ellen Cosgrove, vice dean for academic affairs and education. “The whole point about medical school is not about acquiring knowledge; it’s about that personal transformation from being a layperson to being a healer,” she said. “There’s a lot of personal growth needed — a lot of insights and understanding about people.”
UNLV’s medical students will take three courses — Learning Communities, Nevada Community Service, and Doctoring — designed to foster strong relationships with patients. These relationships are important in providing good medical care, and crucial in providing good end-of-life care.
Learning Communities introduces students to bioethics and other elements of high-value care. In Nevada Community Service, students learn about the social determinants of health and disease, and how local community agencies address these. Students will have the opportunity to volunteer at a community agency or program of their choice for a few hours each month, and by doing so, get directly involved with the local community and the challenges it faces.
The Doctoring course teaches essential clinical skills, such as taking patient histories and performing physical examinations, and includes palliative care. Cosgrove stresses that the course gets to the heart of forming meaningful and therapeutic relationships with patients.
Clerkships and Compassion
The foundation of strong doctor-patient relationships is further enhanced in the second and third years of training through clerkships in clinical settings. The clerkships replace the conventional “block rotation” so often depicted in media — where students follow a physician in a hospital setting and rotate through various required specialists to observe the interaction between doctor and patient. After the hospital rotation, usually one to three months, is completed, students are not likely to see the same patient again.
UNLV School of Medicine is using a different approach — a longitudinal integrated clerkship approach through which students cover the same medical disciplines as the rotations but in a more coherent way. UNLV’s students will work in an outpatient community clinic setting for an entire year. Under a mentoring physician’s supervision, they will contribute to patients' ongoing care. Cosgrove notes that this approach makes for a continual relationship with patients.
In terms of end-of-life care, the clerkship model instills a sense of compassion. Studies have shown that medical students who have undergone longitudinal integrated clerkships are better able to maintain their sense of compassion over time than students who learn through the traditional block rotation approach.
Compassion and concern for the patient are the salient requirements for good end-of-life care. “End-of-life patients need to know that they’re not walking along their path alone,” Cosgrove said. “What’s most important is for physicians to take the time to discern the patient’s goals for their end-of-life care — not projecting the physician’s own goals, hopes, and ambitions, but figuring out what’s most important to the patient. I hope that having a relationship-centered approach in our curriculum fosters exactly that type of thinking wherever our students are along their path of life.”