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P&S Journal

P&S Journal: Spring 1994, Vol.14, No.2
Students Find Learning Beyond the Classroom

By Jodi Godfrey Meisler
Students arrive at P&S eager to learn. For many, it's not enough to sit through classes and absorb volumes of new information; they want to do something to help others. After all, that's why they chose medical school.
"Traditionally, the first two years of medical school have been devoted to the basic sciences. In a departure, we've begun introducing some practical experiences right from the beginning," says Dr. Ronald Drusin, associate dean for curricular affairs and a leader of the recent curriculum revision process. Since first-year medical students don't possess clinical skills, they must identify settings where they can learn about health issues firsthand.
"Learning how to communicate with and be responsive to patients is an essential skill for physicians-in-training," says Dr. Drusin. Although a few programs existed before the new curriculum was implemented in 1992, the electives program formalized as an addition to the curriculum gives first-year students clinical experience as they spend half a day a week in a community-based public health or education setting.
The Adolescent Reproductive Health Clinics, coordinated by the School of Public Health's Center for Population and Family Health in conjunction with Presbyterian Hospital and the Department of Obstetrics and Gynecology, served as an important model for the community service/public health elective field experiences for students in their first year.
"Soon after the Young Adult Clinic began, about 13 years ago, two medical students approached me about volunteering," recalls Dr. Bruce Armstrong, associate clinical professor of public health. "It came as a surprise because I imagined that the medical students would be too consumed by their studies to spend time volunteering." They persisted, working a few hours a week for two semesters. With the support of the dean's office, a formal elective, "Family Planning Counseling in Adolescent Reproductive Health Clinics," was introduced in 1980. Forty students signed up for the 20 slots, demonstrating a keen desire for hands-on experience. In surveying participants after the first few years, Dr. Armstrong found that students joined for a constructive diversion from the classroom, a chance to learn more about the community in which they lived, and an opportunity to help people in need.
One student looks at her choice of Columbia as both an opportunity and an obligation to work in the neighborhood. "It would be a shame to spend four years in Washington Heights and never know the medical challenges facing the people around us," says Anastasia Rowland'97. "Besides, it's important for me to give something back to the community."
In the new curriculum, medical students can select from among 12 community service electives that comprise the Community Health and Education Program. "It is remarkable that so many students are willing to devote time to something for which no academic credit is given," says Dr. Armstrong. Out of 150 new students, 110 enrolled this year. (Students also can choose education-oriented electives, such as observing an anesthesiologist in the operating room.)
These electives focus on the nuances of health care. By putting students into primary care settings, they get a taste for multiple disciplines and the way health practitioners must work together to provide comprehensive care. Often, they work closely with social workers and nurses who deliver health care services to a wide range of population groups in a variety of settings.
Social workers place less emphasis on hard facts, employing psychosocial dynamics to gather information about the patient and environmental factors, such as the family unit, that affect the patient's needs, observed Thomas Tung'96 in a paper for Introduction to Clinical Practice. "Increasing students' sensitivity to emotional, social, and cultural issues that affect health behaviors is another key objective of the elective program," says Dr. Armstrong. Students learn a variety of interviewing skills, such as how to ask effective questions and how to clarify patients' concerns. In the process, they can discover why people take risks and why they fear going to the doctor.
"Learning to ask questions in a way that elicits information can position the doctor as an ally," says Lori Wirth, a first-year medical student. Out in the field, students gain an appreciation for the breadth of skills needed for a physician to be compassionate in delivering the highest quality care in the community.
The role of the preceptor is a significant part of the success of these electives. It's not enough for students to observe or even to conduct an interview on their own; they need to discuss their experiences with someone who can provide perspective, fill in the gaps, and guide the experiences. Here are a few examples of electives:

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