MSHQ 122 : Develop Your Patient Skills with an Incredible Gap Year

Session 122

In this episode, Ryan talks about “gap years” with Blake and Meg from The Center for Patient Partnerships, an interdisciplinary center dedicated to keeping patients front and center. For over 15 years, they’re an international leader for patient advocacy education. On top of this, they are also on the forefront of creating a curriculum about patients’ experiences about health and healthcare. That said, they’re in the business of not only helping patients, but healthcare providers as well along with other people involved in healthcare. They offer “gap year” students an opportunity to get a real experience with interacting with patients and giving them real, unique experience.

What is a gap year?

A gap year is a time between undergrad and medical school. Ryan is a huge believer of gap years because it helps you become more empathetic with patients and understand what a patient is going through since you will experience how it’s like to work all day and live through the worries and stresses of your day-to-day life. In short, gap years are beneficial. They give you tons of experience of what it’s really like to live in a world outside of being a student. Additionally, this contributes to your overall experience in your application.

A Harvard School article

An article from The Harvard Crimson about Students Taking Time Off Before Applying to Medical School.

Robert Mayer the faculty associate dean of admissions at Harvard Medical School talked about how he’s been there for 11 years and noted that 60% of matriculating medical students came straight out of college (traditional students).

Eleven years later, the number has decreased to about 35%. Hence, 65% of students starting medical school have taken some time off before going into medical school.

Here are the highlights of the conversation with Blake and Meg:

Gap year, defined:

  • The term originated in Europe until it came to America, which refers to a gap between high school and entering college
  • Transformed in the last years with students taking a gap year between college and professional school

Why not go straight to medical school?

  • The average age of medical school entrance is 25 years old
  • To get more experience
  • To make sure you exactly know what you want to do in medical school
  • To take some time off to travel
  • To build up GPA and to get experiences needed during application

What The Center for Patient Partnerships are doing to give interaction to students:

  • Opportunity to get the real patient perspective
  • Learn about the intricacies of the healthcare system
  • Learn about the patient's side of the table
  • Opportunity to work directly with patients
  • Opportunity to learn how everything works before being fully responsible for the care of a patient

About The Center for Patient Partnerships:

  • Not affiliated with a hospital or healthcare provider or clinic
  • Patients come to them independently
  • They provide services independently
  • Patients are not charged for the services but in exchange, they have to be willing to work with the students and help them learn what it's like to be a patient and have an empathic ear.
  • An interdisciplinary center where other industries are involved (students, lawyers, social workers, pharmacists, etc) and you get to work with them.

The inclusion of Social Sciences into the new MCAT

It's not all academics. Social experiences are taken into consideration as well.

Going from practice of medicine to the delivery of healthcare

A day in the life of the student at The Center for Patient Partnerships program:

  • Come in and check their mailboxes and messages to see if they have a new case
  • Call the client or patient and read notes
  • Meet with supervisor and discuss cases one by one
  • Discuss strategy and next steps
  • If they have a new case, they would designing and presenting an advocacy strategy,client's goals, questions about the strategy, information needed before execution, and what they hope to achieve.
  • Sit together and go through and talk about the cases and strategies or update facts and developments
  • Meet with patient or client; or accompany the patient to the doctor
  • Helps the patient define his/her team and that it's focused on the work
  • Students are the clarion call for the patient
  • Facilitate conversations between patients and clinicians so patients can make smart moves
  • Taking the online program:
  • Students from across the country can take the certificate without having to move to Madison, WI
  • Using multiple forms of media to connect with patients from across the country or even outside of the U.S.

More about their program:

  • Class size of 10-14 students
  • The importance of small class sizes in building a sense of community
  • 3-day boot camp orientation before the clinical part

Two online courses for the med force:

Advocating for Populations – a 4-week highly intensive course learning about advocacy in media, legislature, community, etc.

Advocating for Patients – to get quick and dirty about the healthcare system, clinician's role, how to be an effective and efficient advocate; developing an advocacy infrastructure in your practice

They have a class starting in the summer if you want to get started right away. Classes start on Tuesday, May 26, 2015. Classes in Fall start the day after Labor Day.

Other ways you can do during your gap years:

  • Volunteering in hospitals
  • Work in research labs and interact with scientists, researchers, etc.
  • Foreign travel healthcare assistance
  • Take the IPA (Introduction to Patient Advocacy) course as a stand-alone at The Center for Patient Partnerships to get a taste of what getting the certificate is like

Some pieces of advice for premed students:

To be an advocate for a patient will expose you to so many things that you will never have exposure to as you're going through medical school or residency. Take the time and learn all about this. In the end, it will make you more sane and it will definitely improve your patient outcomes.

Links and Other Resources

Transcript

Dr. Ryan Gray: The Premed Years, session number 122.

Hello and welcome back to the Medical School Headquarters Podcast; where we believe that collaboration, not competition, is key to your premed success. I am your host, Dr. Ryan Gray, and in this podcast we share with you stories, encouragement and information that you need to know to help guide you on your path to becoming a physician.

If you're struggling with the MCAT, go to www.FreeMCATGift.com, our thirty plus page report with tips and tricks on how to maximize your studying to get the best score possible on the MCAT. If you're not yet part of our fun and collaborative Facebook group, go to www.MedicalSchoolHQ.net/Group and ask to join and I will approve you as soon as I can. We have almost 200 students in there asking questions, suggesting great articles and helping each other in an awesome way. So again, www.MedicalSchoolHQ.net/Group.

Today we're going to talk about gap years. Now if you don't know what a gap year is we're going to dig into it a little bit more with Blake and Meg from the Center for Patient Partnerships. It's a center dedicated to keeping patients front and center. Now for over fifteen years they are an international leader in patient advocacy education. But here's the interesting thing, they're also at the forefront of developing a curriculum about patients' experiences with health and healthcare. Now that means that you as a premed student- or even if you're listening to this as a medical student, or resident, or even a physician, they have something for you. They're in the business of not only helping patients, but in that same breath, they're helping healthcare providers and lawyers, and everybody else that's involved with the delivery of healthcare, we're learning along with the patients. So that's where it all ties in, and it's an awesome opportunity. So let's go ahead and get started.

Gap Years

Now before we talk to them, I want to describe a little bit about gap years. We do talk a little bit about it with them, but then we talk a lot about the Center for Patient Partnerships. So a gap year is a time between undergrad and medical school. Now for a lot of you listening, you have taken a lot of gap years, just kind of the way life has worked out as a nontraditional student. You went to undergrad, you started a separate career, and now you're going back into medicine. A gap year really doesn't apply to you. But for many, a gap year would be if you didn't do well enough in your undergrad that you think- and you want to take a post-bacc year, so you take a post-bacc year and the timing of applying just works out where you're going to have to apply a little bit later, and you're going to have some time in between when you graduate from your post-bacc, or even from undergrad, and when you actually start medical school. Now if you've listened to any of the podcasts, you'll know that I am a huge advocate for gap years because I believe to be empathetic with patients, you have to understand what a patient is going through. You have to understand what it's like to work all day and then come home and try to take care of kids, or come home and worry about paying bills. What it's like to live the stresses of day-to-day life. As a traditional student that goes from undergrad to medical school, you don't really live that life. You've been a fulltime student your whole life. And so when you do that- you go from medical school to residency, to fellowship possibly; and now you're out treating patients and you don't have that same experience or that same vision that the patients are going through. The experience that the patients have. And you can't to their level and really empathize with what it's like to struggle what they're struggling with. I'm not saying that when you take a gap year, you take some time off, that you're going to struggle. But at least you're out of school and you're trying to live a “normal” life outside of being a student. So gap years are very beneficial, they give you tons of experience of what it's like to live in this world outside of being a student, and I think make a huge contribution to your overall experience and your application which really makes a huge difference.

So that's a little bit of what a gap year, and these are becoming huge. Now I'll have a link in the show notes which you can get at www.MedicalSchoolHQ.net/122. But there's an article on the Harvard Crimson, which is the online blog for Harvard College; which is obviously part of Harvard University. And there's an article in here that's written about medical students that are taking time off before applying to medical school. And Robert Mayer, the faculty associate dean of admissions at Harvard has talked about how he's been there for eleven years, and he said when he first started about 60% of the matriculating medical students were coming straight out of college; they were traditional students, they weren't taking a gap year. Now, he says eleven years later it's about 35%. So at Harvard Medical School, 65% of the students that are starting medical school have taken some time off before going into medical school; and I think that's huge. Again, like I said not only for your experiences and being able to relate to patients better, but also for your own sanity. Get to take a break and go explore, and take a vacation and to do something other than being a student and actually breathe. And I think in the long run with physician burn-out and a lot of the issues that we're having with that, I think that will be a huge thing as well.

Center for Patient Partnerships

So enough about gap years, we're going to talk a little bit more about them, like I said with Blake and Meg from the Center for Patients. And the Center for Patient Partnerships is a center dedicated to keeping patients front and center. Now for over fifteen years, they're an international leader in patient advocacy education. But here's the interesting thing, they're also at the forefront of developing a curriculum about patients' experiences with health and healthcare. Now that means that you as a premed student, or even if you're listening to this as a medical student, or resident, or even a physician, they have something for you. They're in the business of not only helping patients, but in that same breath they're helping healthcare providers and lawyers, and everybody else that's involved with the delivery of healthcare, we're learning along with the patients. So that's where it all ties in, and it's an awesome opportunity. So let's go ahead and get started.

I start actually talking with Blake about what exactly a gap year is.

Blake Bishop: A gap year can mean multiple different things. The term gap year actually kind of originated in Europe and came to America, and that oftentimes refers to a gap between high school and entering college. But it's really transformed quite a bit the last few years, and now there are quite a few students that take a gap year between college and professional school. Whether it be med school which is what we're going to be talking about today, or any other professional school.

Gap Year Reasoning

Dr. Ryan Gray: And what are the reasons for taking those years? You had mentioned initially it started between high school and college. And I can maybe understand that, because a high school student really needs to understand maybe what they want to do with their life, if they want to go to college. But it seems like for somebody that knows they want to be a doctor, why not just go straight to med school?

Blake Bishop: Sure, there are multiple different reasons for not going straight into med school. A recent report showed that the average age of medical school entrance is 25 years old. So it really shows that people are taking two or three years between undergraduate and going into med school. Reasons for that are to get more experience and to make sure that you know exactly what you want to do in med school, take some time off to travel, build up the GPA. Med school has a lot of different requirements that they require people to get interaction with patients so sometimes when students are done with their undergrad they don't have those experiences. And then you have to figure out a way to get those experiences. Which is where we come into place with the Center for Patients, and offering gap year students an opportunity to get a real experience with interacting with patients, and getting a real unique experience that they really won't find anywhere else.

Interactions

Dr. Ryan Gray: That's interesting. What exactly are you doing at the Center for Patient Partnerships to give students that interaction?

Blake Bishop: So we offer an opportunity for students to come and learn at the Center to get the real patient perspective, so they're learning about the intricacies of the healthcare system and figuring out what it's like on the patient side of the table. And what's really unique with our program is that instead of just learning about the healthcare system and not doing anything with that, we actually give students an opportunity to work directly with patients. We have- at the Center here, patients call us saying for multiple different reasons, and then the students with the help of a supervisor and with the help of professors, they're the ones that are actually doing the advocacy work. Meg, would you like to chime in more about the experience at the center?

Meg Gaines: Just that patients are people with life-threatening and serious, chronic illnesses that come from everywhere from Texas to Thailand and Portage to Portugal, and every place in between, and they call us and say, ‘Help, I've been diagnosed with something I can't even pronounce much less do I know what to do about it.' Or, ‘I know what I want but my insurance company says it's not medically necessary or it's experimental.' These are contract terms that occur in insurance policies but which get passed off by insurance companies as medical terms. So in many ways this is the first time that future physicians will understand at all that this is not a medical construct and that they get trapped in this insurance restriction like the patients do, and they do as well. And so it's an opportunity for them to learn how it really works before they actually end up having to be responsible for the care of a patient, they get to be kind of abide with patients and as Blake said, learn to see the world from that angle. And I think that's an indelible experience. If you've ever been a patient or you've ever been close to somebody who's a patient, you don't forget what that feels like.

Dr. Ryan Gray: That's interesting. And I agree with you, you don't forget what that feels like and I've talked about my recent healthcare issues on the podcast before. But it sounds like this patient interaction isn't one that's taking place in a hospital, is that correct?

Meg Gaines: No it happens in the Center, we are not affiliated with a hospital or a healthcare provider or a clinic of any kind. So patients come to us independently, we provide the service independently, there's no charge for it. As I always say to the patients, to our clients, ‘We don't charge for it, but it's not free. That is to say your part of the bargain is that you're willing to work with a student and to help them learn what it's like to be you, what it's like to have the problem or the challenges you have, and what it's like sort of day-to-day, and that's a huge gift that you give in exchange for- hopefully some helpful advocacy and at the very least, for a really patient and empathic ear.'

Dr. Ryan Gray: I think that's amazing because when I think back to medical school and starting on my clinical rotations, I had to not only juggle all of the medical side of things, but I also had to start working on my empathy and start working on my listening skills, and all of these other things that it looks like at the Center for Patient Partnerships, students are able to build before, and then they can worry about all of the medicine stuff later.

Learning Empathy

Meg Gaines: Yup. And sometimes now in medical school they are trying to teach sort of empathy and deep listening and that kind of thing. But it's really very- as you know because of how much just volume there is in the curriculum, it's really very minor part of the curriculum and I think it's done in the context- you know context is everything. And it's done in the context of you know, how will you be evaluated by your standardized patient and did you pass this OSCE? You know, it's not done in the context of what does it mean to you as a human being to be with someone so deeply and so profoundly and to try to- you know sort of stand at the edge of their soul and salute and pay attention, and many of our students have clients who die. Right? Who don't survive their illnesses and the students are there at hospice, or at home, or at other places while it's happening because the patients feel that connected to them.

Dr. Ryan Gray: Interesting. So students are having that interaction with these patients that they're working with?

Meg Gaines: Oh yes, it's not primarily the supervisor having it. The supervisor sort of tries to only get involved where there's a need either to deepen the relationship or sometimes very occasionally, to guide it just a little bit. But I try to stay as outside of it as possible because that needs to be the primary relationship, is between the student and the patient. So it's a real deal, you know? It's not, ‘Why don't you come and spend a year watching us do things.' It's you spend a year doing them.

Dr. Ryan Gray: Yeah, that's awesome.

Blake Bishop: It's really being emphasized in medical schools these days, you probably know about the recent changes to the MCAT. MCAT hasn't been changed in a number of years, and this year they finally changed it and they're including the social sciences into the MCAT. They're doubling the length of it, but they're really emphasizing the social sciences. Some of the things that are in the new MCAT that our program touches upon are the critical thinking aspect of it. Teamwork, cultural competencies, service orientation. So medical schools are finally realizing that not only do they want doctors and medical professionals that are really good at the medicine side of it, they also want doctors to be able to work with patients and to have the patients have a really good experience. And that's finally getting emphasized in the new MCAT and it's really kind of emphasizing what we're doing here at the Center as well.

Dr. Ryan Gray: Yeah and I think that's a huge thing to kind of take home, is that the medical schools have learned that the student with the 4.0 GPA and a 42 on the MCAT isn't an ideal student; may not be an ideal student. It's the student that maybe has this experience with you guys at the Center for Patient Partnerships or has whatever other experiences, and they come with a lower GPA or a lower MCAT score, but they're so much more well-rounded and have all of these other life experiences that they're able to take and carry through their medical training.

Meg Gaines: You know I think we went in the end of the twentieth century because of sort of scientific advances. We went unfortunately- and because of economic realities and twists and turns. I mean we went from practice of medicine to the delivery of healthcare. And I think the MCAT efforts that Blake is talking about, and the work we're doing is trying to bring back the practice of medicine and to take it one step further, which is into the co-creation of health. You know, it's not about healthcare, it's about health, right?

Dr. Ryan Gray: Yeah.

Meg Gaines: I mean we've become so focused- the metaphor I keep thinking of is in order to go to the movies you have to buy a ticket, but you don't buy a ticket because you want the ticket. You buy a ticket because you want to see the movie. And you know, you don't go to med school because you want to deliver healthcare, you go to med school- I hope, because you want to be a part of helping people get healthy.

Dr. Ryan Gray: So it's not to drive a Ferrari?

Meg Gaines: Yeah. Well, there is that and you know, when you emphasize that, that's what you get, right? I mean who is it, Einstein who said every system is perfectly designed to get the result it gets.

Dr. Ryan Gray: Yeah.

Meg Gaines: So you know, if these are the physicians and- you know it's not unique to medicine. If these are the physicians and the lawyers and the nurses that we're putting out, that's because these are the ones we're accepting and this is the way we're training them.

Dr. Ryan Gray: Yeah, that's a good point.

Interdisciplinary Center

Blake Bishop: Meg brings up a good point in that we are an interdisciplinary center as well. So it's not just med students, premed students, that are coming to us. We also have lawyers that are working with us, social workers, pharmacists that are in our program as well. So you really get the well-rounded education and you really get to look at healthcare in a different lens other than the healthcare lens. You get to look at it through the law lens and these other lenses that you might not get at lots of other programs.

Meg Gaines: And we also have longitude- age longitude or professional longitude. So we have gap year or pre-professional students, then we have professional students, then we have encore- so-called encore career people. So we have people- we have right now in the program three physicians. One of them was just recently retired and two of them are sort of mid-career. And they're all doing our program- the certificate part of our program because they want to continue differently in the practice. And all those are mixed in together. I mean in the soup are all the students who are wanting to go to schools and students who are going to schools and students who have been to school.

Dr. Ryan Gray: So as a premed student, if I were to come to the Center for Patient Partnerships, I'm interacting with these pre-law or lawyers and social workers and everybody else? And working as a team with all of these people?

Meg Gaines: Yes. And not only that but it's not that you're doing the medical part and the law students are doing the legal part and the social work students are doing the social work part; everybody does all the parts. It's sort of a Davinci- I don't know if you know much about Leonardo Davinci but I'm kind of a big fan. And it's a Davinci concept. You know, the concept that you can be an artist and a designer and a musician and a painter, and you know a whole bunch of other things. And an engineer. And I think if we gave all the legal work to the law students, they'd just get to know more and more about legal stuff. But actually clinicians- future clinicians need to know about the law. It doesn't- you know, even though we teach it in silos, that's not how it plays out in life.

Dr. Ryan Gray: Yeah, no that's awesome. I think that's great and we talk a ton about teamwork and how medicine nowadays is a team sport and the fact that you get that teamwork at the Center for Patient Partnerships, that's great too. So Meg you started- or you're the founding director. Why did you found the Center for Patient Partnerships?

Foundation of Center for Patient Partnerships

Meg Gaines: Well the short version is when I was 38 years old and I had two little kids- three and six months, I was out of the blue diagnosed with ovarian cancer which because I had no history of cancer in my family, knew nothing about it, I proceeded to allow my gynecologist to try to remove what they thought was just a benign mass, but it turned out to be cancerous and it was burst taking it out and it ended up in my liver and all of a sudden I had metastatic ovarian cancer and was told to go home and think about the quality, not the quantity of my remaining days. That was in 1994 so needless to say I didn't go home and think about the quality, not the quantity of my remaining days. And my kids are now 24 and 21. But what I learned in the healthcare odyssey that followed, was- let's just say left a lasting impression on me. And when I came out of my healthcare experience and had a couple of years to sort of get out of shock, I thought to myself, ‘Wow, you know I don't know very much about healthcare at all. But I know a lot more than I did know. And I know that some people will live if they have the opportunity to try- to try to sort of find the way through. And I don't know that much but I know more than I knew,' so I pulled together a group of people including my oncologist who is a terrific guy, and a friend of mine who was in the nursing school and some other folks who knew a lot more about healthcare and healthcare delivery than I do, and they helped me sort of shape this clinical program. So that's why, and your point about teamwork, one of the things that I found when I was in treatment- and I don't think it's changed that much. Is everybody talks about teamwork, but you know I played high school and a little bit of college sports, and when I played a team was about a bunch of people who had different roles. You know there was the forwards and the center, and the guards; and it had different roles but you had equal respect for all of them and you just learned how to use them, and everybody had sort of different moments of leadership and moments where they had to step up and that kind of thing. In healthcare I've found teamwork to be very much a boss and underlings. And I don't think that's real teamwork. In my view, in order to really be a team member, and in order to be an effective team, you have to know and understand the expertise and the skills of the people around you. So you know where you can put weight, where you can trust, and how you can best distribute the both opportunities and challenges of caring for a patient. Or of caring with a patient. And so I think part of the- really one of the big focuses of the century is to bring people from different disciplines together so they can get used to each other, and learn to appreciate the smarts of someone else.

Dr. Ryan Gray: I like that.

Blake Bishop: We really have an extensive website as well for those who are interested. www.PatientPartnerships.org is where students can go and learn more about the educational opportunities, patients can go and learn about the services that we have to offer. Like I said www.PatientPartnerships.org; it's a great website, we're affiliated here at UW Madison. Great city, great place to be.

Day in the Life

Dr. Ryan Gray: So describe a typical day in the life of a student at your program.

Meg Gaines: They would come in and check their mailboxes and their messages because there variably would be phone calls and emails and that kind of thing. One of the emails they might get would be from the person who's in charge of the database and assigning cases, and they might get a new case because they've closed a case or two and so it's time for them to have a new case. We have a database so a lot of what they do is online. And they go in and learn about it and they may call that patient or new client, or they might read the notes of the person who did the intake interview with the client, and go from there. Then they might meet with their supervisor and discuss their cases one by one and discuss strategy and next steps. If they've got a new case they would be filling out- or helping- they would be designing and presenting an advocacy strategy, what are their goals, what are the client's goals and therefore their goals, what are their questions about the strategy, what is the information they need to have before they can execute the strategy and what do they hope to achieve so that we can staff the cases and very often middle of the day there will be a time where people sit down together and go through and talk about the cases and talk about the strategies or update the facts and developments. They may go out to meet with a patient or a client at a coffee shop, or they may accompany a client to the doctor. They might go to a clinical visit with a client and get good news or bad news, or help facilitate conversations. Frequently- I'm working on a case right now where one of the physicians is sort of feeling insecure because another physician is kind of more positive and the patient kind of likes the positive better than the not so positive one, but the not so positive one thinks that the positive one's not being that realistic. So they get kind of insecure and then we come in- and a lot of times what we can do is help keep the relationship and help the patient define her team and make sure that the team is focused on the work, and not on who's being more positive or more negative, or who this, or who that- right, it's not about the people, it's about the work. And oftentimes we are- have this kind of- it's lovely we have this kind of ritual permission because we're not doctors, we're not lawyers, I mean we don't sue people; I'm a lawyer but I don't sue people. You know, I'm an advocate, so oftentimes I get to just kind of- our students get to be the clarion call for the patient. We're all here for the same reason, we're all- so you know they'll be going to a doctor's appointment to try to sort out a little bit of hurt feelings and that kind of thing, and they'll come back and answer more email or phone calls, or look up- learn all about the disability regulations if they have a disability case, or do a clinical trial search for someone with ER/PR positive but HER2 negative breast cancer and metastatic only to the liver, and how would we- you know what kinds of trials and immunotherapy, where is immunotherapy? Not much in breast cancer right now but solid tumor cancer has some immunotherapy trials. Where are they? What institutions? What conditions? What have those people written about? Who has expertise in metastatic advanced disease as opposed to early disease immunotherapy? And facilitating those conversations between clinicians so that a patient can actually get, you know, can make smart moves about- with limited resources, about where they're going to go for a second opinion, and if they're going to go for a second opinion, can we get a second opinion on the phone sort of informally, clinician to clinician without having the patient go spend $4,500 to go someplace. So we sort of try to help facilitate people's way.

Blake Bishop: So Meg actually just got done describing an on-site student, and it is actually very similar. Most people know that our program is online or blended as well. So in 2011 we realized that as great of a place Madison, Wisconsin is, not everybody can- or wants to move to Madison, Wisconsin. So we realized that and decided to move our program completely online so students from across the country are taking the certificate and very similar to what Meg just described, but just doing it remotely. We are fortunate that we live in a time where we have email and phone which is primarily the way to connect with patients; but we also use Skype, we use Adobe Connect, we use multiple different forms of media so that people that are from across the country that want to get this education, but like I said can't move to Wisconsin, they can do the program completely online. Or if they're nearby and they want to take one class on site and another one online, we're a small enough program where can offer that flexibility to really make sure that each student has the appropriate delivery model for them.

Dr. Ryan Gray: With the online version of this, if I live in California, are you trying to direct patients that are also in California to me so that I can do the doctor's visits with them and other things?

Meg Gaines: Not necessarily but I was just going to say that we have recently had a student who was in Atlanta, and she- by virtue of just happenstance maybe, or curiosity, or getting to know certain people; she made a connection I think to a clinician and he ended up identifying several patients she could help there. So she actually did have both in person and a remote client experience. But remember that our students who are sitting here in Madison, Wisconsin help patients that are in Portugal and in Miami and in- so whether your patient lives in the same town as you do or not, you know it changes how you do things. But I've even actually appeared in a doctor's office visit by phone with the patient there in person, and me remotely.

Dr. Ryan Gray: Interesting, okay.

Meg Gaines: Yeah.

Students Who Thrive in the Center

Dr. Ryan Gray: What types of students thrive in that kind of program that you have?

Meg Gaines: Hungry, smart, curious. I mean- and especially I think- I mean who we love to reach out to in the gap year, certainly premed gap year, would be students who are a little concerned about their- and a little nervous about their presence with patients and who want to get past that. Who want to really get where- you know it's like new shoes. They're sort of all uncomfortable at first, right? But if you spend a year here, I think your shoes get more comfortable.

Dr. Ryan Gray: What are some of the stories, or feedback, that you've gotten from premed students that are there during a gap year and what they have carried forward now into medical school?

Blake Bishop: So we recently had a student, Jeff Millen that completed our program that was a gap year student. He had an extraordinary story in that he was on the premed track, and life was good for him, and he went swimming one day and dove off of a dock not realizing that the water was only three feet deep, and paralyzed himself from the waist down. He thought it was going to derail his medical school but he is a determined young man and decided that he still wanted to go into med school, and after he graduated from UW Madison with his undergrad, decided to take our program and he said it really shaped the way that he looked at med school and the way that he looked at patients. He was able to do his capstone presentation on disability resources and-

Meg Gaines: Yeah, he did a great research project. Our students that do the certificate program do a capstone project or experience and Jeff called around to a hundred and something primary care offices throughout the state of Wisconsin, asking them if they had- just two question. Do you have a hoyer lift to be able to lift disabled patients onto the exam table? And do you have an exam table that's adjustable that moves up and down so that someone like him can get on it? Oh the hoyer lift was so they could be- for a scale. So that they- ‘do you have a scale where I can be weighed accurately even though I can't get up and get on the scale,' right? And so he asked those two questions and he- very simple but elegant and beautiful research project. And then when they said if they said they did not, he asked them why not, and if they said they did, he asked them why. And as you might imagine there were very few that did, and most of the ones that did not said, ‘Well we don't really have any disabled patients,' and he said he mostly held his tongue and didn't say, ‘Do you think that might be-‘

Dr. Ryan Gray: Maybe that's why.

Meg Gaines: Yeah, right. Chicken, egg problem here. But anyway, so- and then he presented his results, and I think it not only was remarkably powerful and simple and elegant to the people who were at his presentation, but I think it's really affected what he's decided to do in medical school. In his case, I think in some ways he didn't want to be you know sort of earmarked as somebody who is going to do disability stuff, because he didn't want people to think that that's all he could do. But he's actually gotten really interested in access in healthcare; access in terms of physical disability. And I have a feeling it might have sort of eased him back into something he has a real natural passion for. Maybe partly because of his disability, but hey there are worse reasons, right? I mean there wouldn't be a Center for Patient Partnerships if somebody hadn't hit me over the head with a two by four and ovarian cancer. I'm not that smart or- you know.

Numbers of Students and Class Sizes

Dr. Ryan Gray: What types of numbers are you looking at as far as taking students every year?

Blake Bishop: So we deliberately keep our class sizes small; on average our class sizes are somewhere between ten and fourteen students. We'd like to continue to grow our program but we've decided that if the program gets to be 20 students in a class, we'll deliberately split it up and make it two classes. And so it's a pretty small program but it's really nice because that way you have better interaction with the professor, you have a great- you build a great community with your classmates whether you're on site or online, we've definitely found that the research shows that especially for online classes, small class sizes really make such a big difference when it comes to building a sense of community.

Meg Gaines: And we're very intentional in the online environment about building sense of community; it's remarkable. And then it's kind of fun because we have them first for a semester online and then they come here in person for what we finally referred to as Boot Camp which is three days of intensive kind of orientation before they start the clinical part. The clinical meaning the part where you see clients, right? And it's so cute- it's so amazing to see them all meet each other in person, because they all feel like they know each other, but they've never met. So it's this very strange, fun dynamic.

Dr. Ryan Gray: That's great.

Meg Gaines: Yeah.

Dr. Ryan Gray: What can a student do- a premed student; maybe they're in high school, maybe they're not ready to commit to taking this class that you offer. What can any premed student do to kind of get a lot of these experiences and help them build these skills for themselves?

Meg Gaines: I think they can- I mean students now do- you know they do what we used to call candy striping; I don't know what they call that anymore. But volunteering in hospitals, giving out tea and coffee, and being a runner with files and things like that so they can be around the clinical delivery environment and learn something from that I think. They can work in- and often I think do work in labs and research labs and that kind of thing so they interact with clinicians as well as scientists and research scientists and others, and learn about sort of bench research. I mean I think there are a variety of thing you can do. You can certainly do foreign travel kind of healthcare assistance stuff.

Introduction Courses

Blake Bishop: In addition to all of that, what's great is that as somebody is at Patient Partnerships or looking at the full certificate and saying, ‘Wow it sounds like a great program but boy I'm just not ready to commit for an entire certificate.' What we've done recently is we've taken it up- taken the certificate and broke out the first class- the Introduction to Patient Advocacy course, and said for those people that aren't ready to commit fully to a certificate like this, if you just want to get your toes wet and see what all of this is about, you can take the IPA- the Introduction to Patient Advocacy course as a standalone course. That way they can get the experience of the Center, they can see what the online courses are all about, they can see that this isn't just your traditional post-bacc program, it's not your traditional boring online course. And after they take that IPA we've found that most of the students decide that, ‘Wow this is a great program,' and that they're going to apply to take the entire certificate. But it's a great way that we can give students a little taste of what the entire certificate is like.

Dr. Ryan Gray: Alright. That all sounds amazing, and I think even as a- and you said as you have different levels of people coming in, graduate students, even physicians now. It would be interesting in the future to see this as an elective for medical students or even residents to come through and get a taste of it. Because I think even some small exposure will help everybody in the long run.

Meg Gaines: So we have two courses that are online- fully online, elective courses for med fours that they can do while they're flying around interviewing or whatever. One is called Advocating for Populations, and it is a four-week, very intensive- it's probably eight to ten hours a week, so they complain at how much work it is. But it's four weeks of learning about media advocacy, legislative advocacy, and community advocacy, and sort of advocacy- some of the more theory of advocacy. And then the second course is called Advocating for Patients and it's a quick and dirty about the healthcare system, about your role as a clinician; is it appropriate for clinicians to be advocates? If not, if so, what's the literature, blah, blah, blah. And how can you be an effective advocate without adding twenty hours a week to your already unmanageable- you know, how can you be a more efficient clinician advocate than you are even just a clinician?

Dr. Ryan Gray: Yeah, and I think that's a huge part of it because as a premed student you're not thinking about this, but as a physician I know that when I advocate for a patient, I'm not getting paid for it.

Meg Gaines: That's correct, you're not getting paid for it and it's taking your time. So even if you're not getting paid for it and you don't care, you're still going to see the same number of patients. And if you're going to actually get home in time to actually have a life, and exercise, and you know bounce your baby on your knee, and a few other things; you need to- it's not an acceptable strategy- it wouldn't be for us. For me, as a patient advocate to say, ‘Well you need to be more of an advocate so you're just going to have to add it on.' That's not going to work. But what I will say is that if you develop an advocacy infrastructure in your practice, and you know where your local lawyer is who needs to do pro bono work and wants to help you, you know where your local librarian is who has a whole stack of things about proper nutrition or proper wound care or whatever, and you know where your- you know that when you play golf you're going to play with the city councilman at least once a month because that's the person who's going to help you get the mold out of the apartment that your six-year-old that you're treating for asthma live in. You know, if you do that then you don't wind up just jacking up their steroid level, making them fail in school and feeling like you did harm instead of no harm, right? But it does take building the infrastructure; but once you build it, it helps you- you know it seems to me it must be hell for a clinician to think that because they have just this silo'd prescription pad and no other real power, that all they can do is keep- you know treating and treating more and more, increasingly resistant illness with more and more medication instead of getting at the social causes or the root causes, the environmental causes. Now unless you own a mold abatement business, you're not going out this weekend to clear out the mold from your patient's apartment. But you might be able to pick up the phone and call the city councilman or call your friend the lawyer, or call whoever and say, ‘Hey, I need help with this. This is not going to work.'

Dr. Ryan Gray: That's great, and those are all skills that medical school doesn't teach you and it's awesome that there's a place like Center for Patient Partnerships that teaches this to physicians and to lawyers and everybody else that you mentioned, because I think in the end, the more that we can educate students- even the student listening now who's not going to go to and take your program; the fact that this is in their mind, they know this stuff is available, then they can start asking questions later on.

Meg Gaines: Yeah, and insisting on getting that education somehow. Because everybody knows- I mean Ryan, you and I have never met before, you know exactly what I'm talking about. This is shared understanding without any trouble.

Dr. Ryan Gray: Without a doubt. So Blake, mention one more time where students can find more information?

Blake Bishop: So they can go online and go to www.PatientPartnerships.org. Again that's www.PatientPartnerships.org. We have a class starting in the summer, so if they wanted to get started right away they can apply for this coming summer; classes start Tuesday, May 26th, the day after Memorial Day. If they want to start in the fall, we also have a fall start that starts the day after Labor Day, so a couple different options for them. But we have quite a bit of information at www.PatientPartnerships.org; they go onto the education tab and they can find out all the information about the Center and about all the great opportunities that we have going on here.

Final Thoughts

Dr. Ryan Gray: Alright, again that was Blake and Meg from the Center for Patient Partnerships which you can find at www.PatientPartnerships.org, and again I'll have a link to that in the show notes which you can get at www.MedicalSchoolHQ.net/122. An awesome opportunity if you have the time in your schedule to take advantage of this, to be an advocate for a patient will expose you to so many things that you will never have exposure to as you're going through medical school, as you're going through residency. Take the time, learn all about this. Even if you can't take any of their programs, do yourself a favor and learn as much about it as you can. Because in the end it will make you more sane, and it will definitely improve your patients' outcome, and that's what we're all here for, right? Improving patient outcomes.

So one thing I'm here for is to get awesome ratings and reviews, which is why I bring you a great podcast- hopefully a great podcast every week. And over the last week we got five new ratings and reviews from awesome listeners. So I'm going to read a couple of them here today, and I'll read a couple more next week; and hopefully we'll have some more to read next week as well. But we have AnchoredSoul619 who says, ‘I wish I knew about this in my freshman year.' They're now a fourth year semi-traditional student, and they said- or he or she listened to 120 episodes before leaving a review and a rating because they wanted to make sure that it was really worth five stars, and they said I was. Awesome. KimTayMart says, ‘Wonderful, five stars. Just listened to my first podcast ever and wow was it informative.' Awesome. So thank you for that, KimTayMart. And one more here, MerElyse10 says, ‘So much great information,' talking about how we do lots of good topics and exploring them in depth. So that is great.

Alright again, if you haven't yet left a rating and review go to www.MedicalSchoolHQ.net/iTunes and you can do that. If you're listening on Stitcher you can leave a rating and review in Stitcher as well. I haven't found out a way to look up my ratings and reviews in Stitcher yet. Maybe I should do that one day. But again, our Facebook group, www.MedicalSchoolHQ.net/Group, go join us there, almost 200 students hanging out and collaborating there. And as always I hope you join us next time here at the Medical School Headquarters.

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