In a course believed to be the first of its kind in the nation, medical students at Upstate Medical University are spending 18 months at the side of expectant momfrom mid-pregnancy through birth and the baby's first year of life.
The course is known as the MIRACLE Continuity Elective, seeks to provide students with a solid introduction to issues surrounding patient-physician relations. It also offers insights into the psychosocial dimension of care and the influence that pregnancy, birth and breastfeeding have on women's and maternal/child health and family building.
"This course is the potential savior of the healthcare system," says course co-director Richard Aubry, MD (HS'63), MPH, Professor of Obstetrics and Gynecology at Upstate Medical University.
Faculty say the course represents a significant change in medical education, because it provides continuity-based patient interaction from the student's earliest days in medical school. Extensive patient interaction is traditionally reserved for third-year students, which makes this course a desired elective by the students.
Students are with the expectant mother and her family every step of the pregnancy. They visit the family's home, observe doctor visits, experience the birth process, accompany the family during the newborn's well-child visits and even celebrate the child's first birthday. This results a bond or a special relationship between the family and their students that can last beyond the elective.
"First-and-second year students tend to get buried in basic science and become very disconnected from the patient. The reason they went to medical school is to be with the patient."
The course is significant, faculty say, in that it highlights four areas often overlooked in formal medical curriculums:
The term "continuity of care", which has been part of the medical jargon for years, refers to coordination of care that a patient receives over time. "Usually students learn medicine by going from patient to patient, but this program enables students to understand the continuity of care by participating in a patient's healthcare needs for nearly two years," says Dr. Aubry.
The MIRACLE Continuity Elective enables students to understand wellness, over and above illness. It is usual for medical students to be introduced to illness and disease, which is usually the focus, and not focusing on the overall wellness of a patient.
This elective introduces the student to the Wellness Index, by John W. Travis, MD, in which the student learns the thirteen mind/body areas of wellness and apply it to themselves and to their patient's. A baby's future wellness is strongly influenced by the quality of prenatal care, delivery and the first year of life. This is what the medical students want, are exposed to, and learn from.
One of the unique and most important elements of the course, Dr. Aubry notes, is the requirement that students visit their assigned families at home on at least three occasions.
"These home visits are immensely important, as they help students better understand their patient and the impact that home life has on health." says Dr. Aubry. "Students quickly learn that issues related to environment, lifestyle, motivation, character and family must be understood in order to provide comprehensive medical care."
Students also understand the physician's disappointment when the patient does not follow instructions, such as, heeding to the advice to quit smoking during the pregnancy. The students learn the day to day compliance problems that physicians face and help students to look for better approaches to these common dilemmas.
"Clearly, the program has proved itself to the faculty, who have now witnessed the educational benefits." says Dr. Aubry.
These benefits can be personal as well as professional. This course allows for the students to think about their own future reproductive experience and the understanding of continuity care with their own families. It is a wonderful concept that these students can apply the MCE experience to both their professional and personal lives.