Medical Students Stand In as “Patients” in Training Exercise for Physiatrists
First-year medical student Hannah Brooks sat on an examination table while residents in physical medicine and rehabilitation (PM&R) performed several diagnostic tests on her. Ms. Brooks was volunteering as a “patient” in a class on musculoskeletal (MSK) anatomy—relating to muscles and bones—one of a number of short instructional lessons organized by the clinical and developmental anatomy course for Einstein’s affiliated residency programs.
A medical student stands in as a patient while residents in PM&R practice their examination and diagnosis skillSponsored by the department of PM&R, the class aims to train future PM&R specialists, also known as physiatrists, in helping patients regain control of movement and improve quality of life after a disabling disease or accident.
“Musculoskeletal medicine is an area that’s not well covered by the curriculum in most medical schools, including Einstein, so the course seeks to address that deficit,” said Dr. Sherry Downie, professor of anatomy and structural biology and of PM&R.
“When Dr. Maya Therattil and I created the course more than a decade ago, we thought it would be helpful for residents to practice their skills in a real-life situation,” she recalled. “Asking students to serve as stand-in patients seemed like a good idea, since both residents and students could then benefit.”
Training Future Physiatrists
The course’s five sessions take place in the anatomy lab, with the first three focusing on the trunk, upper limbs and lower limbs. Each of these initial sessions begin with a quiz in which residents are asked to identify tagged structures on a cadaver, followed by discussions with the faculty.
In the fourth session, residents perform physical examination maneuvers that they would employ in clinic, with Einstein medical students in the role of patients, and in the fifth they review other procedures.
As they practice their skills, residents are able to correlate their observations with anatomical details provided by the cadavers, which are nearby.
“The exercise allows residents to more clearly interpret why a procedure might be critical to diagnosing a particular musculoskeletal condition,” explained Dr. Stephanie Rand, assistant professor of PM&R and of anatomy and structural biology and associate director of residency training for the Arthur S. Abramson Department of PM&R at Montefiore.
And residents are encouraged to explain to the medical students what they are doing and why, thereby educating the students in musculoskeletal medicine while practicing their own teaching skills.
Learning Opportunity for Medical Students
“It was very informative to see doctors using skills that we learned about in anatomy lab,” said Ms. Brooks.
“During our anatomy course, we had learned about muscles and nerves in the upper and lower limbs while working through clinical cases with PM&R residents,” she added. “By taking part in this session, I got to see how they apply that anatomical knowledge for testing and diagnosing in various clinical scenarios.”
Portraying patients also allows students to interact with residents and observe clinical education in progress when second- and third-year residents discuss their experiences with guidance from senior residents.
“Residents share their insights with the students, giving them additional physical examination knowledge and skills to draw from during their clerkship rotations,” said Dr. Rand. “It also exposes students to the field of PM&R.”
In addition to learning about MSK testing, students receive $50 for participating.
“I appreciated seeing the residents work together to solve problems and the professional camaraderie that they shared,” noted Ms. Brooks. “While I’m not sure what field I’ll ultimately choose, participating in the course has definitely piqued my interest in physiatry.”
Posted on: Friday, June 24, 2016