The Experience of Illness Module for Beginning Medical Students

Objective: The Experience of Illness is the initial module of a two-year longitudinal patient-based experience at Mount Sinai School of Medicine. Its purpose is to enable students to use their personal experiences as building blocks for the creation of their professional role. Description: The Mount Sinai School of Medicine has created for preclinical students a new two-year course entitled the Art and Science of Medicine, developed by a team of medical educators from medicine, social work, and nursing. The basic assumption behind the curriculum is that grounding in personal experience is a prerequisite for the development of a professional role. Small groups of ten to 12 students stay together throughout the two years, learning, growing, and processing experiences with sets of preceptors as their training continues and skills develop. Each group has two or three preceptors, both physicians and non-physicians, in these roles. The students keep journals, writing about both their assignments and impressions of their evolving professional selves. The course goals are to develop skills in communication, develop skills in history taking and physical examination, shape attitudes and values that emphasize professionalism, become aware of the organization of the health care delivery system, and develop awareness of the impact of illness on the patient. The first module of the eight offered in year one explores students' personal experience with illness, allows them to observe and listen to patients' experiences of illness, and offers them a chance to assume the role of a person with a handicap, impairment, or disability. This module was developed by physicians, nurses, and physical and occupational therapists. The topics presented and discussed have included patient interviewing, the influence of culture on the experience of illness with a special focus on the World Health Organization guidelines relating to disease, impairment, disability, and handicap. A recent class of the module had the students experience impairments in New York City. The impairments were simulated, by using a variety of equipment to design the exercise. The types of equipment utilized to simulate the impairments were wheelchairs, canes, walkers, slings, eye patches, crutches, and oxygen tanks. Experiencing impairment for a short time was the intent, with colleagues assisting and observing how society reacted to the individual. The students were given written instructions to guide them through their experiences. In setting up each student with the equipment, an impairment was also described. The students who used a cane and a sling were simulating what it would be like to be hemiplegic, and the wheelchair users were experiencing what it would be like to have paraplegia. There were also groups that did not have any visible equipment, with the impairment of aphasia. The exercise was designed to raise the students' awareness of what it means to be impaired, and to begin to evaluate their own values, beliefs, and expectations of individuals they will be caring for. Groups of three students were sent out with tasks to perform, e.g., get lunch, go to the bank, shop for groceries, etc., with each student having a specific role. The roles were the individual with the impairment, a family member, and an observer of the exercise, with each student given the chance to serve in each role. The actual activity lasted approximately three hours, with time to discuss the experience within their small groups afterwards. The insight developed and questions raised during this exercise were very powerful for the class. Many students had not had such a unique, powerful learning experience. Discussion: The Art and Science of Medicine course is adding a new look to medical education. The intent of the course, and the reason for the Impact of Illness being the first module of the course, is to initiate first-year medical students into the dynamic, multifaceted learning process they have begun. The Impact-of-Illness module, being very experiential, allowed the students to see things from the perspective of a patient as they went through the exercise. For some students, such an experience could also be a catalyst for personal growth, change, and a greater openness to the complexities of medicine in the 21st century. The initial feedback from the students was that the module had been a good experience. Physicians' expectations have changed. Some students, as well as some of the preceptors, have traditional expectations of medical education. It has been an unsettling process for all to learn how to proceed in this fashion. It is hoped that students as well as educators will move into the second module, Communication, with greater respect for themselves and their community, and a commitment to accepting the responsibility of medicine as it continues to change.