Return to Main Menu

Health care students gain new respect for colleagues

by Susan Brink

At first glance, the summer practicum looks like a typical medical school course. A professor throws out a question based on what the students have seen in a rural clinic that week: A diabetic patient walks into a medical office with early signs of gout–what do you do? But the resulting discussion is anything but conventional.

A medical student suggests scheduling an appointment to counsel the patient on diabetes control. But he's suggesting the evaluation be done by a nurse. Then a nurse joins in, suggesting the patient talk to a pharmacist about potential drug interactions. Future occupational and physical therapists add their 2 cents, as does a would-be hospital administrator, who raises the difficult subject of cost.

At the Medical University of South Carolina in Charleston, medical, dental, nursing, pharmacy, and physical and occupational therapy students–all bound for jobs in settings that increasingly demand teamwork–are learning to work together. Although the students still do the bulk of their coursework within their own professional schools, they come together for practicums, clinics, and some seminar-style classes.

For instance, dental students and pharmacy students work side by side at an off-campus clinic, and medical and nurse practitioner students study neonatology side by side in one course. Charleston's program, six years old, was one of the first in the country. The concept is taking off at other schools, including Case Western Reserve University in Cleveland; the University of Rochester in New York; George Washington University in Washington, D.C., and Allegheny University of the Health Sciences and Thomas Jefferson Medical College, both in Philadelphia.

Group practice.

The programs are prompted by fundamental changes in the health care system.

Many students will work for managed-care organizations, which are squeezing the time patients spend with doctors, the highest paid professionals on the health care delivery chain. As a result, patient care is delegated more widely among different health care professionals who have to coordinate their work closely.

Further, those traditionally lower on the chain, including nurses and physician assistants, are given greater responsibility for patient care. “Managed-care organizations, hospitals, multispecialty groups are telling us they want people who understand what it means to be an employee and to work with other members of the delivery team,” said Janis Bellack, associate provost for educational programs.

As students at the Medical University of South Carolina study together, their respect for the expertise of their colleagues in different disciplines grows. Charlotte Collins, a third-year dental student, says she has learned better communication skills from the nurses she has worked with at the Gethsemane Community Center in Charleston, a local facility the schools use for interdisciplinary training. “We've always got our hands in people's mouths. I've learned from the nurses how to ask questions and listen to answers,” she says.

Katherine Lalas, a pharmacy student, says her training has given her a broader view of how she'll function after she graduates. She now sees part of her job as looking over the shoulder of those writing prescriptions, and suggesting alternative drugs that might be more effective, cheaper, or safer.

The school is turning out a new wave of physicians with no illusions about having a lock on medical answers. Ben Wilson, a medical student who plans to go into rural family practice, points to a hypothetical case summary he prepared last summer after spending six weeks in a Varnville, S.C., clinic. The patient was a newly diagnosed diabetic. He referred her to a pharmacist to review her medications and see if there might be any dangerous interactions, to a dietitian to talk with her about her eating habits, and to a nurse trained in diabetes control to counsel her about how to live with her illness. Not a single referral was to another physician. Editor's note: Copyright, March 29, 1999, U.S. News & World Report. Visit us at our website at <http://www.usnews.com> for additinal information.