Learning Social Determinants through Longitudinal Preclinical Patient Relationships

INTRODUCTION: Albert Einstein College of Medicine is in the Bronx, where residents face unparalleled socioeconomic and health challenges.  The voluntary Patient Advocate Connection (PACt) preclinical medical student program aims to: (1) develop student empathy, advocacy skills, and dedication to underserved communities; and (2) help patients better understand and engage in chronic illness management.  The first full program year (2012-2013) was evaluated with mixed methods.

METHODS: Twenty-four students in pairs formed longitudinal partnerships with twelve patients living with chronic disease, and established and pursued patient health goals.  Three faculty physicians mentored students, recruiting patients from 2 Montefiore health centers. Initial student training included phone patient introductions.  Patient-student teams spoke weekly, with EMR documentation.  Students met monthly in groups with physician mentors, alternating skills workshops and reflection. Participating students were surveyed before and after, and patients once, on attitudes, knowledge, and behavior.  Anonymous bi-monthly student written reflections were analyzed thematically.    

RESULTS: Students (n=17) joined PACt for various reasons; self-perceived knowledge of patient resources increased; and plans to pursue primary care increased; but unremarkable student empathy scores remained unchanged; and plans to care for the underserved declined.  Challenges included time constraints, role confusion, frustration, and logistical issues.  Patients (n=11) joined PACt for various reasons; reported poor or fair health; achieved goals with student help; and rated student communication highly.

DISCUSSION: Despite goal-oriented progress for patients, valuable learning opportunities for students, and a modest increase in students committed to primary care, the experience discouraged some students from working with the underserved.