Walk with Me:
Early Clinical Experiences for Medical Students
Motivated to integrate the science and art of medicine, incoming medical students at most institutions arrive on campus anticipating opportunities to engage with real patients and their families — at some point in the future. Medical students at Stanford, on the other hand, have an unusual opportunity to interact with patients in their very first month, even as they pursue the critical study of the basic sciences in their first two years.
The Walk with Me class, one offering of Stanford’s Patient and Family Engaged Medical Education program, is a student-patient-caregiver partnership experience that offers early, authentic engagement with patients and their families.
Students in the Walk with Me class are the beneficiaries of a key outcome of the Transforming Medical Education Initiative, according to Erika Schillinger, MD, professor of medicine and vice chief for education in the division of primary care and population health. That key outcome suggested that authentic early experiences with patients would put patients and their caregivers center stage from the very start of medical education, establishing the patient’s perspective and experience of health and the health care system as vitally important to being excellent clinicians.
The first practical step in putting early patient experiences in place was to create a curriculum in health systems science and deliver it monthly with didactic workshops, patient perspectives and practical skills building. According to Schillinger, “Health system science has become the essential third pillar of medical education, along with basic science and clinical science. It means everything that anticipates, surrounds, and forms the context for health care.”
The course was designed to “prepare students for a 21st-century health system in which they will be leading health care,” says Schillinger. Specifically, she continues, “we asked the patient-student pairs to meet a minimum of one hour per month to explore the patient’s and caregiver’s experiences of the health care system, focusing on the topic of the month with the goal of providing rigor and structure and accountability to their partnership. The result has been a magical, game-changing experience that puts patients and families front and center in medical education from the very beginning.”
Three students who enrolled in the course share their experiences.
Marija Kamceva switched her major at Yale from English to premed following a biology class she took as a junior. Once she got to Stanford and learned about the Walk with Me class, she jumped at the chance to take part because “it seemed like a really good opportunity to understand the role I was about to play either as a primary care physician or a psychiatrist. I thought it would contextualize the rest of my education.”
When she learned her patient’s name, she says, “I called her, and we met for coffee the first time near Stanford. We bonded really well.” Meeting her patient two or three times a month, Kamceva found that they shared many of the same interests, and they even learned to crochet together. “My patient’s story was long and interesting,” she says, “and this was the first time she had the opportunity to really tell it because it’s hard with something so personal to even talk with your friends about it. I feel like I will always have her story with me as I go on and work with patients.”
A Mind-Boggling Medical History
Isaac Jackson, an MD/PhD student, plans to be a pediatric oncologist or maybe an obstetrician and gynecologist; he is drawn to research. Early on he wondered what steps he could take “to become a good doctor and a good care provider. I felt that building relationships, getting to know patients, and starting to understand what patients go through, was a very important part of that process.” Given the specialties he is interested in, he says, “I realized that I was going to be dealing with difficult situations I don’t know the first thing about. How do I learn to be empathetic and understanding about something I have no firsthand knowledge about?”
Then he enrolled in Walk with Me. He emailed his patient to get to know her and was invited to an upcoming doctor appointment. To bring him up to speed, his patient partner sent him a summary of her previous appointments and medical history. He found it “mind boggling. It’s easy to read words on this nice crisp page, but then I’m thinking about what that really represents: dozens of rounds of treatment, multiple hospitalizations, four near-death experiences over a few years.”
After several visits with his patient, Jackson could see what he was getting out of the relationship, but he wondered about his patient partner: “What could I offer, as a medical student who just parachuted in years after the start of someone else’s medical journey?” He later learned his patient partner had similar thoughts. “Being so sick for so long became a more and more integral part of her identity. There was family and a significant other, but then there was the sickness. In a way, the relationship we formed illustrated her potential to still form meaningful emotional connections despite such serious illness.”
Sandrene Cassells came to medical school after several years teaching high school, where she was used to “being part of the day-to-day experiences of my students, being able to see their academic growth and their personal growth.” Thinking about the first two years of medical school made her realize she “didn’t like not tracking closely with patients until my third year. I was looking for something that would allow me to develop a close relationship with a patient early in my medical school career.”
Then she got involved in Walk with Me. Partnered with a patient undergoing treatment for cancer and sick from chemotherapy, Cassells drove to the patient’s home the first time they met, and they talked and had tea. After that they set up breakfast dates. “We met at a halfway point and we always got pancakes.”
During their year together, Cassells’ patient partner worried about what it would mean when she came to the end of her treatment. At Cassells’ suggestion, “we went together to a nutritionist and explored things she could do in hopes of preventing the cancer from coming back. I felt like I could advocate for her in that situation because we had had all those interactions around food.” In summary, says Cassells, “My entire world has changed from knowing her.”