Last summer, Peter Nauka, 23, a first-year medical student at New York's Hofstra University's Northwell School of Medicine, was on his second night as an EMT assistant when his ambulance received its first serious medical call. Someone needed immediate help in Queens.
“How real everything is about to become,” Nauka recalled thinking as the vehicle sped along city streets, its emergency lights spinning and sirens blaring. “I was going to be expected to play a very real and vital role in patient care.”
When they arrived at the scene, the EMT, Nauka and another first-year medical student ran into the house and placed the patient—unconscious and without a pulse—onto a stretcher. At first, Nauka watched the paramedic and the other first-year apply ventilation and chest compression. After a few minutes, it was his turn.
“I was not even really thinking at this point. I just became very automatic in my task,” Nauka said. “I do remember trying not to look at the patient's face.”
Once at the hospital, the staff took over and rushed the patient into the intensive-care unit. “I was absolutely drenched in sweat at this point,” Nauka said. “I sincerely hope that they ended up surviving.”
Hofstra's decision to immerse first-year students like Nauka into the nitty-gritty of day-to-day medical care is part of a growing movement among U.S. medical schools to train the next generation of physicians in ways that will allow them to adapt quickly to changing delivery-system models. High on the list of skills the programs seek to instill in students is how to work in teams and understand the roles played by other professionals.
“When you apply to schools, they ask you if you are a team player. But that's lip service,” Nauka said. “You don't see it until you're enrolled.”
Architects of the new programs also say that by exposing students to the complex needs of patients with multiple chronic conditions, they will be more willing, once they're in their residencies and beyond, to understand the special needs of such patients and how to care for them in a more holistic manner. Proponents say immediate immersion with the seriously ill should instill greater empathy for such patients, spark interest in taking up primary care and make future doctors more attuned to helping patients navigate the complexities of a highly specialized healthcare system, which is the essence of the medical home model for care coordination being touted by Medicare and other payers.
“It can create a passion for improving the situation,” said Dr. Don Goldmann, chief medical and scientific officer at the Institute for Healthcare Improvement in Cambridge, Mass. “Walking in patients' footsteps is critical.”
At the very beginning of medical training at Hofstra Northwell, which opened in 2008 at Hofstra University in partnership with North Shore-LIJ Health System, first-year students are assigned to work shifts with local emergency medical technicians. The nine-week course results in their becoming certified as EMTs.
The course provides an overview of actions the students will learn later in medical school, including medical history-taking, CPR and responding to crises, said Dr. Lawrence Smith, dean of the Hofstra Northwell School of Medicine. “We wanted to get the students comfortable with seeing patients right from the beginning and link classroom work to what they see with patients.”