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Broadening Medical Students’ Exposure to the Range of Illness Experiences

A Pilot Curriculum Focused on Depression Education

Pandhi, Nancy MD, MPH, PhD; Gaines, Martha JD, LLM; Deci, David MD; Schlesinger, Mark PhD; Culp, Cecilia MA; Karp, Zaher MPH; Legler, Christie; Grob, Rachel PhD, MA

doi: 10.1097/ACM.0000000000002893
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Problem: Exposing medical students to a broad range of illness experiences is crucial for teaching them to practice patient-centered care, but students often have limited interaction with patients with diverse illness presentations.

Approach: The authors developed, implemented, and evaluated a self-directed online curriculum followed by a small group discussion focused on depression education. The curriculum was based on a module created using the Database of Individual Patients’ Experiences methodology. Findings from 40 interviews with young adults across the United States about their diverse experiences with depression were summarized online, and the summaries were illustrated by video, audio, and text clips. From August 2016 to April 2017, third-year students completed either this online curriculum and the usual clerkship curriculum or just the usual clerkship curriculum. These intervention and control groups completed pre and post surveys.

Outcomes: Students in the intervention group reported the online curriculum influenced their thinking about depression (51/56) nearly as often as they reported seeing patients in clinic did (53/56). They also reported greater decreases in personal stigmatizing attitudes towards depression than students in the control group as measured by the Depression Stigma Scale (5.75 to 4.02 intervention; 6.50 to 5.65 control; P = .004). In open-ended responses, students in the intervention group were 13 times more likely to describe key lessons from the curriculum that reflected patient heterogeneity.

Next Steps: Future collaborations include implementing and evaluating this curriculum at other medical schools and developing additional versions based on other illness experiences.

N. Pandhi is associate professor, Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.

M. Gaines is director, Center for Patient Partnerships, and distinguished clinical professor of law, University of Wisconsin Law School, Madison, Wisconsin.

D. Deci is associate professor, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

M. Schlesinger is professor of public health and chair, Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.

C. Culp is outreach specialist, University of Wisconsin Population Health Institute, Madison, Wisconsin.

Z. Karp is health care analytics specialist, healthfinch, Madison, Wisconsin.

C. Legler is department coordinator, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

R. Grob is senior scientist, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A714.

Acknowledgements: The authors wish to thank the students involved in this intervention for their thoughtful participation and Madison Crowder for her editorial assistance.

Funding/Support: This project was supported by the Josiah Macy Jr. Foundation, the University of Wisconsin School of Medicine and Public Health, the Wisconsin Partnership Program, the University of Wisconsin Medical Foundation, the University of Wisconsin Institute for Clinical and Translational Research which is supported by the Clinical and Translational Science Award program, the National Center for Advancing Translational Sciences (grant 1UL1TR002373), the Center for Patient Partnerships, the University of Wisconsin Department of Family Medicine and Community Health, and the Health Innovation Program.

Other disclosures: None reported.

Ethical approval: The University of Wisconsin-Madison institutional review board deemed this study exempt from review.

Previous presentations: A portion of these findings were presented in a poster at the North American Primary Care Research Group Annual Meeting in Montreal, Quebec, Canada in November 2017.

Correspondence should be addressed to Nancy Pandhi, Department of Family and Community Medicine, University of New Mexico School of Medicine, MSC 09 5040, 1 University of New Mexico, Albuquerque, NM 87131; telephone: (505) 272-0510; email: npandhi@salud.unm.edu.

© 2019 by the Association of American Medical Colleges