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Telling patient stories to teach new medical students

I once sat in on a medical school class at Stanford as a reporter in which the professor Gilbert Chu, MD, PhD, invited a cancer patient to come help him teach about oncology.

It was a memorable class and quite moving. The students listened intently as the patient described both the medical and emotional aspects of his illness. The patient's talk provided a perfect jumping off point for the professor to expand on the science of the illness — which the entire class was now deeply interested in.

No one touched a cell phone, no one even rustled a paper.

It’s this type learning experience that authors of a study published last week in Academic Medicine hope to recreate through the use of online teaching videos. The videos combine science with patient stories to engage medical students during their pre-clinical years.

"We've all heard many physicians say they only learned medicine once they saw patients," commented Maya Adam, MD, first author of the study and creator of online educational content for the "Re-imagining Medical Education Project" led by Charles Prober, MD, senior associate dean for medical education at Stanford. Prober is also senior author of the study.

During the first two years of medical school, students spend most of their time in a classroom and often complain of a disconnect between the reason they went to medical school — to help patients — and sitting in a classroom listening to lectures. Prober's mission is to transition from this passive learning method to a more active learning experience — fewer lectures, more interaction, and more teaching videos that tell a story.

"It's wonderful if you can actually arrange for a patient to come to class but you can’t always get the right patient with the right illness when it’s being taught," Adam, who is also a lecturer in infectious diseases, said. But with a video, you can prepare evergreen content that can be shared between institutions, and even globally.

To create the 36 videos, most under 10 minutes in length, Adam (who is storyteller, illustrator, videographer, narrator and medical editor) also did her own research to find examples of patients to help illustrate the topic of each video. Part of the research entailed interviewing infectious disease physicians to hear about their firsthand experiences with patients.

Sometimes Adam used well-known stories, like that of David Vetter, a boy from Texas born in 1971 who was forced to live in a specially constructed sterile plastic bubble from birth until he died at age 12. Nicknamed the "Bubble Boy," David was born with severe combined immunodeficiency basically he had no immune system.

Other times she used stories of patients who were an amalgamation of actual cases that the physicians described to her. In a video on malaria, she describes the case of a little girl living in Uganda whose father wouldn’t put her under the mosquito netting at night because it was more important to protect the bread winners in the family — the boys and the men — from getting sick. Ultimately, the little girl gets bit by a mosquito, malaria sets in, her eyes turn yellow, her mother takes her to the clinic where they send her to a hospital driven on a moped. During the trip, she suffers a seizure and dies.

To determine the success of these story videos, they were used as a pilot teaching project in microbiology and immunology courses in medical schools at Stanford, the University of Washington, UCSF and Duke University. "We had very positive responses," Adam told me. Sixty-one percent said the videos added value to the learning experience and that they "enhanced retention" of the material.

"If you are learning about microbiology, a lot is at the microscopic level," Adam said. "If we can use illustration and stories to bring that to life, like we did in this course, we can get medical students hooked, get them emotionally involved, that’s when the information sticks."

Previously: Using the flipped classroom model to bring medical education into the 21st century, How the flipped classroom boosts faculty interest in teaching, and A closer look at using the flipped classroom model at the school of medicine
Illustration by Maya Adam

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