Patient education is typically interpreted as doctors teaching patients about health; but the opposite is often true at the Wayne State University School of Medicine. In an effort to educate the most qualified and most humanistic physicians, WSU faculty members are introducing patient interactions into the curriculum much earlier and more frequently than before--and for good reason.

"It’s one thing to learn about the biology of a disease. It’s quite another to be face-to-face with a person who has the disease," said Robert Frank, MD, associate dean for academic and student programs. With that in mind, more clinical correlations have been added to the curriculum to make the scientific lessons and lectures more meaningful and applicable for physicians-in-training.

Maryjean Schenk, MD, chair and assistant professor of family medicine, teaches medical students about environmental and occupational health. She believes that one great way to learn about the effects of toxic environmental exposures is to speak with somebody who has experienced them. Although many medical schools choose a purely scientific approach to teaching toxicology, Dr. Schenk believes that the practice of medicine is primarily about caring for patients, and that is evident in the programs she directs. While scientific expertise is critical, the integration of that knowledge is what medicine is about, she says.

For several years, Dr. Schenk invited patient Paul Schikora to share his story about the serious health problems he developed from years of on-the-job exposure to asbestos. "Mr. Schikora educated medical students about his own health problems, so as physicians, they could educate their patients in turn," said Dr. Schenk. "He discussed his symptoms, explained the subtleties of his disease, expressed his concerns about public health, and told doctors how they could help patients like him. He was deeply committed to his role as a patient-teacher." His wife, Maryann, shared the perspective of the family’s response to the illness. Mr. Schikora died last year as a result of his exposure-related illness.

These patient-education programs, which are meant to heighten the relevance of basic science rather than replace it, are scattered throughout the four-year curriculum. During the unit on public health issues, for example, students talk candidly with laryngectomy patients who developed throat cancer as a result of smoking. During the lesson on connective tissue disorders, patients with rheumatoid arthritis explain how this disease impacts their lives. In the geriatrics unit, students interact with elderly people and even go through exercises in which they simulate the loss of vision, hearing, and balance, so they get a patient perspective--not just a biological one.

The essence of the philosophy is: the more medical education is tied to real patients the better it is. "The appropriate concern for physicians should be the patient, not just the disease," said Dr. Frank. "And although it’s critically important to understand biology, pathology, pharmacology and anatomy, it’s the application of that knowledge that is most important if we are to train truly humanistic doctors. Doctors don’t just make patients better. Patients also make doctors better."

The first application of this patient interaction begins in Year I shortly after students learn about the anatomy of the arm and hand. Last fall, several patients with nerve damage came to Scott Hall so medical students could better understand the physical manifestations and the practicalities of living with such a condition. In addition, students began expanding their interpersonal skills as they interviewed the patients, performed simple diagnostic tests, and used deductive reasoning to arrive at possible diagnoses.

Sylvia Ball, who retired from veterinary medicine several years ago, never expected to become a teacher for medical students, but now she is thrilled at the opportunity to do so. Upon retiring, she took a part-time job in a light assemby plant and after just one day of completing a repetitious task with her hands, she suffered permanent damage to her median nerve, which affected the feeling in her thumb and forefinger.

Patients volunteered to become Wayne State Instructors for a day.  They helped teach medical students to diagnose physical conditions and practice clinical skills.

"There are many good outcomes from all these experiences, but in essence, we are trying to give students exposures that will allow them to become better doctors. As a side effect, they may also become better listeners, better communicators, act with more compassion, gain practical knowledge, or get in touch with their own feelings--but in essence, we hope they will become better doctors."