November 3, 2006

Chronic illness care at heart of VUSM initiative

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Steven Gabbe, M.D., and Bonnie Miller, M.D., are involved in a new program to help students learn to care for patients with chronic illnesses.
Photo by Neil Brake

Chronic illness care at heart of VUSM initiative

Vanderbilt University School of Medicine students and residents are learning a new approach to care for patients with chronic illnesses as part of a grant initiative from the Association of American Medical Colleges' (AAMC) Institute for Improving Medical Education.

Ten U.S. medical schools are each receiving a $100,000 grant, which includes funding from the Josiah Macy Jr. Foundation, to revamp undergraduate curricula over the next two years with a contemporary approach to understanding and treating chronic diseases.

Nine of those schools also received a one-year, $75,000 planning grant for residency program reforms.

Chronic illness care education has traditionally been limited to treatment of hospital inpatients for acute disease episodes, but the AAMC's "Enhancing Education for Chronic Illness Care" initiative will shift that focus to long-term disease management of patients in ambulatory settings.

"More than 100 million Americans are affected by chronic illness, and that number is likely to increase as our population ages," said AAMC President Darrell Kirch, M.D.

"As medical educators, we need to re-think how we teach tomorrow's doctors about chronic illness so they can provide the best care for their future patients. This initiative moves us closer to that goal."

VUSM students will observe team approaches to chronic illness care, establish long-term relationships with patients throughout their medical school experience, and understand the day-to-day challenges that chronically ill patients face as they navigate through the health care system.

Dean Steven Gabbe, M.D., who has lived with diabetes for many years, said caring for these patients requires a different approach that can be very rewarding.

“You become familiar with the challenges patients are facing every day at home and at work. That is very different from treating patients in the hospital,” Gabbe said.

“You understand that a patient with a chronic illness needs to be supported by a team including their family, their social workers, nutritionists and teaching nurses, as well as physicians.”

Each student will be assigned a patient to follow throughout the four years of medical school. Students will accompany patients on visits to providers and throughout any hospitalizations, and document their findings in an electronic learning portfolio.

Bonnie Miller, M.D., associate dean for Undergraduate Medical Education, said Vanderbilt is looking at the broadest possible definition of chronic illness in selecting patients for students to follow.

“We are looking at chronic illness across the spectrum — children with cystic fibrosis, asthma and diabetes, and adults with chronic obstructive pulmonary disease, cancer, coronary artery disease or congestive heart failure,” Miller said.

“If possible, we'd like to include patients with chronic mental illnesses, including depression.”

The first-year experience will be aimed at establishing a social and cultural profile of the patient and family. As students move into the second year, it's expected that they will understand more about their patients' disease processes and treatments,” Miller said.

In the third and fourth years, students will learn about a chronic illness care model that emphasizes a multi-disciplinary approach to care, and the use of evidence-based protocols and patient registries that document important quality of care indicators.

“This approach to chronic illness care is greatly facilitated by sophisticated information technology systems, and thus Vanderbilt is a great place for students to learn and practice it," Miller said.