MedEdPORTAL (Jul 2009)
Joe Thornton: Teaching and Assessing Medical Students Chronic Disease Management Skills Utilizing the Chronic Care Model and a Standardized Patient
Abstract
Abstract Introduction Chronic illness affects over 100 million Americans, accounting for 75% of national healthcare expenditures. Current medical education may worsen attitudes toward providing primary and chronic care. Innovative educational initiatives are needed to teach and evaluate chronic disease management skills. The Chronic Care Model (CCM) is a well-known framework for caring for patients with chronic illness that is increasingly being used to teach chronic disease management skills. Medical students need skills to manage chronic illness and schools have been asked to integrate this into their curricula. The CCM is increasingly used as a framework to teach these skills. Methods “Joe Thornton” is a formative standardized patient case, postcase exercise, and teaching session developed for third-year medical students. Joe is a 68-year-old man with hypertension, hyperlipidemia, and congestive heart failure. Joe is grieving the sudden death of his wife that occurred 3 months prior to the visit and is having difficulty taking his medications consistently. Students are asked to evaluate Joe in a continuity clinic setting when he presents complaining of worsening fatigue, weight gain, and increased difficulty with breathing while lying down. Results In 2007–2008, 172 third-year students participated in the case, postcase exercise, and teaching session. When asked whether the case was “useful for my learning,” 51% of students (n = 86) “strongly agreed” and 40% (n = 67) “agreed.” 7% (n = 12) rated the case “equivocal,” 1% (n = 2) “disagreed,” and 1% (n = 1) “strongly disagreed” with the usefulness of the case. The case and postcase exercise are being used to assess student performance prior to implementation of a chronic illness curriculum at our institution. Because of the range of student performance prior to implementing the chronic illness curriculum, we anticipate that the case and postcase exercise will be a useful tool to measure impact of our curriculum. Discussion Due to the complicated nature of chronic illness and the multiple medical and psychosocial issues outlined in the Joe Thornton case, students found it challenging to address so many concerns in one visit. In an effort to simplify the case and help the students focus, we decided to make the Joe Thornton character less depressed. By making these adjustments, the students did not feel as pressed to spend the entire visit on the depression and could allot time to discuss medication non-compliance, self-management skills, and heart failure.
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