Teaching Principles of Managing Chronic Illness Using a Longitudinal Standardized Patient Case

Abstract

Abstract The prevalence of chronic illness in the United States is increasing, and all medical students must have the knowledge, skills, and attitudes to effectively manage it. However, medical students may have limited opportunities to participate in longitudinal care of patients, particularly during the preclinical curriculum. Recurrent visits with a standardized patient provide a unique and structured opportunity for exposure to longitudinal care and chronic illness management. Thus, we developed this longitudinal case to advance student skills in caring for patients with chronic illness. The case features a 60-year-old retired schoolteacher with hypertension, hyperlipidemia, tension headaches, and coronary artery disease. She has multiple psychosocial stressors that impact her ability to make recommended lifestyle changes and manage her chronic illnesses. She initially presents to establish care with a new physician and then returns for three follow-up visits. These standardized patient encounters occur in a small-group setting and include a 30-minute interview but no physical examination. Each small group has a consistent standardized patient over the first and second years of medical school; a different student in each group conducts the interview at each visit. Students were surveyed at the end of their first year about their satisfaction and perceived learning in the case. Eighty-two percent of student respondents agreed or strongly agreed that the case should be continued for first-year students in subsequent years. Although preliminary evaluation data suggest a high degree of student satisfaction with the case, less than half of students responded; further modifications to the case will depend on fuller incorporation of feedback from a broader sample of students.

Keywords

• Chronic Disease
• Adaptation
• Chronic Illness Management
• Psychological
• Health Maintenance