BFA Blog – January 23, 2018

 

Carolyn Pointer, JD

A medical school, by definition, is a professional school, preparing graduates for their future profession. What are we preparing graduates to do? As we debate the future of our health care system, we must decide if physicians are responsible for improving health in a broader sense, or only for diagnosing specific patient problems and prescribing treatments.

Professions come with the expectation that you use your knowledge to improve people’s lives. Medical students prepare for clinical care, but do medical schools teach doctors to advocate for their patients holistically? Are doctors trained to meet the Triple Aim by promoting population health?

Allopathic schools teach the art and science of medicine in 130 weeks. The Liaison Committee on Medical Education (LCME) standards for accreditation list nine areas that medical school curricula must cover, including:

  • Contemporary scientific knowledge and their application to the health of individuals and populations;
  • Health-related impacts of behavioral and socioeconomic factors;
  • Diagnosis, prevention, appropriate reporting, and treatment of the medical consequences of common societal problems;
  • Developing solutions for health care disparities and medically underserved populations; and
  • Providing effective care in a multidimensional and diverse society.

Given the colossal nature of this task, and the pressures of Step exams throughout medical school, non-clinical training in communication and collaborative skills, recognizing and developing solutions to disparities, understanding the needs of underserved populations, and developing professionalism to effectively provide care in a diverse society are not prioritized by faculty or students. Medical schools need to find creative solutions to the curriculum crunch.

A Medical-Legal Partnerships (MLP) creates an interprofessional team to address the legal issues impeding patient and population health. Doctors identify legal issues during a patient visit and collaborate with lawyers to help patients address these barriers to health. At SIU School of Medicine, our commitment to problem-based learning led us to incorporate MLP into undergraduate medical education.

Our pilot program used second-year medical students as legal needs screeners for our inpatient MLP, located in the Department of Family and Community Medicine. Students develop history-taking skills that will serve them well in addressing patients’ social needs in their clinical experiences. Medical student participants report increased comfort addressing sensitive social and legal problems with patients. Trainings with our legal partner, Land of Lincoln Legal Assistance Foundation, resulted in a new student knowledge of the local resources for these issues. An evaluation comparing MLP-participating students’ with their non-participating classmates’ mastery of social determinants of health, and of the resources available to patients, is currently underway.

Assigning students to serve as Medical-Legal Partnership screeners, where they are exposed to real patient problems, cements the students’ understanding of social determinants of health while successfully providing a much-needed service to the patients. Participating in a Medical-Legal Partnership can help medical schools meet the demands of the LCME standards, preparing medical students for the social problems plaguing patient and population health, without adding significant demands on curricular time. As we meet our mission of training the doctors for the future of central and southern Illinois’ healthcare, we want to make sure our graduates have the skills to smooth the road to improved health in their communities.

Carolyn Pointer, J.D., joined the faculty at Southern Illinois University School of Medicine and School of Law as an assistant professor in 2014. She teaches social determinants of health to undergraduate and graduate medical students. She also teaches a law school course on rural health law. Her research focuses on the benefits of addressing patients’ health-harming legal needs to both patients and medical providers through a Medical-Legal Partnership built with the Department of Family Medicine and Land of Lincoln Legal Assistance Foundation.