Physicians-in-Training Experience Care through the Patient's Eyes

It's unusual for doctors-in-training to put themselves in the shoes of their future patients.  However, all first year medical students in the new Foundations Curriculum at the University of Toronto (U of T) were asked to do just that in a recent mandatory, one-day simulation experience titled, 'Getting to Know Patients' System of Care' (GPS Care).

The first of its kind in Canada, GPS Care involves students role-playing patients with physical and mental health issues and their caregivers in order to gain an understanding of what it's like to navigate a complex healthcare system. GPS Care is supported by the Medical Psychiatry Alliance, a recently established health partnership between the Centre for Addiction and Mental Health, The Hospital for Sick Children, Trillium Health Partners and U of T. Its goal is to improve health outcomes and quality of life for patients living with both mental and physical illnesses.

"We want to expose medical students to an authentic experience in our healthcare system that they otherwise might not see until they are actually practicing medicine," says Dr. Yvonne Kwok, a family physician who helped design the GPS Care case scenarios.  "In GPS Care, students are able to put themselves into a patient's shoes and really feel the barriers that arise in their complex health care journey."

Based on last year's successful pilot of the GPS Care experience to about 20 first year medical students, this year's mandatory experience reached over 200 students. The recent GPS Care scenario focused on the life of a geriatric patient. Students were assigned a role to play (the patient or their caregiver) and then rotated between five health care providers, such as a geriatric nurse practitioner, a social worker, pharmacist, occupational therapist and a geriatric psychiatrist/psychologist. After their rotations, students shared their thoughts about the experience in a de-brief session.

During the debrief, students discussed how they could help patients and their families navigate the health system better. Some solutions identified included being tactical about multiple referrals from providers, being responsible and an advocate for their patient's needs, how much information to provide at certain points in the patient's journey, and having a good understanding of how interprofessionals need to work collaboratively together in order to achieve the best health outcomes for their patients.

Dr. Kwok adds, "Our population is aging. Most of us are going to be seeing older patients in our practices, so it's good that students can see early on what these patients have to face – going to all these appointments, managing their health and their lives between each appointment – and its impact on their daily quality of life. This initiative is going to be a very important tool that we can use for many years to come."

Following the 2016 pilot run, a team of MPA researchers at U of T's Wilson Centre published a study providing evidence on the effectiveness of the experience for medical students and how important it is to their exposure to integrated care training in medical school. The study was led by Aatif Qureshi, first author of the paper, and a medical student who is leaning toward specializing in internal medicine.

"When students go through these various stations in the GPS Care experience, the way I did during the pilot run, you start to understand how frustrating it can be for patients," says Qureshi. "Each healthcare provider is throwing different information at you, having you fill out endless forms, and you don't know where to go next. I found the experience disconcerting but also eye-opening. Patients need more support."

For more information about the Medical Psychiatry Alliance, check out www.medpsychalliance.ca.