Realism Key to Educating Physicians at NEOMED

ROOTSTOWN, Ohio -- It looks like a standard doctor’s office. The walls are light blue. The green-cushioned exam table is covered in translucent tissue paper. The jars, lined up evenly on the countertop, are filled with tongue depressors, cotton balls and bandages.

Even the people in the room aren’t out of place. Patients come in and wait before they talk to the “doctor,” who is dressed in the requisite white coat, about their concerns and ailments as he or she reviews their charts.

Just on the other side of the mirror sits a professor taking notes, keeping track of what the medical student does, what he says, how he interacts with the patient. A video camera in the corner above the door records it all, broadcasting to another room just down the hall where others might be watching.

This is the Wasson Center, where students at Northeast Ohio Medical University learn what their textbooks don’t tell them about what it takes to be a doctor. Here, “patients” – volunteer actors ranging in age from 5 to 80 – interact with the students, whether it’s just talking or describing their symptoms. Those symptoms almost cover the gamut, from common health issues to rare diseases.

“The cases portrayed here are the ones that are commonly encountered or the cases that students might not get to actually participate in because of the subject matter,” says Holly Gerzina, NEOMED executive director of interprofessional education services and simulation.

The more complicated cases can include problems with vital organs such as congestive heart failure and pulmonary diseases, Gerzina says. On the other end of scale, common problems such as asthma strike all age groups.

“Asthma can occur in children as well as adults,” Gerzina explains. “So we think about the age ranges we want because we’re training mostly primary-care physicians.”

After meeting with the patient, the student leaves and consults with an instructor watching from the other side of a two-way mirror. The instructor, typically a physician, then reviews his notes with the student and, as needed, they watch or rewatch the video.

“They can teach the students the proper way to interview patients and to show the concern and let the patients know they’re concerned about them,” says Michael Miladore, a NEOMED graduate and associate professor of orthopedic surgery.

Students begin using the Wasson Center their first year. This gives them two years of practice interacting with patients before they ever set foot in a hospital or clinic. Throughout their four years at NEOMED, students take various doctoring courses – as they’re called – where they learn what their textbooks don’t teach about what it takes to become a physician.

“Bedside manners are pretty much everywhere. The doctoring courses are a longitudinal curriculum that runs the thread across the four years,” says Dr. Elisabeth Young, a NEOMED graduate and vice dean of the College of Medicine. “They have you think about patient care, medical knowledge, communication skills and professionalism. Medical knowledge is different than patient care.”

To obtain a better understanding of that difference, students get immediate feedback from the professor on the other side of the glass. They review the notes and, if needed, refer back to the tape to look at what they could improve. Without feedback as soon as they finish, Gerzina says, students might gloss over some their mistakes.

“If you think of anything that we’re trying to gain expertise in, whether it’s playing the piano or playing a sport, we get practice, we get immediate feedback from a coach or instructor and then we practice again. That’s what happens in this environment as well,” she explains. “Medicine health care is a performance-based profession, so you’re actually out there performing with your patients.”

Also helping students perfect their craft is the layout of the exam rooms in the Wasson Center; with no earlier knowledge, it would be easy to confuse them with any number of doctors’ offices across the country.

“We want it to look very much like the environment they’re in. Everything feels and looks like a clinical practice environment,” Gerzina says. “They can more easily practice and demonstrate the skills that we’re asking them to.”

Although the Wasson Center hadn’t been built when she was a student at NEOMED, Young sees firsthand the benefits of the center and how it plays into the university’s mission to mold better doctors.

“It’s uniquely different than what you’re going to read about with simulation centers where they use high-tech models,” the vice dean explains. “There are variables where maybe the patient has a unique characteristic or socioeconomic background. Maybe they’re diverse in some way. You build into that story. Then the students have to address all the social determinants of health.”

Once students begin working in hospitals their third year on campus, they still come back to the Wasson Center for more work to fine-tune their soft skills.

“They do it after every rotation,” says Dr. Dianne Bitonte Miladore, a member of the first graduating class at NEOMED who sits on the university board of trustees. “Say obstetrics and gynecology [is your area], you have to come to school for what’s called a clinical skills assessment and interview a patient with obstetrics or a gynecological problem. And you’ll also have an oral exam with a professor.”

After a stint in pediatrics, a student might come to the center and speak to someone portraying a mother or, after a surgical clerkship, a student might give abdominal exams to patients. The center’s patients can be prepared for any situation after a student returns from his rotation.

“The patient actors actually come in for education themselves. They are taught the case and go through that case for eight hours a day while they see different students,” Bitone Miladore says. “They know the history and the questions the students will ask.”

In another effort to form and strengthen bonds with the communities the university serves, local paramedics and other health professionals use the Wasson Center.

“We have mental health and public safety programs where folks come in and learn de-escalation skills and crisis intervention skills because they’re the first responders for the mentally ill and the community,” Gerzina says.

For all involved, from patients to emergency personnel to students, the value of being able to work with living, breathing people – not just mannequins that simulate issues – cannot be overstated, Gerzina says.

“The simulation is a valuable tool in teaching, not only in the clinical skills that folks think about treating diseases, but also the communication skills that are important,” she observes. “It’s valuable in the sense that it keeps things safe and fun for patients and the learners. It essentially ends up with better health care and a better health-care system.”

Pictured: Every exam room in the Wasson Center is set up like a real doctor’s office, down to the supply jars on the counters. “We want it to look very much like the environment they’re in,” says Holly Gerzina, executive director of interprofessional education services at NEOMED.

Editor's Note: The October edition of The Business Journal features extensive coverage of NEOMED and its growth over 40 years. Be sure to watch Thursday's DailyBUZZ for the third in a series of video reports.

Copyright 2014 The Business Journal, Youngstown, Ohio.
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