BACKGROUND

OBJECTIVES

METHODS

NEEDS ASSESSMENT

REFERENCES

Medical students who participate in early clinical, longitudinal experiences reportgreater confidence in communication, comfort in clinical settings, and self-esteem during transition to clerkship year [1,2]. Students engaging in longitudinalclerkship rotations also report greater satisfaction through patient advocacy andstronger relationships with patients [3,4]. However, few longitudinal patientexperiences exist at our institution; moreover, for preclinical students, theseopportunities are even more limited.

Current literature is lacking in the evaluation of longitudinal patient experiencesin the preclinical phase of medical school, an experience with the potential toconfer many of the same benefits, with more enduring effects, such asmaintaining patient-centered values [4]. Furthermore, existing longitudinalpatient programs have not explored the impact of such an experience on patientsthemselves.

Finally, students at our institution receive few preclinical lectures on pregnancyand prenatal care, leaving many feeling unprepared for their OB/GYN clerkship.

1. To develop a longitudinal clinical program, “P&S Partners in Pregnancy,”pairing first-year, preclinical medical students with prenatal patients

2. To assess the impact of a longitudinal care experience on both medicalstudents and patient partners

3. To expose preclinical students to OB/GYN in experiential and didactic settings4. To assess feasibility of implementing such a program at our institution and

others

A retrospective needs assessment evaluating interest, motivating factors, andperceived barriers to participation was distributed to second-year students atour institution. In response, we utilized a small grant to develop a student-runpilot program pairing ten first-year students with pregnant patients. All first-yearstudents were invited to apply. Patients in their first trimester of pregnancy whowere receiving care in our resident continuity clinics were recruited toparticipate. Baseline student characteristics such as interest in a particularmedical specialty, understanding of prenatal care, and comfort navigatinghealthcare systems were assessed before the start of the program. Studentspartook in didactics on prenatal care and pregnancy taught by a senior medicalstudent supervisor, and accompanied patients to prenatal appointments, otherhealth care visits, and delivery.

Initial perceptions of the patient-physician relationship were assessed in bothgroups prior to the program’s start using the validated Patient-PractitionerOrientation Scale (PPOS), which measures two components of the relationship:“power sharing” and “patient caring,” with 1 indicating “doctor-/disease-centered,” and 6 indicating “patient-centered.” Both groups also completed pre-program surveys with statements employing a five-point Likert Scale. To assesscomprehensive impact of the program, after the program’s completion allparticipants retook the PPOS, completed post-program surveys, and participatedin focus groups aimed at assessing overall experience.

Composite, sharing, and caring PPOS scores were computed for both groups,pre- and post-program. Given small sample size, survey results were analyzed forgeneral trends. Focus groups were recorded, deidentified, and transcribed, andanalyzed qualitatively for themes.

49% of polled second-year students completed the survey. 90% reported that they wouldbe at least “somewhat interested” in a longitudinal prenatal pairing program; furthermore,students expressed desire to participate in the program regardless of early interest inOB/GYN as a future specialty choice (Figure 1). Motivating factors included desiringlongitudinal patient experience (87%), early clinical exposure (82%), patientadvocacy/community engagement (78%), and interest in OB/GYN (49%).

1. Saba TG, Hershenson MB, Arteta M, Ramirez IA, Mullan PB, Owens ST. Pre-clinical medical student experience in apediatric pulmonary clinic. Med Educ Online. 2015; 20:10.3402.

2. Godefrooij MB, Diemers AD, Scherpbier AJ. Students’ perceptions about the transition to the clinical phase of a medicalcurriculum with preclinical patient contacts; a focus group study. BMC Med Educ. 2010; 10:28.

3. Diuguid-Gerber J, Porter S, Quiah SC, Nickerson K, Jones D, Audi Z, Richards BF. The Columbia-Bronx VA amalgamativeclerkship: an effective, 12-week, integrated, longitudinal clinical experience. Med Educ Online. 2017; 22(1):1301630.

4. Ogur B, Hirsh D, Krupat E, Bor D. The Harvard Medical School-Cambridge integrated clerkship: an innovative model ofclinical education. Acad Med. 2007; 82(4):397-404.

5. Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients:the effect of doctor-patient congruence on satisfaction. Patient Educ Couns. 2000; 39:49-59.

P&S Partners in Pregnancy: A Longitudinal, Patient-Centered Program for Preclinical Students

Logan Mauney1, MD; Elizabeth McMillen3; Emily Auran3; Rini B. Ratan4, MD1 Brigham and Women’s Hospital, 2Massachusetts General Hospital, 3Columbia University Vagelos College of Physicians and Surgeons, 4Columbia University Medical Center

OUTCOMESTen first-year students were accepted into our program and paired with patientpartners. Retention and participation from both students and patients were high.At program start, 80% of students listed OB/GYN as one of their specialties ofinterest. Pre-program mean composite PPOS score was 4.64 for students,compared to 3.96 for patients, indicating greater initial patient-centeredness instudents (Table 1). After program’s completion, both student and patientcomposite PPOS scores increased; PPOS sub-scores of “sharing” and “caring”attitudes increased in both groups.

Regarding student surveys, post-program scores increased for rating knowledge ofprenatal care. Scores were relatively unchanged for both understanding socialdeterminants of health and comfort navigating the healthcare system (Figure 2).After program completion, interest in OB/GYN as a specialty choice increased in50% of students and was unchanged in the other half. All students wouldrecommend this program to their peers.

All but one patient agreed or strongly agreed that having a student present duringpregnancy made them feel more supported (Figure 3). Most patients agreed thathaving a student present helped them remember appointments and understandinformation from their doctors.

Preliminary analysis of focus groups revealed positive experiences for bothstudents and patients. Themes elicited include students feeling better preparedfor clinical year, greater comfort in communicating with patients, and greaterunderstanding of social determinants of health in pregnancy.

SIGNIFICANCEStudents in early medical education are enthusiastic about longitudinal patientexperiences and demonstrate patient-centered mindsets. Programs such as oursmay help maintain and cultivate patient-centeredness in medical students. Thelongitudinal care experience may also have the potential to improve patients’attitudes towards patient-centeredness, as well as provide support for patients,improve patient satisfaction, and create positive attitudes towards medicalinvolvement [5].

Our pilot program provided valuable information about the benefits, challenges,and overall feasibility of running such a program. Lessons learned from our smallparticipant group can shape future programming that reaches students andpatients in a more effective way. Additionally, we believe that our program couldbe adapted at other medical schools using the timeline and materials we havedeveloped. While the grant received was invaluable in running the pilot program,we believe that future implementation of such a program would require atminimum the support of the institution’s OB/GYN department and a fewdedicated medical students to coordinate and oversee the program.

Overall, we believe that students and expectant mothers from other communitiescould benefit from a similar program.

Table 1. Mean PPOS Scores of Medical Students and Patients

Pre-Program Post-Program Change1

StudentsComposite 4.64 4.90 + 0.26Sharing 4.54 4.86 + 0.32Caring 4.75 4.95 + 0.20PatientsComposite 3.96 4.14 + 0.18Sharing 3.97 4.12 + 0.15Caring 3.94 4.16 + 0.22

1Pre-Program - Post-Program Score

0

1

2

3

4

5

6

7

VeryGood

Good Fair Poor Very Poor

Num

ber o

f Res

pons

es

Figure 2. Knowledge of and comfort with navigating the healthcare system

Pre-Program

Post-Program

Patient Participant Comments• “My student was beyond my expectations. It was very

helpful to have her by my side during this beautifuljourney of my life.”

• “My student was a great resource and support person forme. My husband's work schedule didn’t allow him to be atmany appointments so it was nice to have her there.”

• “My student was present throughout the entire process ofmy pregnancy… she was the most responsible, respectful,kind, and understanding person that a pregnant personcould ever have as a support. Her knowledge made mefeel so confident.”

• “Everything that the doctors told me she could explain tome later… she was like a teacher to me.”

• “She was available if I had a question and I couldn’t reachthe hospital.”

• “I'm thankful she was with me throughout the pregnancy.I went through a lot, and my student was there giving mestrength.”

0

1

2

3

4

5

6

StronglyAgree

Agree Neitheragree nordisagree

Disagree StronglyDisagree

Num

ber o

f Res

pons

es

Figure 3. Having a medical student present during my pregnancy made me feel more supported

We extend our gratitude to the Virginia Apgar Academyof Medical Educators at Columbia University VagelosCollege of Physicians & Surgeons for their generoussupport in funding this study.

3%

47%

77%

78%

82%

Plan to go into OB/GYN

Interest in OB/GYN

Want to witness a delivery

Interest in patient advocacy/community engagement

Want more clinical exposurein pre-clinical curriculum

Percentage of Respondents

Figure 1. Why are you interested in this program?

Figure 4. Themes from student focus group