© The Regents of the University of California, 2015
Professional students Megan Henry, RN, Annemarie Everett, P3, Shakiba Feroz, D3, and Jordan Nahas-Vigon, MS3, work together in the hallway
Photo: Jeffrey Chen
By Jeffrey Chen, MS1
Elsie Smith is a pleasant elderly lady who lives in the Outer Sunset. She recently came in to UCSF to establish care with a new team of healthcare providers. For years, she has struggled to control her high blood pressure, high cholesterol and diabetes. More recently, she has developed problems with her balance, and she has started to fall frequently at home, where she lives alone. During a recent fall, she bruised her jaw, making it painful for her to eat.
This story is all too common but immensely complicated—rife with many complex issues that regularly afflict the elderly citizens of America. What’s peculiar about Elsie’s story is that she’s actually one of eight Elsies being seen simultaneously in the Kanbar Center for Simulation in the UCSF library. Elsie is a standardized patient, played by actresses who are trained to portray a real-world patient with a list of medical problems. She has her own list of past medical issues, current symptoms, and medications—her own family and life story, her own everyday concerns. On this day and on many more from October to December, the Elsies help teach students from all of UCSF’s professional programs to learn from each other and to work together.
Today’s geriatric patients have extensive health histories, intricate life stories, and multiple, complex diseases. Patients like Elsie need a team of healthcare providers working together to help manage it all. Their problems are too numerous and complex for any one professional. She needs multiple providers, each with their own skill set, who can work fluidly together to provide comprehensive, holistic, and cohesive care for their patients.
And that’s exactly the environment that UCSF is training its students to work in.
“Do you have a cell phone, Elsie?” asks Jordan Nahas-Vigon, a third-year medical student.
“No, I don’t,” replies Elsie. “Why do you ask?”
“We just want to make sure that if you fall again and can’t get up, that you’ll be able to reach somebody,” Nahas-Vigon explains. “What do you think about that idea?”
The visit continues. Cell phones are just one of many issues that Elsie’s healthcare providers must help her manage. From a medical perspective, Nahas-Vigon must also try to figure out how bad her patient’s balance issues are and what’s causing them, plan what she can do about controlling the pain that results from these falls, make sure her patient continues to control her chronic hypertension, hyperlipidemia, and diabetes, all while answering questions about insurance coverage and billing details.
It’s a lot for a 15-minute visit.
Nahas-Vigon runs through her history and physical with Elsie, trying to add up the pieces to a basic assessment and plan. And before you’d know it, a buzzer goes off. “You have two minutes remaining,” announces a soft voice over the intercom. Nahas-Vigon ties up a couple loose ends about Elsie’s hypertension drugs and finishes with just under a minute to spare.
With that, her team, which has been observing from the corner of the room and taking notes, files out into the hallway. Here, they gather to share some feedback and to plan the remaining visits.
“I thought it was a great idea to bring up the cell phone,” the physical therapy student, Annemarie Everett, chipped in. “I think I’m going to bring it up again during my session when I address some other things related to her falls.”
The team continues to plan their visit. The nurse practitioner student, Megan Henry, RN, discusses Elsie’s feelings of loneliness and depression. The dental student, Shakiba Feroz, tells everyone what she plans on asking in her examination.
“OK, so what are we going to do about her pain?” asks Henry.
The discussion continues, and the team finishes their plan with time to spare. Naturally, the conversation turns to the students’ experiences in their respective schools.
“So what exactly have dental students done by their 3rd year?” asks Nahas-Vigon. “Have you done extractions yet?”
“Not yet, except for wisdom teeth extractions,” replies Feroz casually.
The students continue to ask questions, trade stories, and laugh about shared experiences—being a new student in a new clinic, for example, and having to learn a brand new medical records system from scratch. The buzzer goes off again, and the team files in to the patient room, ready to build on each other's work.
While setting her agenda at the beginning of the next visit, Everett brings up points from the visit with Nahas-Vigons. “I’d like for us to figure out if there are any dangers in your house that predispose you to falling—power cables, for example. And I know you talked to your doctor about getting a cell phone, so I’d like for us to discuss that a bit as well….”
Maria Wamsley, MD and Kimberly Topp, PhD, PT, in the control room in the Kanbar Center
In a room full of computer monitors and TV screens down the hall from the practice patient rooms, faculty members from each of the five professional degree programs at UCSF—Medicine, Nursing, Pharmacy, Dentistry, and Physical Therapy—observe the patient visits remotely. They watch the team visit Elsie on their screen for a few minutes, scribble some notes about the students they’re observing, and then switch the screen to another Elsie.
“Students get a lot of feedback from doing these exercises,” explains Maria Wamsley, MD, co-chair of UCSF’s Interprofessional Curriculum Development Working Group. From the standardized patients, she says, they hear about their communication skills; from the other learners, their teamwork skills. They even get videos of their visits to evaluate themselves and watch for the other feedback they’re given. “All the faculty do is lead the general debrief session at the end!” she laughs. “The students are really learning from each other.”
The interprofessional standardized patient exercise, now in its 5th year, is meant to do just that, mixing students from all UCSF professional schools together to learn from each other while working together to care for a patient. The model is meant to follow the increasingly interprofessional nature of patient care in the real world, such as at the VA, where team huddles are common before starting clinic every morning. The standardized patient exercise represents just one of many efforts that UCSF is making towards bridging the various health professionals that train here.
Last year, the program reached out beyond UCSF and began bringing in nutrition interns and social work students from SF State to join in on the exercises. “This idea was driven by students and learners,” recalls Wamsley. “They’re the ones who are really interested in learning about the scope of other health professionals.”
Nahas-Vigon agrees. “I always feel like I learn so much from the dental students!” she laughs.
But all in all, the most important part of the exercise is learning, both about each other’s professions and how to work with each other. “The exercise reinforces the different perspective of different health care professionals and how each school focuses on different aspects of history and management,” continues Nahas-Vigon. “At the same time, it also shows that obviously, we all have the same goal…. of great patient care!”