Background/Purpose: Medical students learn about acute illness and sometimes have experience with longitudinal care, but they do not encounter concepts specific to the management of chronic, non-lethal, intermittent, disabling illness, such as the rheumatic diseases. Here we describe a novel curriculum designed to address this gap.

Methods: We initiated a pilot course on chronic illness at Weill-Cornell Medical College, Medicine of the 4^th and 5^th Dimension (time and communication). The course did not focus on biology or treatment. Each of 7 seminar sessions focused on one or more of the following themes: time scales (making decisions for immediate, short-term, and long-term needs); communication (patient priorities, hearing the unsaid, seeing the unseen, physician arrogance); living with disability; managing co-morbidity; decision-making when the evidence is incomplete or the patient disagrees; working with other medical personnel; attending to externalities (family, insurers, society); and maintaining an identity other than that of a person with a chronic illness. At the conclusion of the course students submitted essays on strengths and weaknesses of the course; patients were interviewed separately.

Results: Two first-year and one fourth-year students, one rheumatology fellow, one parent-patient advocate, one parent, and 9 patients participated. Patients had lupus, scleroderma, Sjogren’s with and without cryoglobulinemia, Wegener’s, kidney transplant, and undefined autoimmune illnesses.  Patients were 17-60 years old, female, and of Caucasian, Hispanic, and Asian ethnicities (two African-Americans initially volunteered to participate but did not). All patients, recruited from rheumatology practices, were articulate and well-informed about their illnesses.

Students particularly valued the ability to learn from rather than about patients. They noted that: there is a distinction between “staying healthy” and “getting well”; patients are not defined by their disease; fear of future pain can be worse than current pain; humble and arrogant physicians have different effects on patients; lectures on empathy do not substitute for hearing a patient’s words and observing her body language; not all problems have right answers; external influences affect patients’ decisions.

Students asked for more didactic instruction on how to speak to a patient when knowledge is uncertain. They asked for a session how to manage stalled progress (keeping up patients’ hope) in a chronic illness. Because the patients had been selected for reliable attendance and for articulateness, students felt they did not get a sense of managing a patient across language, cultural, socioeconomic or intellectual barriers. They felt that video-taped interviews or on-line exercises would not substitute for face-to-face interviews.

Conclusion: This pilot program identified important needs of students with regard to learning about chronic illness. With a larger program (more students, more time per year, more years in medical school, broader patient base) these needs can be met.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/teaching-medical-students-principles-of-chronic-disease-medicine-of-the-4th-and-5th-dimension-at-weill-cornell/