A natural storyteller, Kevin Dekis floods with emotion when he talks about the past few years of his life. Life has been hard for Dekis: two and a half years ago, complications in surgery for colon cancer meant the removal of his small intestine and the onset of short bowel syndrome, a chronic condition requiring constant medical attention.
“It’s changed my life,” said Dekis.
As terrible as his experiences have been, Dekis’ condition and innate ability as a narrator make him a perfect candidate for a pioneering medical school program at the University of Pennsylvania School of Medicine. The LEAPP program, or Longitudinal Experience to Appreciate Patient Perspectives is Penn’s attempt to get students to “see chronic illness from the patient’s point of view,” according to Carol Phillips, the program’s coordinator.
The LEAPP program pairs patients with chronic illnesses like Kevin Dekis with med students entering their first year at Penn. Two students are assigned to each patient from whom they are expected gain insight into coping with a chronic illness.
“[The students] will contact the patient once a month by phone or e-mail and they’re supposed to see them in person at least once a semester, or more,” said Phillips. As one of the patients, Dekis is eager to impart his experiences.
“Anything I can do to enlighten anybody to my situation or help anybody out, I’d be more than happy to do,” said Dekis.
Students must complete assignments to fulfill the requirements of the LEAPP program. First-year students in the program’s launch completed four assignments where topics ranged from the effect of chronic illness on patients to difficulties with the health-care system. And response to the program from its students has been mostly favourable.
“It’s hard to teach how to be a good person, in some ways, but really [difficult] to…teach the doctor-patient relationship,” said Adam Lessler, a second-year med student. “[The program] at least gives us an exposure to that so we start thinking about it more consciously.”
However, the program is not free of snags. Finding willing patients to participate can be a challenge. That’s where Dr. Paul Lankin, director of the LEAPP program, comes in. He approaches different doctors in the university health network who have a good practice and many patients. If the doctors want to be involved, they become preceptors who not only suggest candidate patients but also mediate the interaction between patient and student.
“We need patients who like to talk and that like to share what they’re going through,” said Phillips. Breakdowns in communication also mean students are not always notified when a patient has been admitted to the hospital for a prolonged stay. The notoriously busy second year at Penn can make it difficult for students to keep in touch with their patient.
The program, despite its drawbacks, is making an impact in the way universities teach medicine. In fact, U of T’s med school may soon follow suit.
“I think there’s definite value in being attached to a patient for a longer period of time,” said Dr. Jay Rosenfield, the vice-dean for undergraduate medical education at U of T. “It’s more challenging in the undergraduate program [to implement] but it’s definitely something I think is valuable.”
U of T is considering changing its program to incorporate the recommendations of a task force that suggests students should have a more long-term experience with a family doctor in the first two years of the program.
