At a time when most pre-med students were cramming for exams, David Amsalem, an adventurous junior in Vanderbilt University’s Medicine, Health and Society (MHS) Program, decided to take a semester off to volunteer and ended up trying to solve one of the toughest public health dilemmas in the world. After gaining the respect of his superiors at Katmandu’s largest hospital, the 21-year-old took on the daunting task of helping to develop an emergency medical response system that would offer life-saving care to millions in Nepal.
“Once you leave the city there are no hospitals,” Amsalem said, explaining Nepal’s mostly rural landscape. “People can be 100 to 500 miles from care. I had seen people carrying people on their backs to the nearest clinic, so I knew an EMS system would make an enormous difference.”
Anselam explains that he was “encouraged and inspired to work on the project,” by the unique education he received in the MHS program. MHS had a similar impact on Brett Sklar, the program’s first graduate, who learned his early lessons in patient care by walking the streets of Nashville, rather than taking notes in a lecture hall. “We took trips to homeless shelters and assisted living facilities in the poorest areas of the city,” said Sklar, who is now about to start his residency at Ohio State University Medical Center. “We toured supermarkets and parks to understand the lives of the people in those communities,” Sklar.said. “It was so important for me to learn that there were so many health disparities in our society and that I needed to know more to really understand my patients.”
Giving Students a Global Perspective
MHS prepares young physicians and nurses for the future by embracing some of the most powerful and healing touchstones of the past. Students are taught the importance of knowing, respecting and truly understanding their patients.
“The program is intended,” explains Arleen Tuchman, Ph.D., MHS’s director, to represent a sea change in the education of physicians, nurses and health care providers.”
“We began taking students in 2006, “[Sklar pre-dated the first, full class] Tuchman said. “Since then MHS has become the school’s fastest growing major, we’ve gone from 29 students to 250 in our last class, about 50 percent of them are pre-med and a large number are pre-nursing” said Tuchman. A graduate seminar is also being added that is open to medical students. “Our students also tend to be more diverse than those in the more traditional pre-med track,” she notes.
Vanderbilt’s MHS students are introduced to medicine as a career that cannot be embraced unless a broad range of very human issues are understood, training them to provide an improved quality of care that is sensitive to diverse populations. Coursework includes: culture and disease; religion, philosophy and health; ethics; disparities and vulnerable populations; death and dying; doctor/patient narratives, community health; global public health and field work in diverse communities.
By providing a 360-degree view of all that contributes to health here and abroad, the MHS curriculum empowers students to think creatively about health care. Because of his coursework in global health, Amsalem says he was able to set aside his fears when he was asked to use his experience as an American-trained EMT to help design an emergency response system. “I had amazing professors like Carol Etherington, R.N., who had worked with Doctors Without Borders,” Amsalem says, "so I saw it as an opportunity to be useful.”
By chance, his quest came to the attention of Paul S. Auerbach, M.D., from the Division of Emergency Medicine at Stanford University Medical Center. With the help of Stanford and the Health Care Foundation of Nepal (HECAF), Amsalem is following through on the project, while he prepares to begin medical school.
Other students credit the program with helping them comprehend what it really means to become an effective nurse or physician. “Because of my MHS courses, I’m prepared to work with patients with values very different from my own without being judgmental,” said Stephanie Mehr, an MHS graduate who is pursuing a master's in nursing. “I now realize that a patient’s culture might affect their objection to certain treatments or that their ability to take care of themselves might include problems such as transportation or coverage.”
Disha Kumar, a second year medical student, found herself excited about primary care. “Having the MHS perspective has changed the way I look at this kind of care,” said Kumar. “Now I won’t be choosing a specialty because I want to provide that care.”
“I’ve discovered that there’s so much more to being a doctor than I ever thought possible,” explains Sherie Bird, an African-American student who plans to be a pediatrician. “I wanted to understand the human side of medicine. Now I know about barriers to care, language and the importance of the doctor/patient narrative—truly listening to people and understanding what they are really feeling.”
Vanderbilt’s program is unique not only in the classroom, but in its faculty as well. David Boyd, Ph.D, D.ip.TOM, an associate professor, is trained in traditional Chinese medicine, integrated medicine, has worked in immigrant communities in Los Angeles and specializes in end-of-life care.
“Our students learn things about medicine here that are very different than other programs,” Boyd says. “First, they increasingly start to understand that health is population based, they come in thinking of it as a personal issue. Many of them have also never thought about cultural competency before. We hope to teach them the role the determinants of health play; the connection between medicine and social issues and make them aware of global health.”
The predecessor to Vanderbilt’s program—if any—is the history-based health and society program at the University of Pennsylvania, conceived in 2000. “We looked at the explosion of global issues and health policy changes and tried to bring them down to the undergraduate level,” says Janet Tighe, Ph.D, dean of freshmen at Penn and the founder of the program.
As health care reform redefines the practice of medicine and the Association of American Medical Colleges reports that this year’s enrollment—18,000 students—is the highest in U. S. medical schools in history, it’s clear that Vanderbilt’s program has come at the right time. “We are determined to teach our students that medicine is so much more than just the care you provide in a clinical setting,” Tuchman said.