老司机直播

老司机直播 medical students strive to be patient advocates

Megan Woolner
Megan Woolner, a student at 老司机直播's Faculty of Medicine, worked on an advocacy project addressing patients' needs at North York General Hospital (photo by William Suarez)

Megan Woolner was a third-year medical student at the University of Toronto when she met Anahita (not her real name), a recent immigrant from Iran who had come to the family medicine clinic at North York General Hospital.

The patient had signs of major depression, and when she returned to the clinic three weeks later, this time without her husband, Woolner began to think her symptoms were linked to social isolation and loneliness. Anahita spent most days at home alone with her two toddlers while her husband worked or cared for his ailing mother.

Woolner and the care team at NYGH started Anahita on anti-depressant medication, referred her to a Farsi-speaking therapist and gave her a culturally sensitive list of local health resources. But Anahita was most excited about starting a Farsi-speaking mother's group, an idea floated by Woolner's supervisor and promoted in the neighbourhood. The day of the meeting they had received no RSVPs, and Woolner was glum as she waited in the clinic with Anahita.

Suddenly the elevator doors opened.

鈥淚n came this mother with a stroller and a smile from ear to ear. I was so relieved,鈥 says Woolner, now in her last year of medical school. Two more mothers showed up. 鈥淲hen I saw my patient a few weeks later, the difference was night and day. She was well put together, confident and starting to make her own social connections. It was a really big change.鈥

Woolner鈥檚 work was part of an 鈥榓dvocacy project,鈥 which some students at 老司机直播's Faculty of Medicine do during clerkship (in the last two 鈥榗lerkship鈥 years, students start to see patients in clinics). Medical students in the advocay project devise interventions to address patients' social needs. They recently presented .

Advocacy projects have been part of the family medicine clerkship program since 2014. Last year, 55 students did one, about 20 per cent of the medical school鈥檚 third-year cohort. For students in traditional 鈥榖lock鈥 clerkships, who rotate through different medical specialties every six weeks, advocacy projects are optional. They鈥檙e mandatory for students who have chosen (in which students learn multiple specialities at once and follow patients over several months).

In one advocacy project, a student negotiated reduced rates with physiotherapy offices near the home of a low-income patient with an ankle injury, after she learned the patient had no coverage. Another student made a list of resources for an autism patient鈥檚 family members, who were struggling to find and understand local services.

鈥淲e鈥檝e seen some amazing projects that really make a difference in people鈥檚 lives,鈥 says Assistant Professor Azadeh Moaveni, director of undergraduate medical education in the Faculty of Medicine's department of family and community medicine. 鈥淎nd they help students think about the social context 鈥 where patients come from, where and how they live and get around, the systems that surround them and influence health.鈥

Some students also advocate for broader changes at the community or provincial level to deal with social determinants of health. One wrote a letter to an MPP in his home province of Nova Scotia about the importance of giving the HPV vaccine to boys. He later met with the politician, and a few months later, Nova Scotia became the first Maritime province to extend free coverage for the vaccine to boys.

All students who do an advocacy project give an oral presentation and write a reflection on their experience. Some develop a more reflective approach to their interaction with other patients.

Cheryl Young (left) was a block clerk at the St. Michael鈥檚 Academic Family Health Team at St. James Town Health Centre. There she met a working mother and student with a problem she hadn鈥檛 previously considered a barrier to health care: access to child care. The woman had depression and was struggling to make her medical and therapy appointments, so Young drew up a list of government services and city-funded child care options 鈥 some of which the patient couldn鈥檛 access because she hadn鈥檛 filed taxes recently.

鈥淚t opened my eyes to several issues,鈥 says Young. 鈥淣ow when I鈥檓 doing a patient history, I鈥檓 more likely to ask about access to health care, child care, time lost from work and if they鈥檝e filed taxes in the last year. Many marginalized patients miss out on benefits and services that can improve their health.鈥

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