Medical Students Experience Life on the Other Side of the Bed
VA Vascular Access Nurse Kassidy Dias, RN, gently taps her forefinger on the blue vein in the arm of Vietnam War Army Veteran David Preston.
“Feel the bounce? That’s perfect,” Dias tells second-year medical student Juan Guerrero as he prepares to draw blood from Preston, a former sergeant in the 101st Airborne.
Guerrero is one of five second-year medical students from BU, along with a student from Harvard and another from Tulane, working on wards at the West Roxbury VA Medical Center, training in an innovative program known as The Other Side of the Bed. The six-week summer program, which began in 2009, has medical students undertaking many of the routine patient care tasks typically performed by the nursing staff.
“Our goal is to increase physician/nurse collaboration by helping medical students understand the role of nursing and the skills that nurses bring to healthcare,” says Cecilia McVey, MHA, RN, FAAN, associate director of nursing and patient care services at VA Boston Healthcare System. She estimates that more than 200 medical students have participated over the past 15 years.
Throughout my first year [in medical school], I was afraid of having too much physical contact [with patients], too afraid of invading their privacy. It’s a hard line to walk, in how to provide hands-on care while still respecting their privacy and sense of personhood
Rachel Kim
The program addresses what numerous studies have found: that an uneven power dynamic and issues around professional respect between doctors and nurses hinder collaboration, teamwork, and patient care. VA Boston Chief of Staff Michael Charness, MD, believes the increased use of technology has exacerbated the problem.
“I think that as healthcare and medical education have evolved it’s harder for the different members of the team to understand and appreciate the skills each profession brings. And I think patient care can suffer from insufficient collaboration and communication,” says Charness.
“I watch physicians as they are coming in for an hour, a half-hour, sometimes less, talking to patients, but there is a big difference being on the floor and being with patients the whole time,” says second-year medical student Rachel Kim.
Kim says nurses are continually asked to expand their responsibilities. On one of her first days on the ward, she watched a nurse juggle her patient load while taking time to accompany a veteran desperate for a walk, but who was a fall risk navigating with a walker while trailing an IV pole.
When a patient rapidly deteriorated and prognosis went from recovery to palliative care, Kim noticed nurses making careful observations of the changes. Although unconscious, the patient appeared to be experiencing pain. When the resident came on to the ward, Kim noted that he first turned to the nursing staff to ask what they had observed and what they thought should be done.
“It was the first time I saw one of the physicians take the time to get the full story from the nurses,” says Kim. “I saw that, and I said ‘okay, this is what I want to keep with me and emulate as I move forward in my training.’”
Studies also found that increasing reliance on technology, even just entering patient information and observations into a laptop, estranged physicians from patients. Students in The Other Side of the Bed said it was the opportunity to work directly and intensively with patients that drew them to the program.
“One thing that really surprised me is how quickly you can make a valuable connection with a patient,” says second-year med student Douglass Bryant. “They are more than just their medical problems. They matter to so many other people and that’s all the more reason to do a great and respectful job.”
Working alongside nursing assistants (NAs) and nurses for eight- and sometimes 12-hour shifts, the medical students perform the most basic, but vital, tasks: bathroom assists, help with feeding and testing, and responding to call lights. Students shadow and learn skills from various teams, including vascular access, EKG, and respiratory therapy. There are weekly lunchtime lectures by a physician or researcher from the VA or BU.
Like most of the students, Guerrero was drawn to the intensive hands-on care experience, but found the reality of that work challenging.
“I thought I knew what I was getting into, but this was a lot more difficult; changing a patient for the first time, understanding how to move around a catheter, dealing with someone who feels really betrayed by the system and not knowing how to get through to them,” he says.
Sometimes, it’s the small details of care that make patients’ lives in the hospital more bearable. Glucose testing is a daily ritual on many wards, and it involves pricking the patient’s finger with a needle to raise a drop of blood. No painkiller is used for this test and Kim found herself massaging patients’ hands to warm them and get the blood flowing.
“Throughout my first year [in medical school], I was afraid of having too much physical contact [with patients], too afraid of invading their privacy. It’s a hard line to walk, in how to provide hands-on care while still respecting their privacy and sense of personhood,” says Kim. “I learned a lot from [nurses] about how to do these really intimate tasks with dignity.”
Success is measured in achievements most people take for granted and patients provide life lessons that are humbling to students accustomed to accolades and success.
When a patient started sharing his ignored requests, Guerrero jumped in to express his sympathy, only to be rebuffed.
“He was very clear that he just wanted to be listened to. He didn’t want to be fixed; he wanted me to bear witness to his suffering,” says Guerrero.
Second-year medical student Jackson Wallner thought the most underrated aspect of the program was the opportunity to talk with patients and not feel rushed to move on to something else, a luxury he expects they won’t have as a physician. It’s why he knew that a shave was important to retired Army drill sergeant Robert “Rick” James. It’s a remedy that won’t be found in a medical textbook or that he’ll be expected to do on his future clinical rotations and residency, but Wallner grabbed shaving gear and fulfilled James’s request.
“He’s going to make a good doctor. He’s got the heart,” says James, a Vietnam War veteran.