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Analyzing the Effects of a Longitudinal Medical Student Curriculum in Diabetic Patients
All Authors: First Author: Janet Lee Rasha Ahmed, Michael Couse, Fanglong Dong, Cesar Ochoa, Edward Barnes
With the expanding healthcare burden of chronic disease, it is important to find novel and inexpensive ways to prevent disease and equally important to educate medical students regarding the social determinants of health. An innovative program at our institution pairs first year medical students with diabetic patients from our Western Diabetes Institute (WDI) for the duration of their medical school careers. Students accompany their patients to their appointments and are encouraged to meet with their patients outside of assigned sessions to build meaningful relationships/partnerships. As of 2009, 32 AAMC medical schools had a medical student longitudinal care course however little data exists on its efficacy.
We hypothesized that patients paired with medical students would have improved disease management. This study was a retrospective chart review which examined blood pressure, hemoglobin A1c, and body mass index between the paired and unpaired patients at WDI over 12 months. Both groups had a similar demographic makeup and received comparable medical care often from the same providers. Patients in both groups were expected to follow up every three months for comprehensive diabetes care where we obtained basic vitals and standing A1c values with each office visit.
Our analysis started out with 36 paired patients and 211 unpaired patients. Patients were excluded from the study if they relocated/withdrew from the WDI, became pregnant, had a mental deficit, or became incarcerated. Most patients in both groups were excluded due to poor follow up leading to incomplete data sets. After examining the data over a 12 month period, we had complete data sets for 5 paired vs 6 unpaired patients for A1C taken, 9 vs 17 for BMI checked, and 9 vs 23 for blood pressure. While the rate of attrition in the study is high, that rate is much higher in unpaired patients vs paired patients.
Our data was limited by small sample sizes, yet we found that patients from the paired group had lower BMIs than those from the unpaired group. Conversely, both groups had an overall increase in their hemoglobin A1C and the analysis of blood pressure values yielded no pattern. P values were unable to be assessed due to the sample sizes. As a pilot study for a novel program, this study demonstrated the need for increased patient follow up to better characterize the effect of medical student partners-in-health. Further analysis is needed to not only stratify levels of student involvement but also disease severity. Regardless, this study demonstrates the importance of exploring new ways to manage preventable disease.