A middle-aged man comes into the JayDoc Community Clinic with what turns out to be poorly controlled asthma. He’s a smoker and works in construction, surrounded by co-workers who share the habit. The smoking-asthma connection isn’t fully clear to him.

The man is also a standardized patient whose fictional issues are real and common at Guadalupe Clinic, which serves uninsured Sedgwick County residents. And he’s just one of eight standardized patients at a November workshop that schooled clinic volunteers and other students from KU School of Medicine-Wichita and KU School of Pharmacy-Wichita on asthma, smoking cessation, and medications and equipment to treat pulmonological conditions. Standardized patients are people who have been trained and coached to simulate actual patients – their symptoms and their personal characteristics.

“We see a lot of patients with asthma, and some patients are smokers,” says third-year Wyel Halimeh, JayDoc director of education. “We stress in every visit to quit smoking, but we don’t really know how to advise them about the proper steps and new medications to help. … It is something we should invest our time in during visits.”

The workshop was a case of JayDoc organizers seeing and filling needs. For clinic volunteers, especially first- and second-year students, it’s a gap in knowledge and clinical familiarity with asthma and smoking cessation — they just haven’t handled them much yet. For patients, it’s a possible gap in the evidence-based care the clinic strives to provide. And for JayDoc, it’s an opportunity to fulfill its goal of team-based, interdisciplinary care.

“The great thing about this workshop is the focus on collaboration between medical students and pharmacy students,” says Sarah Talley, the standardized patient program manager who helped prepare the asthma case. “It allows them to practice and bring awareness to everybody’s unique roles within the health care setting. It’s a great experience for the students but ultimately for the patients at JayDoc.”

“I can get swept away by the amount of information in our curriculum,” says first-year medical student Sophia Mazzetti, one of over 30 participants. “It’s easy to lose track of the end goal of applying all of this knowledge to patient care, but workshops like this, and JayDoc in general, remind me why I’m doing this.”

Seeing the standardized patient was the final piece of the workshop, which began with educational sessions. Craig Beavers, D.O., chief internal medicine resident, talked about different kinds of asthma. Tiffany Shin, Pharm.D., clinical associate professor and JayDoc pharmacy adviser, discussed asthma treatment guidelines, smoking cessation approaches and medications, including those the clinic has on hand to prescribe.

Full of knowledge and Chick-fil-A (like any good medical meeting, there was free dinner), students moved to the hands-on, inhaler and respiratory stations.

Inhalers and the spacers that improve their effectiveness come in many varieties, and all too often students and providers “see them in a box” instead of in action. “If you give a patient an inhaler and you don’t tell them how to use it properly, it’s kind of useless,” says Halimeh, whose father, Nizar, is a respiratory therapist and workshop volunteer.

Pharmacy students, who study inhalers and will counsel patients about them in practice, ran the inhaler station. For physicians, proper use can influence care decisions. “It’s important to know whether a patient is using it correctly and be able to talk about correct use before making the decision to escalate therapy and add more medications,” says Shin.

At the respiratory station guided by therapists, students learned about and tried CPAP and BiPAP machines, a cough-stimulating device and a vibrating vest for cystic fibrosis patients. So, in addition to asthma, they learned about tools for other conditions, including sleep apnea and COPD.

“Students loved that,” Halimeh says. “They got to put on the CPAP masks and see how it feels when patients have to wear them. That really makes a difference when you’re able to tell a patient, ‘I’ve tried it; it’s very comfortable.’”

Ike Abrams, a second-year medical student, appreciated getting to “try out the breathing machines and better understand how they work.” Overall,  the workshop appealed to him as a refresher on pulmonology and an “opportunity to practice seeing a patient in a risk-free environment.”

That safe zone is an intent of the standardized patient approach, which can “terrify” students at first, Talley says. “We essentially focus in on all the questions that a student would ask in a medical encounter — history of current illness, family history, social history, all that good stuff.”

In the patient stations, teams of three or four visited with their “middle-aged man,” heard his symptoms, stepped away to consult with a third- or fourth-year student playing the role of “pre-attending” (pretending? Get it?), and then returned to discuss the condition and treatment options. Medical and pharmacy students alike could draw on their developing specialties.

“It’s allowing them to be the expert on pharmacology while the medical student focuses on the overall patient,” Talley says.

For Thomas Barnaby, a second-year pharmacy student and JayDoc pharmacy director, the workshop let him “better understand respiratory therapy devices and review guidelines for smoking cessation and asthma management.”

“My favorite part was working alongside the medical students in the standardized patient encounter,” Barnaby says. “We could take better care of the patient by working together and utilizing each other’s strengths for the patient’s benefit.”

“I loved getting to work with more advanced medical students and our pharmacy team member — their clear communication, quick grasp of brand-new information and overwhelming competence was so impressive,” Mazzetti says. “It gives me something to strive toward.”

Pharmacy and medical students regularly learn together at JayDoc, but workshops provide larger, more systematic training.  “You only get a handful of students at a time at the clinic,” Shin says. “When we have a workshop, we can talk to dozens of students and provide a more guided learning experience that’s still applicable to the clinic setting.”

Research has shown the value of collaborative, team-based training. Talley seeks to bolster that body of evidence, so organizers collected data through pre- and post-workshop surveys about student comfort levels with the team approach.

Talley is collaborating with Dulcinea Rakestraw, Ph.D., MPH, in the KUSM-Wichita Department of Family & Community Medicine on the research. Depending on the findings, Talley hopes to submit it to the Association of Standardized Patient Educators as well as the Kansas Journal of Medicine. From what Mazzetti and others shared about the event, they’ll have something to go on.

The event is part of the student-run clinic’s tradition of closing gaps in training and services, including recent cardiac and diabetes workshops.

“Volunteers didn’t have a good sense of what resources we had immediately available for patients,” says Nazeen Morelli, fourth-year medical student, JayDoc’s executive director and organizer of the cardiac workshop. “Particularly that both clinic sites had EKG machines for our use. Beyond that, it was noted that many people were not familiar or comfortable performing EKGs, which is what sparked the motivation for the initial cardiac workshop.”

“The JayDoc students put this together on their own,” Rick Kellerman, M.D., professor and JayDoc faculty adviser, says of the pulmonology event. “They identified a need and decided that they wanted to sharpen their skills to better serve JayDoc patients.”

“It really shows the student dedication to improving their knowledge and providing high-quality care to patients and especially the underserved patients at Guadalupe Clinic,” Shin says.

Supporting JayDoc

If you would like to support JayDoc Community Clinic’s mission to provide quality, compassionate health care to people in need in partnership with Guadalupe Clinic, please consider a donation. The clinic accepts financial contributions, pharmaceuticals and other donations.

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Photo album

To see more photos from the pulmonology workshop, view the Flickr photo album.