Medical students showing up for their first Doctoring and Clinical Skills class in the new PURCH Track at the Baystate campus of UMass Medical School may have been a bit surprised to see the master clinician who would be teaching that day—a local auto mechanic.
Photo right: Dr. Harry Hoar and auto mechanic Peter Zimmerman demonstrate the diagnostic reasoning process.
How Can Medical Students Learn From Mechanics?
Dr. Harry Hoar, Assistant Professor of Pediatrics, got the idea for this unusual lesson from an article titled, "The Mechanics of Reasoning" by Gurpreet Dhaliwal MD, in the September 7 2011 issue of the Journal of the American Medical Association.
“The cognitive task of the mechanic is virtually identical to that of the physician," wrote Dr. Dhaliwal. Both diagnose problems using a remarkably similar reasoning process: history, examination, and tests.
So, Dr. Hoar invited Peter Zimmerman of Wilbraham Tire and Auto to help illustrate the process of problem solving and reasoning.
Dhaliwal says “students learn reasoning by listening to others reason,” and suggests that using an auto mechanic as a role model may be an effective teaching tool. By eliminating the complex medical facts, students can focus in on the reasoning process.
How Are Auto Mechanics and Doctors Alike?
With Dr. Hoar role-playing a customer with car trouble, Zimmerman asked questions as he attempted to diagnose the problem.
"What does the noise sound like?" "Where is it coming from?" "Does it happen all the time or only certain times?" "How long has it been happening?" "How old is your car?"
After determining that Hoar's vehicle had a suspension problem, Zimmerman continued to demonstrate his skilled clinical reasoning process by diagnosing—with 100% accuracy—car problems called out by the students.
Hoar followed up by guiding the students' attention to the seven cardinal features of the HPI (History of Present Illness). Physicians question patients about the location, quality, timing, severity, context, modifying factors, and associated symptoms—strikingly similar to questions used to diagnose car problems.
Patients Are Not a Collection of Symptoms
In August, the first class of 21 medical students started their training in the PURCH Track (Population-based Urban and Rural Community Health) at the University of Massachusetts Medical School-Baystate.
The population-based health model shifts a physician's perspective to include the many factors influencing a patient’s health, as well as the health of the entire community.
"The patient is not a collection of symptoms. The patient is a whole person," Rebecca Blanchard PhD, Senior Director of Educational Affairs at Baystate Health, was quoted as saying in "Springfield's UMass Medical School Baystate campus welcomes first students" on MassLive.com.
UMass Medical School's expansion into Springfield is an effort to increase the number of doctors practicing in western Massachusetts.
To create the new regional medical school campus, Baystate Health renovated 6,000+ square feet in an existing building at 3601 Main Street. The space includes classrooms with teleconferencing connections to the main campus in Worcester, study areas, lockers, interview rooms, a kitchen and lounge area, and administrative offices.