What are the greatest aspects of the MetroPAP program? Here’s a behind-the-scenes perspective from a former North Minneapolis MetroPAP student.
1. Continuity of patients
Developing a fluency in continuity of care with a patient is nearly impossible in a traditional medical curriculum, but it’s an important muscle to start exercising as a medical student. I followed some patients in my MetroPAP panel for six to seven months, but did not feel as though I developed a therapeutic bond with them until the fourth month.
Developing a skillset for fostering those relationships and knowing how to effectively chip away at that wall patients may initially put up is an invaluable learning experience. The benefit of continuity was not limited to the outpatient setting; one of the greatest revelations for me was realizing that, as someone who loves hospital medicine, the in- and out-patient settings exist on a spectrum of care, and are constantly speaking with one another.
This becomes especially apparent when working with a patient with high-utilization of healthcare—someone who is in-and-out of the hospital every two weeks—and the goals of care in the clinic and hospital settings start to merge. I learned what a privileged position it is, as a provider, to know what you've tried and haven't tried in prior admissions; to know what your patient’s concerns are, what their social issues are that might reinforce high utilization of care.
It was an unexpected, novel way of thinking about both outpatient and inpatient service—of conceptualizing my role in the overarching spectrum of healthcare.
2. Continuity of educators
The longest rotation in the traditional medical curriculum is six to eight weeks. Oftentimes, even within those six to eight weeks, two to three preceptors oversee and assess students based on a handful of 10-15 minute windows of patient presentations. Even during positive rotations, over time, it can feel a bit dehumanizing, to be reduced to how well you can recite and craft your presentation down to what a particular attending likes.
On MetroPAP, though, because the faculty/residents are overseeing you, you feel as though they are invested in your specific interests and outlook on medicine. I think extending the timeline of education from six weeks to nine months liberates you to another level of flexibility in your education—it helps you to hone in on what you’d like to accomplish and learn on a given rotation.
The faculty and residents quickly become familiar with a student’s strengths and weaknesses, yet provide a safe venue for them to continue honing strengths and improving upon weaknesses. From that understanding, residents/attendings were more likely to give me autonomy, and in turn, I was given more responsibility.
My experience with clinical rotations is that once a medical student has two to three rotations under their belt, they've recognized the role of learners in the care team, and figured out how to be a medical student (e.g., learn how to give a focused patient presentation, conduct a strong admission interview, compose a concise yet informative patient note).
Consequently, the bulk of the actual clinical learning comes from doing something yourself. In my experience, MetroPAP allowed for a lot more of these opportunities. From delivering more newborns and performing more circs to leaving clinic to see one of my patients in the hospital and performing a home-visit, I felt like I was given the space and autonomy to be empowered about my role in patient care. MetroPAP played an enormous role in helping me to find and define my “physician voice.”
3. The setting
You will be treated as an intern, given responsibilities similar to that of an intern, invited to clinic/resident events, etc. Beyond the implications this has for building confidence and encouraging self-motivation, it gives students a sense of what residency will be like (not just family medicine residency, but the kind of working relations one develops with fellow co-residents and attendings), and has really guided what I will look for when I apply to residency programs.
4. The community
The North Minneapolis community is special. There is a complex set of social determinants of health at play within the area, and you will find that your public health brain is constantly engaged in clinic. Moreover, there are ample opportunities to volunteer in Broadway’s community-based initiatives, partner with their HIV outreach coordinator, and collaborate with other disciplines to broaden your conceptions of health and wellness.
I often view my MetroPAP year as a valuable precursor and supplement to my following year, when I pursued a Master of Public Health degree. These two experiences informed each other.