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A lesson on life’s end: How one college class is rethinking doctor training

by Shayla Love, Stat News, 7 December 2016

Ms Love reports on a new class for pre-med students at Columbia University.

The class, called Life at the End of Life, places students with medical aspirations — before they even apply to medical school — with patients at the Terence Cardinal Cooke Health Care Center (TCC), a nursing home in Harlem. The students enter the doors of the clinic knowing that their patients will not get better, and likely never leave.

In an increasingly tech-enabled medical profession, where death is postponed as long as possible, the class challenges pre-med students to confront that ultimate reality, and to learn how to guide patients and their families through it. And along the way it’s challenging their field’s hidebound distinction between medicine and palliative care — between doing everything to keep someone alive, and helping them die with dignity.

The Columbia class is the brainchild of Robert Pollack, a biology professor, and Dr. Anthony Lechich, the medical director at TCC. In 2005, they started to place one or two students per summer in an internship at the facility. Six years in, one of their interns was pre-med student Ashley Shaw, who saw in her own experience something that flagged up a shortcoming in medical education more widely.

“Medical students and trainees enter medicine thinking that medicine is an exact science,” Shaw said. “There are the signs and symptoms of a condition, and this is the treatment, and this is what the evidence is, and all you have to do is learn that. [But] a large percentage of this endeavor is dealing with uncertainty. You’re in deep trouble if you’re unprepared to handle that.”

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