LAW AND MEDICAL STUDENTS JOIN FOR COVID-19 CO-LEARNING EXERCISE
April 30, 2020 — Students enrolled in Penn State Dickinson Law’s Medical-Legal Partnership (MLP) Clinic focus on identifying and addressing the socio-legal causes of poor health in order to prevent negative legal, financial and health consequences for their clients. During the COVID-19 pandemic, health disparities due to socioeconomic status have come into sharp focus.
In a recent interprofessional education (IPE) collaboration between the MLP Clinic and Penn State College of Medicine, law students and medical students learned from one another about how members of each profession are trained to address these challenges.
It was a unique opportunity for students to apply their developing skills while working interprofessionally to explore ways to combat the virus’s proliferation.
“The spread of COVID-19 is not caused just by the virus but by all kinds of societal dysfunction—things like poverty and racism, which influence who is being struck most heavily by the pandemic,” says Dickinson Law Assistant Professor of Law Medha Makhlouf, who founded and directs the MLP Clinic. “We wanted the medical students to understand that supportive legal measures are just as necessary as medication for treating the spread of COVID-19. And we wanted the law students to understand how doctors are trained to think about patients with socio-legal barriers to achieving good health.”
The idea for the exercise came about after Dr. N. Benjamin Fredrick, a professor of family and community medicine, public health sciences, and humanities at the College of Medicine, reached out to Makhlouf. Fredrick co-created a four-week virtual course, “Health System and Equity,” focused on coronavirus for all third-year medical students. He invited Makhlouf to lecture on the theme of “COVID-19 and Health Inequities.”
“I naturally thought of Medha,” says Fredrick, “because her important work is at the nexus of people’s social and medical needs. Even early on in the pandemic we were all becoming aware of how people’s economic and legal challenges were starting to mount.”
Makhlouf agreed and also proposed an IPE activity for Dickinson Law and College of Medicine students. In her lecture to the more than 190 medical students, Makhlouf introduced the MLP Clinic’s work, described how COVID-19 has impacted their clients, and summarized recent changes in law and policy that address pandemic-related concerns of vulnerable populations.
After her lecture, the medical students received case studies of MLP Clinic clients drafted by Dickinson Law students. The medical students analyzed a case and wrote up their observations and recommendations. The next day, each Dickinson Law student met with the group of 15 to 20 medical students who had analyzed their case study to discuss their observations. “This was an incredibly valuable learning opportunity for the medical students,” says Fredrick. “Each case represented a real person who already had complex social and medical needs before the pandemic. The medical students were able to apply their training on the social and systems level challenges posed by the COVID-19 pandemic to these cases. This was a rubber-meets-the-road assignment, and proved to be a rich opportunity for the medical students to work with the law students on behalf of some of the more vulnerable people in our communities. This was both a wonderful learning experience and also a way to potentially improve health outcomes for these clients.”
“The main goals were for the law students to learn how their training has prepared them to be helpful during a public health crisis and to give medical students insight into the social issues that impact the health of their patients. It was an eye-opener,” says Makhlouf.
She says that MLPs are an ideal platform for health care providers to learn about and address their patients’ socio-legal needs. For example, physicians know when patients don’t take their medicine; the clinical signs tell the story. But they may not recognize the reason behind the behavior. Perhaps a patient lacks health insurance and/or money to pay for a prescription or transportation to pick it up at the pharmacy.
“Medical students have not traditionally been trained to think this way. They think about biology and disease pathology, developing an appropriate differential diagnosis, and formulating a medical treatment plan,” says Makhlouf. “Considering socio-legal elements of health is a new way to think about managing illness, and we wanted to explore those concepts in an interprofessional setting.”
The exercise gave both sets of students the opportunity to share knowledge about their relevant areas of expertise. For instance, one group discussed a patient who had been diagnosed with leukemia. The medical students described the cause of and course of treatment for the disease and debated whether a bone marrow transplant would be considered elective or essential, at a time when many elective procedures are being canceled because of the pandemic.
“One of my MLP Clinic students told me that this exercise was one of the best things she’s done in the Clinic,” says Makhlouf. “I was thrilled to hear that, and it encourages me to incorporate more IPE into the Clinic curriculum.”
One medical student noted that learning about a patient's social history made her feel more empathetic. She said it changed the way she would think about future patients who are “noncompliant.” Rather than end the inquiry there, she will consider what she, as a physician, can do to address the patient’s concerns and who she can contact to help.
Third-year Dickinson Law student Jasmine Sandhu ’20 believes the exercise reshaped some medical students’ perceptions of lawyers as well.
"Collaboration between medical providers and lawyers is necessary for individual and community health. As Professor Makhlouf has repeated during my time at the MLP Clinic, the human ecosystem is interconnected, meaning one’s health impacts others’ health,” says Sandhu. “This is why collaboration with physicians goes beyond an individual’s health. In this time of a pandemic emergency, this notion is even more evident.”
“Working with Medha and her wonderful law students has been very gratifying and enlightening. We have generated more ideas on how we might continue this collaboration,” says Fredrick.
Makhlouf agrees that both law and medical students walked away from the experience with a new appreciation for the other profession.
“I wanted my students to see how having this kind of interprofessional consultancy can be helpful to their work as lawyers,” says Makhlouf. “Our medical partners are busy and typically can’t take half an hour to analyze a client’s case with us. This exercise gave law students more than an hour to sit with medical students to engage in deep discussions focused on the real and urgent needs of our clients. It was a really different and valuable experience.”