"Growing up, I had a wonderful science teacher in middle school and high school. We would go out into the community and incorporate various hands-on experiments,” reflected Tarin Schmidt-Dalton, M.D., director of year one clinical sciences and skills at the Virginia Tech Carilion School of Medicine. “She really helped me apply science to things that were practical, interesting, and fun. I was academically challenged and I enjoyed learning that way.”
Schmidt-Dalton was lucky enough to be able to continue this type of interactive learning when she began medical school at Southern Illinois University. She was selected to be part of an experimental group that used a problem-based learning format, instead of traditional lectures. “I like having the freedom and flexibility of working in smaller groups to develop learning objectives and apply adult learning principles. Also, I like to do new and creative things. I recognized problem-based learning as a cutting-edge form of medical education.”
Problem-based learning is a student-centered, faculty-facilitated approach to education. Students work in small groups, analyze a patient case study, and identify what they already know or do not know about the many issues raised in the case. From there, the groups create learning objectives, conduct research, and then present the new information to each other to work towards a solution.
When Schmidt-Dalton heard a few years ago that the newly-forming Virginia Tech Carilion School of Medicine would use a problem-based learning format, she wanted to get involved. “I had something to contribute as far as a personal learning experience since I had used it in medical school. I was very familiar with it and knew it could work. I had the bias that I thought it was the best way to learn medicine.” Schmidt-Dalton added, “Also, I wanted, for the same reasons, to be able to be on the ground floor of starting something new in my community.”
Schmidt-Dalton has been a busy woman the past couple of years, helping to shape the clinical skills curriculum. Since August, she has seen the planning payoff by teaching the charter class. Schmidt-Dalton had one item in particular she wanted students to take away. “The foundational clinical skill is communication: interviewing patients and their families, learning to listen and observe, and being comfortable building rapport and a solid relationship. From my years of precepting residents, students, and physician assistant students, I have seen that many of their diagnostic errors, as well as much of patient dissatisfaction with care, have stemmed from poor communication skills.”
The VTC standardized patient program has been developed in parallel to the clinical skills curriculum this year. Students interact with standardized patients to practice various interview and physical exam skills. Standardized patients are trained to act like real patients with a variety of symptoms and problems, augmenting the clinical skills curriculum by allowing students to practice in a safe setting
“Learning the different ways people react to questions during interviews with standardized patients provides us with much needed practice for the real world,” said charter class student Caroline Osborne. “Not everyone responds the same way. Our curriculum places an emphasis on a physician’s capacity to elicit details from the interview by listening and allowing the patient to fully elaborate their story. This has even helped me outside of the clinic, training me to listen more attentively to both friends and family.”
As a family physician, Schmidt-Dalton also had another goal with the curriculum. “Being able to truly teach clinical skills across the entire lifespan was the second most important thing. It’s important for students to be comfortable with patients of any age whether it is a newborn baby, a middle-aged adult, or a geriatric patient.”
Schmidt-Dalton believes her clinical skills class helped students bring the learning objectives from all of their classes together. “They are able to learn a certain organ system in the morning, the physiology, the anatomy, and then are able to do some hands-on exam skills in the afternoon,” said Schmidt-Dalton. “I think that just cements their learning, puts all the pieces together for them, and makes it a very practical model for medical education.”
Her hard work is recognized by the students. “Not only does Dr. Schmidt-Dalton carefully plan out our sessions, but she is always present and involved in our education,” said Osborne. “The faculty does an amazing job not only imparting clinical wisdom from their own experiences, but also preparing us for our boards.”
The students are not the only ones learning in Schmidt-Dalton’s class. “With the [clinical skills] workshops, we collaborated with faculty from many clinical disciplines. As busy physicians, we can get in a rut and do the same thing year after year. It’s really nice to bring different disciplines together to teach clinical exam skills and to learn from each other.”
When Schmidt-Dalton is not busy in the classroom, she does not have time to slow-down. She regularly sees patients, is a wife and mother of two, and is actively involved in her church, teaching Sunday school and going on mission trips.
Schmidt-Dalton says the mission trips keep her grounded. “It really opened my eyes to how incredibly fortunate we are in this country, the freedoms that we have, the things that we take for granted day-in and day-out, not only within our own personal lives at home, but as a society and in medicine. Mission trips can focus you - remind you of what really is important.” She says the trips are valuable to her skills as a physician as well. “It reminds you how important it is to be able to take a good history and incorporate solid physical exam skills. On the mission field, you don’t have a lab or MRI at your fingertips. You really have to be able to communicate well and use your clinical skills to make an appropriate diagnosis and plan.”
As for teaching Sunday school, Schmidt-Dalton says the task is important to her faith, but she’s also gained knowledge she can put into practice with her patients. “I’ve had children over the years with developmental delays, Asperger Syndrome, autism spectrum disorders, and Down syndrome. It’s really given me a better appreciation, even though I may have them for just an hour-and-a-half on a Sunday morning or working with them on a Wednesday night, of what their families go through and how hard and challenging that is. When I have families come into my office to talk to me about those demands, I can understand where they are coming from. I can be a much more empathetic physician, and I think in the long run, a much better physician.”
Schmidt-Dalton says her support system – particularly her husband and good friends - helps her juggle all of the demands. “My husband has been a great supporter of my career and my experience has been that such support can be hard to find sometimes as a female in medicine.” As a typical mother, Schmidt-Dalton worries about the amount of time she is able to spend with her children. She recently attended a conference that put her mind at ease. Schmidt-Dalton said they shared information from studies that “found it is more important that the time you spend with your children is of great focus and quality – that your kids know that you love them, that you support them, and that you do what you need to do to keep the lines of communication open. That is more important than a parent who is there 24/7 but doesn’t provide those things. Learning that was really helpful. Honestly, as a mom and a female physician, that was very freeing. A lot of women who are physicians struggle with guilt, trying to balance everything. It has helped me focus, not on the amount of time, but on the time that I am there being of good quality.”
As part of the clinical sciences and skills value domain, Virginia Tech Carilion School of Medicine students get early practice in a clinical setting with standardized patients as well as other volunteers from the community. Check out some pictures from a class session as students practiced checking heart rates, blood pressure and breathing.