Your Future Doctors Will Start Seeing You Now, New Jersey

By Seth Augenstein

The patient explained their successes, hopes and desires – and their struggles. The person explained how life, once driven with a successful career, had become more difficult with the setbacks in their own health, and that of a loved one. As the person talked, it became increasingly clear the patient started to feel vulnerable as those personal struggles intensified. The medical student just listened. At some point, tears came.

It just so happened that person was one of the first patients Candace Pallitto, an M.D. candidate at the Hackensack Meridian School of Medicine, met in a clinical setting at the beginning of Pallitto's second year of medical school.

The patient, recovering from multiple medical conditions, said they felt immediately better. Talking about their "old self," the inner strength which had driven their life to that point, had made them "feel like a person again."

Pallitto's experience was one of many for the inaugural class at the school, which has students wear white coats and practice the clinical side of medicine – the "human factor" of things – from the very first day. But this week, this first class of students will take a step farther out into the wide world today. They begin the "Phase II" of their Hackensack Meridian School of Medicine education, as they begin their clerkships at more than a dozen sites across the health network.

Pallitto, a New Jersey native and one of the roughly 60 students in the inaugural class, said the conversation with the woman has inspired her as she heads into this next stage of her education and career.

It begins this week, for the school's first-ever group of students.

"During the next year with our clinical rotations, we are part of the clinical team and we have been told that we have to take ownership of our patients," said Pallitto, explaining how treating decisions will still be made by licensed doctors.

"The one thing we do not need permission for and should be really taking the time to do is to make all of our patients feel like a person," she added. "I think our first year and a half has helped prepare us to do just that."

A Unique Medical SchoolThe program to train the students as doctors includes an innovative three-year path to residency and partnerships in some underserved communities.

The school touts a "pedagogic approach" – an experience which emphasizes team-building and cooperation. No distinction is made between the basic, clinical and epidemiologic sciences they take in the first year, and the clinical curriculum they learn throughout their years at the school.

The vision: to create a new generation of doctors who are humanistic, socially responsible and collaborative across the health care system – professionals who are equally adept at the biomedical intricacies, as they are the behavioral, social and health system sciences in treating people.

The first year is packed with classes like anatomy, molecular and cellular principles, and neuroscience and behavior, among other required courses. But the basic science is always placed in its clinical context, from pathology to physiology, to pharmacology, according to the faculty.

The Human Dimension, a three-year course, is one of the key components of the program. An immersive community-based experience, it links pairs of students to families in the community, with a focus on four domains of health: social, environmental, psychological, and medical.

Along the months and years of the Human Dimension, the students follow the health trajectories of individuals and families, in locations including Hackensack, Garfield, Paterson, Passaic, Bloomfield, Clifton, Nutley, Union City, and West New York. Through longitudinal experiences in the family's home, community, and health care settings, students will come to understand the role of community and context in health and well-being, as well as the role of the physician in all elements that contribute to promoting health and preventing disease.

Embracing the HumanismApart from the Human Dimension program, which runs throughout the students' time at Hackensack Meridian School of Medicine, the clerkships starting this week will bring the students through different rotations, at different clinical sites, over the next year.

They include participating on the clinical team in inpatient and outpatient settings. The school has a focus not only on the inpatient setting, as most medical schools historically have, but also on the outpatient setting – where the majority of medical care in the U.S. takes place.  There will also be a core curriculum covering clinical skills, specialty-specific content, and clinical reasoning. These will occur utilizing case-based active learning, high-fidelity and task-based simulation, Standardized Patient sessions, procedure training, and other opportunities.

"The frame for the entire School of Medicine is the 'Determinants of Health' – the different factors that we know drive health outcomes – to be good or bad," said Miriam Hoffman, M.D., the associate dean of medical education. "All that our students have been learning and developing until now – across all the sciences and all the Determinants – will be integrated and applied in their patient care.

"Students will use the frame of the Determinants as they develop their differential diagnoses, trying to figure out what ailments their patients have," added Hoffman. "They will think about all the Determinants – from the genetic to the social to the economic – as they work with their patients and the clinical team to develop treatment and management plans for their patients."

The inaugural class of students themselves have embraced the coming clerkships out in the medical world with a mixture of nerves – and excitement.

Just before Thanksgiving, as the class was completing its transitional clerkships, the school held its first annual "Student Clinician Humanism Ceremony" in the auditorium of the school.  Students, including Alina Bazarian and Kristen Grotheer, and others recognized some of the faculty members who had made the biggest impact on the students. The student body once again recited the "Physicians' Pledge," as adopted by the World Medical Association in 1948 and 2017. Among its maxims: "The health and well-being of my patient will be my first consideration; I will respect the autonomy and dignity of my patient."

"It is difficult to imagine a more fulfilling and exciting career—helping others to feel better; understanding rich and exciting concepts in biology, psychology, chemistry, sociology, physics, and economics; conducting physically transformative activities that will impact an individual's life—the medical profession offers you the opportunity to choose a career in which you can participate in many or all of these categories of human creativity," said Bonita Stanton, M.D., the founding dean of the school, and a pediatrician. "But as you focus in on your areas of interest, never lose sight of the patient. It is the patient or group of patients who will become—and should remain—at the center of all that you do in a medical career."

Earlier in the day, the students had heard from a panel of experts, including cancer survivors. The "life altering information" was intended to bring home the importance of treating patients with that dignity and the autonomy they are due as individuals, said Ofelia Martinez, M.D., director of clinical skills for the school.

"That was meant to frame what matters to patients," said Martinez. "We want them going out into their clerkships knowing what it means to be a patient on the other side of an exam, or a diagnosis."

The effort has been made to prepare for the toughest part of the career. Recently, the inaugural class had an entire series of lessons on breaking bad news to patients.

And already the students have been making rounds with their peers at various clinical sites for weeks as part of the transitional clerkship, said Joseph Torres, another M.D. candidate in the inaugural class just starting his clerkships.

All the training has been leading up to this next phase, said Torres, originally from Elizabeth, N.J. The most formative event so far that made an impression on him was the "White Coat Ceremony" held during the very first week of school last year.

"This day also motivated me. As I donned the white coat for the first time, I realized the amount of hard work and dedication it would take to finish medical school and eventually get the credentials 'M.D.' after my name," said Torres. "I still remember the day as if it was yesterday, and it was a great beginning to my journey of becoming the best physician I could be."

That experience, and the interactions since, have prepared him for what comes next, in the days and the years to come, Torres explained.

"I'm still nervous, but I'm also less nervous because of this," said Torres.

Certain patients in New Jersey will see Torres and Pallitto and their nearly 60 other peers throughout the state over the coming months. The M.D. candidates will be lending their ears, taking notes – and preparing for a future in medicine.

"Seeing the patient as a whole person – that's something we do every day," added Pallitto.

Hackensack Meridian School of Medicine, New Jersey's first private medical school in decades, announced its second class of 91 students over the summer. The class was selected from nearly 5,000 applicants. The school has drawn from a diverse community in the Garden State – and beyond. The newest class is half female; 58 students are from New Jersey. Nine members of the class have prior degrees from Seton Hall University and nine have advanced degrees in law, public health, bioethics and other fields. The class also speaks 23 languages.