New Pathway in Health Law Further Personalizes Medical Education

A stroke patient who could not speak and had no advance directive was aphasic, a condition resulting from damage to the part of the brain that controls language. But the patient could think and gesture, so with input from her doctors, her lawyers created a series of images from which she could select her wish that her sister handle her finances.

Without the novel but legally enforceable instrument, the woman would have been declared incompetent and appointed a guardian to make her decisions. That’s just one example that JoNel Newman, J.D., director of the UM School of Law’s Health and Elder Law Clinic, cited to explain the growing national trend of medical-legal partnerships in hospitals and health centers. It’s also why the new Medical Student Pathway in Health Law, along with the Miller School’s five other pathways, is so relevant.

As Melissa Swain, J.D., clinical instructor and associate director of the legal clinic, added at a Q&A session on the Health Law Pathway last month, “The days are over when you can graduate from medical school and say you’ve never worked with any other profession. Collaboration among disciplines is key to solving complex problems.”

Alex J. Mechaber, M.D., associate professor of medicine and senior associate dean for undergraduate medical education, likewise envisions the day when all Miller School students pursue an area of expertise, through one of the Miller School’s growing number of pathways of emphasis, or dual degree programs.

The Miller School, which offers M.D./Ph.D., M.D/M.B.A., and M.D./M.P.H. degrees, is exploring an M.D./J.D. degree and, with the addition of Health Law, now has six pathways, or areas of scholarly concentration, as they’re known at other institutions.

The first, in Genetics/Genomics, was established in 2005, followed by pathways in Social Medicine, Ethics/Humanities and, more recently, Molecular Medicine and Immunologic Medicine/Infectious Diseases. Four more — in Health Policy, Medical Informatics, Medical Education and Translational Medicine — are in various stages of planning or approval, putting the Miller School at the forefront of another trend, the personalization of medical education.

“I’d love to see a time when every medical student has a personalized niche by the time they graduate,” Mechaber said. “It’s valuable for students to develop a level of expertise in one area for focused research and scholarly work. It’s important for their training, and their future practice.”

Selected by UM faculty who voluntarily serve as directors, pathway students begin pursuing their area of interest after the first semester of their first year and remain on their chosen pathway through the remaining four years of medical education. Requirements vary, but pathways generally require students to attend monthly meetings, conduct research, make presentations and complete a mentor-guided project. Those who meet their pathway requirements receive a certificate of completion and recognition in both their Medical Student Performance Evaluation for residency and at their commencement ceremony.

In early December, about 80 first-year students attended an overview of the existing pathways and, in the ensuing two weeks, one or more of the small-group Q&A sessions on those of interest to them. About a dozen showed up for the Health Law session, which was moderated by three of its four directors: Newman and Swain, the attorneys from UM’s Health and Elder Law Clinic, and Edwin Olsen, M.D., M.B.A., J.D., professor of clinical psychiatry, who earned his law degree from UM in 2001. The fourth director, Panagiota “Pat” Caralis, M.D., J.D., professor of medicine, is also a member of the Florida Bar.

While students have initiated some pathways, the Health Law Pathway evolved from the Medical-Legal Partnership the Health and Elder Law Clinic established in 2005 to more effectively address the complex health needs of vulnerable populations and mitigate health disparities. Now an elective clerkship offered to Miller School seniors, the partnership pairs medical students with law students who, working with medical and legal faculty, residents and attending physicians, help patients at UM’s HIV clinics, the Jefferson Reaves Sr. Health Center, and the VA secure disability or other benefits, or tackle complex legal-medical issues that neither discipline could resolve alone – such as the one faced by the aphasic stroke patient.

Students selected for the Pathway in Health Law will likewise be paired with law students and jointly assess and manage legal-medical cases they encounter during their clinical experiences. They’ll also be expected to complete an in-depth, faculty-mentored project that contributes to a greater understanding of, or solution to, an important medical-legal issue.

“It could be writing a recommendation for a policy change, or for making a particular formulary available for patients in the AIDS Drug Assistance Program,” Newman, associate clinical professor of law, explained at the Q&A. “We’d like it to come out of your client case work.”

A member of the class of 2015, Juhi Jain asked a question likely on the minds of all her classmates at the session: “Do we have to have knowledge of the law?”

Newman assured her medical students would not, but as Olsen noted, both they and law students likely will end up speaking each other’s language, and more importantly, understanding their diverse perspectives.

“One of the things they will learn is how lawyers approach problems and their responsibilities,” Newman said. “It is fundamentally different from doctors.”

For more information or an application for any of the pathways, visit the Department of Medical Education website.

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