Central PA Medicine - February 2017 - 11

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It makes sense that learning about research
would take place in the earliest phases of medical
education. Doing so may naturally dovetail the
facts we learn as medical students. What better
way to understand medical best practices than
to understand the evidence behind it all?

Importantly, the program then illustrates trends
by plotting these data. The users may become
more empowered by visualizing their weight
and exercise tolerance across time. As the device
is wi-fi enabled, the data is also simultaneously
recorded on a secure database. This gave us the
ability to monitor the patients' routines remotely.
Many medical schools incorporate research The prospect of remote monitoring may also
into their curriculum in one form or another. augment the patients' intrinsic motivation to
For example, each student at Penn State College remain diligent in their self-care.
of Medicine is required to participate in at least
one research experience. We call it the Medical
The results of this month-long pilot study were
Student Research project or MSR. The goal of promising. Quantitatively, there was a collective
such a requirement isn't to get published (though compliance rate of 86%. That reassured our reit is often a welcomed side-effect), but instead to search team that patients could reliably track their
gain an intimate experience of medical research own self-care routines with the Heart Assistant.
through active participation.
We were also happy to discover improvements
One of the most constructive periods of our in participants' overall health. By trending the
medical education has been completing our MSR. data across their 30-day participation period, we
We spent an entire summer working with the found that the patients tended to lose weight
Penn State Hershey Heart and Vascular Institute and increase exercise tolerance at a statistically
as well as the Department of Public Health and significant level.
Science on an interprofessional project. The
research team had identified readmission rates
What was even more interesting was the qualiamong patients with chronic heart failure (CHF) tative data. We conducted thorough, standardized
to be a major stressor on the country's healthcare exit interviews with each patient to learn from
resources. More importantly, the group had their experiences. Most participants enjoyed
identified this as a problem we may be able to fix. the idea of having a single tool to organize their
CHF self-care. Several users thought the Heart
As any patient with CHF knows, their individ- Assistant was exactly what they wanted to help
ualized self-care routine can be very complicated. adhere to their routines.
They're told to trend weights at specific times
and to tally the sodium they consume every day.
We also gathered points for improvement,
Daily exercise becomes crucial and should also as some patients had trouble operating the
be recorded. On top of that, many patients are tablet. Especially amongst the older patients, we
on multiple diuretics, beta blockers, and other learned that there was some difficulty in using
medications, each with a specific dosing schedule. the touchscreen technology which we had taken
Some patients struggle to follow such a daunting for granted. By listening to their experiences, we
self-care routine. Indeed, more than 25% of walked away with a better understanding of what
hospitalized CHF patients end up re-hospitalized is important (and not important) to patients
within 30 days for a CHF exacerbation1.
as they navigate their illness. Their feedback
continues to help shape future iterations of the
To help address this issue, we assisted the team Heart Assistant.
in a pilot study of their device: the Penn State
Heart Assistant. Specifically, the Heart Assistant
As medical student researchers, our priis a tablet-based program that provides patients mary role was to serve as the participants'
feedback as they record their daily routines. It liaisons. We got to see the entire CHF
prompts patients to record their weight, medica- patient experience: admission to the hospital
tion, and time spent completing a stair-stepping with CHF exacerbation, inpatient medical
exercise every day.
therapy, discharge home, and transition to
outpatient cardiac rehab. Seeing the "big
picture" gave us insight into the medical

management of CHF patients and how it
can be improved.
This continuity helped us build rapport with
the patients as well. We gained an appreciation
for their struggles in leading independent lives
while managing a chronic disease. The patients
then offered candid, invaluable feedback when
debriefing about the project. For example, the
difficulty that some patients had in operating
technology was particularly profound. It
demonstrated that details we find routine may
be challenging for our patients, which results
in unavoidable noncompliance. Furthermore,
it showed us that such challenges can be
overcome by understanding and respecting
the patient's perspective.
Research is important to medical education
because it allows students to explore medical topics
in an entirely new light. From basic sciences, to
outcome studies, to social determinants of health,
students can exercise their curiosity and seek out
research mentors in their fields of interest. The
resulting partnerships are also an important part of
student academic and professional development.
And yet, these benefits are secondary to the
true prize: medical students enrich their own
education and perspectives by engaging the process of research. This prepares fledgling doctors
to meaningfully contribute to our ever-growing
fund of medical knowledge, shaping the future
of healthcare.
Even the best clinicians can only be armed
with the tools that research provides. Such an
armament must therefore keep pace with a
constantly evolving landscape of society and
disease. It seems that emphasizing research in
medical school addresses just that, as it develops
today's scientists for tomorrow's problems.

REFERENCES:
1. Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS,
Horwitz LI, Barreto-Filho JA, Kim N, Bernheim SM,
Suter LG, Drye EE, Krumholz HM. Diagnoses and
Timing of 30-Day Readmissions After Hospitalization
for Heart Failure, Acute Myocardial Infarction, or
Pneumonia. JAMA. 2013;309(4):355-363. doi:10.1001/
jama.2012.216476.
Central PA Medicine February 2017 11

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