Just a few months before they started clinical rotations, second year medical students at the University of Cincinnati College of Medicine got a glimpse into the challenges of medication adherence through an experiential learning project—and many, many, Tic Tacs.
This project was funded by a grant from the Arnold P. Gold Foundation, authored by Laura Malosh, PhD, who runs the college’s Gold Humanism Honor Society. The week-long learning experience involved giving students a supply of six “prescriptions” (boxes of differently colored Tic Tacs) in their weekly learning community sessions.
The prescriptions were for complicated, chronic conditions like diabetes, hypertension and a seizure disorder, and each came with its own specific instructions: take the green pill three times a day, take the orange pill twice a day, take the red pill the morning, take the white pills with food, etc.
Student Emily Hautman said she felt overwhelmed just looking at the collection of pills.
“I had to read the labels several times before I understood what the dosing schedule would look like,” she says, “and I had to write out my own calendar before I felt like I could reliably take the medications as prescribed.”
Natalie Hood said she started the project fairly confident—but after the first day, she realized she was already forgetting pills.
“It was so easy to get caught up in my day and realize suddenly that I missed my lunchtime pill,” she says. “It was cumbersome to carry around so many medications, to have to reread the instructions every time to decide when I needed to take each.”
Though both Hautman and Hood were familiar with taking regular medication, they each had instances of nonadherence during this experience.
Once the week was over, all second-year students discussed their experience in small groups led by their learning community professor.
Associate professor Zélia Corrêa, MD, PhD, who leads Hautman and Hood’s community, reported that almost two-thirds of her students had difficulty with completely adhering to the schedule.
“Their reactions were very diverse,” she says. “But for the most part, I think they got a lot out of it. They were exposed to some of the challenges patients face dealing with their medications daily. In a few months, when they start having regular patient contact as third years, this experience will be a timely reminder for them and hopefully provide the right tools to increase their empathy toward patients.”
She said the idea came from student Maggie Schneider, a student representative on the planning group for the course “Physician and Society.” This longitudinal block covers a variety of topics outside the typical basic science curriculum, and Malosh says it’s an ideal place to discuss medication adherence.
“Difficulty with medication adherence is fairly rampant in the patient population,” she says, “and it can have devastating effects for the patients, as well as the effectiveness and efficiency of the health care system.” More so, she says patients who don’t adhere to their medication can get the black mark of “non-compliant.”
“We’re trying to move students away from that notion of ‘compliant’ or ‘non-compliant,’ and towards the idea that this patient is having difficulty with their program,” says Malosh. “Hopefully, the student can then ask, ‘Why? What’s making this difficult for you?’ and develop a sense of compassion around it.” Hautman points out that the medical students didn’t have to deal with two large issues that may hurt patients’ adherence: drug cost and difficult side effects.
The students say they now have firsthand experience with juggling multiple prescriptions—and feel better prepared for future care of their patients.
“I think this experience was such a good demonstration, especially for medical professionals who have never had chronic illness,” says Hood. “When a patient doesn’t comply, I would never jump to the assumption of apathy or disregard. Having stood in a patient’s shoes for a week, I know how easily I lost track of it.”