Mother Infant Relationship A Continuous Loving Exchange (MIRACLE)
Assistant Professor of Obstetrics and Gynecology
In a course believed to be the first of its kind in the nation, medical students at Upstate Medical University are spending 15 months at the side of expectant mom from mid-pregnancy through birth and the baby's first year of life.
The course is known as the MIRACLE Continuity Elective seeks to provide students with a solid introduction to issues surrounding patient-physician relations. It also offers insights into the psychosocial dimension of care and the influence that pregnancy, birth and breastfeeding have on women's and maternal/child health and family building.
Dr. Richard Aubry created the elective in 1998 and was extremely passionate about the course and said "This course is the potential savior of the healthcare system."
He turned over the course in 2013 to Dr. Wallis who states "I was so proud and excited to be the Co-Director of the Miracle Elective as i believe this is a fantastic program for students - one that can truly make them better doctors and one experience that they will never forget. They will use this experience over and over again during residency and during their careers in many different ways."
Early exposure to patients and families is one of the many benefits of the Miracle Elective. Not only do students interact with patients but they learn about pregnancy, birth and family dynamics. Often the students and the patients/families form a bond that lasts well beyond the duration of the elective.
Faculty say the course represents a significant change in medical education, because it provides continuity-based patient interaction from the student's earliest days in medical school. Extensive patient interaction is traditionally reserved for third-year students, which makes this course a desired elective by the students.
One of the Family
Students are with the expectant mother and her family every step from mid-pregnancy to the child's first year. They visit the family's home, attend provider office visits, experience the birth process, accompany the family during the newborn's well-child visits and even celebrate the child's first birthday. This results a bond or a special relationship between the family and their students that can last beyond the elective.
"First-and-second year students tend to get buried in basic science and become very disconnected from the patient. The reason they went to medical school is to be with the patient."
Medical students enjoy the elective so much because the first-and-second year students tend to get buried in basic science and become very disconnected from the patient. The reason they went to medical school is to be with the patient.
Three Areas of Emphasis
The course is significant, faculty say, in that it highlights four areas often overlooked in formal medical curriculums:
- Continuity of Care
The term "continuity of care", which has been part of the medical jargon for years, refers to coordination of care that a patient receives over time. This elective is unique because the students have the opportunity to participate in one patient's healthcare for an extended period of time, allowing the students to have a unique perspective. They are there for prenatal visits, birth and baby visits which allow the students to have a good understanding of the care of the patient.
The MIRACLE Continuity Elective enables students to understand wellness, over and above illness. It is usual for medical students to be introduced to illness and disease, which is usually the focus and not focusing on the overall wellness of a patient.
Students also present on a "Healthy Living" topic related to the pregnancy, postpartum or the child's first year of life. Students are encouraged to choose a topic that is interesting and important to them.
One of the unique and most important elements of the course, is the requirement that students visit the assigned families. These home visits help students better understand their patient and the impact that home life has on health. Students learn that issues related to the environment, lifestyle, motivation, character and family must be understood in order to provide comprehensive medical care.
Understanding Barriers to Compliance
Students also understand the physician's disappointment when the patient does not follow recommendations, such as, heeding to the advice to quit smoking during the pregnancy. The students learn the day to day compliance problems that physicians face and help students to look for better approaches to these common dilemmas and form a partnership with the patient.