Teaching multimorbidity to medical students

Background: Multimorbidity is a rising health care phenomenon and doctors require specific skill sets to effectively care for patients with multiple illnesses. Despite this, most medical education is taught using a single-disease, systems-based approach. Consequently, students can struggle to manage patients with multimorbidity. To help final year medical students manage patients with multimorbidity in clinical practice, we devised, taught, and evaluated a heuristic: collect, cluster and co-ordinate.

Approach: Students attended a 1-hour online workshop during their family medicine clerkship. Using a flipped classroom design, students watched a podcast, followed by facilitated small-group work.

Evaluation: Out of 132 final-year medical students, 102 participated in the evaluation. Students rated their confidence managing patients with multimorbidity, pre and post teaching on a Likert scale. Prior to teaching, 36% (n = 37) students rated their ability to manage a patient with multimorbidity as slightly confident. After teaching, 74.5% (76) students rated their ability to manage the same patient as fairly or completely confident. Prior to graduation students were surveyed to determine if they had applied the framework during clinical placements. Sixty-one students responded; 32 applied the heuristic during family medicine and in other clinical rotations such as paediatrics, obstetrics, emergency medicine and anaesthesia.

Implications: Specific instruction on managing consultations with patients experiencing multimorbidity during undergraduate medical education increased learner confidence caring for these patients. The heuristic was relevant and applied in disciplines outside family medicine. Students indicated that earlier teaching on this topic would have prepared them better for clinical placements.