Dan Keller 0:08
Welcome to this episode of Substantial Matters: Life and Science of Parkinson's. I'm your host, Dan Keller. At the Parkinson's Foundation, we want all people with Parkinson's and their families to get the care and support they need. Better Care starts with better research and leads to better lives. In this podcast series, we highlight the fruits of that research, the treatments and techniques that can help you live a better life now, as well as research that can bring a better tomorrow. Long as medical school residency and advanced training are time is limited for trainees to get experience in all the possible diseases and conditions within a medical specialty area in medical school, students go through a core curriculum of required clinical rotations, those approximately four-week periods in which they shadow physicians and residents at teaching hospitals and see patients to develop their clinical skills of diagnosis and treatment. Often, neurology is not a required rotation, even though it is likely that many graduate physicians will need skills in this area. Sagari Betté is a neurologist pursuing advanced training in movement disorders at the University of Miami. When we spoke, she told me that it's important for medical students to get a good foundation in neurology and movement disorders early in order to best care for people with Parkinson's disease once they are in practice themselves. She explained how medical education in neurology is done now, and proposes how it could be improved in the future, including videos of various movement disorders. In essence, she said, the more conditions students and residents see in training, the better equipped they will be to recognize and treat them later on.
Sagari Betté 2:11
So it's important to have a good foundation in key concepts in neurology, in movement disorders, and in Parkinson's disease early in medical education, not just so that learners and trainees can build upon that, but because that foundation directly affects their ability to care for people with Parkinson's disease and other movement disorders further on, once they become fully qualified physicians.
Dan Keller 2:43
How are they being trained now and what may be lacking?
Sagari Betté 2:46
So currently in medical training for physicians, we have what's called pre-clinical years, primarily in classrooms or in small groups or in simulation labs, followed by clinical years, which are primarily in the inpatient setting, meaning in hospitals rather than in clinics. And as people with Parkinson's disease and their caregivers know, their evaluations and treatments are primarily provided in clinics. So there's a little bit of a disconnect there between the information that we'd really like to be educating students and residents about and the setting in which they're learning.
Dan Keller 3:34
So are there efforts underway now to modify training, give them more practical experience in the outpatient setting, and other ways?
Sagari Betté 3:45
There are, and there's certainly been a shift over the past several years across the United States to shorten the amount of pre-clinical training to give a longer amount of time in the clinical years. However, the training remains primarily inpatient. There is a lot of institutional variability in that, but the overall trend of the inpatient focus has not yet changed.
Dan Keller 4:20
Do you think these changes, if they come about, will be implemented across the board? Will they be part of the requirements for training, for certification, or subspecialization in movement disorders?
Sagari Betté 4:31
I think that remains to be seen. I think it's certainly a possibility, and it will be helped by advocacy from large institutions in neurology, large institutions in movement disorders, and their affiliated foundations. And the reason I say that is because currently, actually, it is not required to have a clinical neurology experience during medical school, and that's for general neurology. So therefore, it's not required to have clinical training in Parkinson's disease either. So the first step would be requiring clinical neurology training, so that the second step would be to incorporate a greater understanding of Parkinson's disease.
Dan Keller 5:26
How is this going to help patients? And when it sounds like a very long-term kind of adjustment in the education?
Sagari Betté 5:36
It certainly does require a long-term vision, but the downstream benefits are actually huge. As we know, there's a large population of people who are affected by Parkinson's disease, not just the patients themselves, but their families, their caregivers, and their communities, and we have an overall aging population in the United States, which means that there's the potential to have a growing population of people affected by Parkinson's disease. So the idea is to invest our time in medical education and really helping future physicians understand how to evaluate and how to treat Parkinson's disease and develop a level of comfort with it early in their careers, so that as they start to see these patients, they feel that they can competently care for them and address all of their needs. Right now, they are still able to learn how to evaluate and care for people with Parkinson's disease, but a lot of times it happens after they've already finished their training, after they're out in practice, and they realize that they have a large population affected by the condition.
Dan Keller 6:58
We hear quite frequently about a team approach to Parkinson's disease—social workers, various kinds of other therapists, physical therapists, occupational therapists, speech language—as well as the movement disorder specialist. How much in training do trainees learn about forming a team, being part of a team, using it best?
Sagari Betté 7:23
That part of training really comes during residency, when medical residents learn how to ask for help from those allied health specialists to help care for their patients, to plan for patient discharges and for their transition back to their normal lives at home, what we call continuity of care. The inpatient setting is unique in how those allied health specialists provide care for patients. It's a little bit different than in the outpatient setting. So certainly, I feel that a lot of training in how to coordinate that care in a clinic only comes once a physician is actually practicing in that clinic. And that's something that we're hoping that these videos and this emphasis on teaching disorders like Parkinson's disease early in medical education can help bridge that gap.
Dan Keller 8:27
So you're coming up with a library of videos.
Sagari Betté 8:31
Yes, through the University of Miami, we're creating a video library to teach about Parkinson's disease and movement disorders, because the main way that these disorders are evaluated is clinically, by seeing people who might have the disorder. So you really have to see it to understand it. And if you don't have the opportunity during your education to see these patients, then another way to learn about the disorder would be to see a video of the disorder. Currently, the available videos are either difficult to access or at a much higher educational level than a beginning student or a resident, so we're seeing a gap there in their education that we're filling by creating a library of videos that's specifically targeted to where they are in their medical education.
Dan Keller 9:28
How many do you have so far?
Sagari Betté 9:30
So far we have a total of 10 videos. Three are specifically on Parkinson's disease, and the other seven are on other movement disorders, some of which can also be seen in people with Parkinson's disease.
Dan Keller 9:47
How can an individual person with Parkinson's or through an advocacy group or support group help to push along better movement disorders education?
Sagari Betté 10:01
I think that they can certainly help through raising awareness through national foundations, through local foundations, even by contacting their congressman or their senator to let people know that this is something that is important for them and important for other people like them. And that level of awareness in people who are really policy makers, lawmakers, can have an incredible impact in the work that's being done around the country and around the world. In individual institutions, it's really a Herculean task to create this sort of paradigm shift, both in the realm of education curriculum as well as the downstream translation of that curriculum to actual patient outcomes, and I think it really needs to be addressed at all angles. And patients know best what they need. And I think by communicating that, that helps us provide that for them.
Dan Keller 11:15
You're still in training, and you've picked up on this topic—I won't call it a cause—but something that needs attention. How did you pick up on it? Is it something you see a need for in your institution, or are they already excelling and you think it should be brought to other ones?
Sagari Betté 11:33
I've been interested in medical education for quite some time. I've been interested and involved in education since high school, through tutoring my peers. That continued throughout my higher education, and once I joined fellowship at the University of Miami, I started discussing a video library with the neurology clerkship director who directs the clinical training of the medical students in neurology, and started investigating what was available out there to teach movement disorders, and I realized that there's really not that much, and what was out there was expensive or difficult to access or not quite directed towards the students, but directed towards people who are already experts in the field. So it was something that I saw a need for both at my own institution but also nationally and internationally. My pre-existing interest in medical education is what's really fueled the project from that initial idea to the creation of a video library. The videos are currently available at my institution, and what we're working on now is how to expand that access, how to make our vision to change and improve medical education a reality.
Dan Keller 13:11
What's important to add?
Sagari Betté 13:13
Well, actually, apart from expanding the videos themselves and including both common movement disorders such as Parkinson's disease and more rare disorders, we would like to expand the library to include patient and caregiver resources, and particularly video resources, and create an app that makes it very easy to access these videos—something that could be on a mobile device and include not just the videos but interactive information and links to resources. We'd also like to study exactly how these videos impact education, impact quality improvement within education and within patient care, and impact patient outcomes, and particularly their quality of life. The ultimate goal of improving medical education is to improve patient care.
Dan Keller 14:18
Very good. Thank you.
The Parkinson's Foundation is committed to improving how Parkinson's is taught to students who will eventually care for people with Parkinson's through our Edmund J. Safra Visiting Nurse Faculty Program and the Physical Therapy Faculty Program. We offer a training curriculum to teach nurse educators and physical therapy educators the latest in proven PD care techniques, who then teach their students. Medical students are also encouraged to learn more about PD care while earning CEUs through our free courses designed for nurses and rehab therapists. Additionally, two students in each discipline are permitted to attend our Allied Team Training for Parkinson's program, which takes place twice a year, helping medical professionals from diverse disciplines learn the best techniques in PD care through a dynamic team-based approach. You can learn more about all of these programs at parkinson.org/professional-education. There is also a variety of expert briefings, which are free webinars hosted by the Parkinson's Foundation, led by experts in PD on our website that provide education to health care professionals, as well as ones for people living with Parkinson's, and some are appropriate for both. Just go to parkinson.org/eb to view all upcoming webinars and past expert briefings available on demand. The next expert briefing addresses PD and medication and will take place on April 9 at 1 p.m. Eastern Time. As always, PD information specialists are available on our toll-free helpline. They can answer questions and provide information about this topic or anything else having to do with Parkinson's. You can reach them at 1-800-4PD-INFO. If you have any questions about the topics discussed today, or if you want to leave feedback on this podcast or any other subject, you can do it at parkinson.org/feedback. At the Parkinson's Foundation, our mission is to help every person diagnosed with Parkinson's live the best possible life today. To that end, we'll be bringing you a new episode in this podcast series every other week. Till then, for more information and resources, visit parkinson.org or call our toll-free helpline at 1-800-4PD-INFO, that's 1-800-473-4636. Thank you for listening.
