As a medical student, you spend a great deal of time learning to deliver care to an individual patient. You gather a history and perform a physical exam, then formulate a diagnosis and select the appropriate course of treatment to remedy the patient’s illness or complaint. Longitudinal therapeutic relationships are incredibly meaningful, and are a major reason why I plan to pursue a career as a Family Physician practicing in a primary care setting.
However, as a PCLT student, I’ve been lucky to have the opportunity to step back and explore healthcare in a context broader than the individual patient-provider relationship. The Duke third year provides a unique opportunity to devote time to a comprehensive research project and academically explore a question or topic of inquiry in great depth and comprehensiveness.
As a medical and MPH student, I’ve always been intrigued by the challenge of considering the healthcare system as a whole. When I was looking for a third-year project, I wanted to find an experience that would allow me to addresses a critical question: how can a system be restructured to improve health? This framework helped me settle on the topic for my third-year research project – evaluating the effect of group prenatal visits on neonatal and maternal health outcomes.
Traditionally, prenatal care for low-risk patients consists of an initial visit with complete history and examination, followed by brief office visits of 10 to 15 minutes throughout the course of the pregnancy, with a uniform schedule of screening tests. However, a clinic in Charlotte, North Carolina was experimenting with group visits for prenatal care. At the clinic, groups of 8-12 woman were brought together for a visit that lasted 90 to 120 minutes. During visits, patients received education on topics including nutrition, infant care, childbirth, breastfeeding, and contraception. Women also had individual time with a provider when a physical examination and evaluation of the fetus were performed. While, anecdotally, women enjoyed the group visits, a more systemic evaluation of the effect on patient outcomes had never been conducted.
I worked with my research mentor, Dr. Larissa Huber, a professor in the Department of Public Health Sciences at UNC-Charlotte, and Dr. Tara Vick, an OB-GYN from Carolinas Healthcare, to analyze data from the women who participated in group prenatal visits. My project involved retrospectively comparing the women who participated in group prenatal care with those who received traditional individual care, exploring outcomes such as preterm birth, low birth weight, cesarean birth and postpartum visit attendance.
My project allowed me to explore a novel and innovative method of delivering healthcare – reimaging the traditional prenatal visit structure – and assess the effectiveness of this model of care delivery in improving patient health. The unique structure of Duke’s third year gave me the time and support to carry out a project from scratch, and truly act as project leader (with excellent support from my mentors)! Under their guidance I wrote the project IRB, was the primary contact for the data analytics team who extracted data from the clinic’s electronic health record, and conducted the analysis of the data. We were able to turn our findings into a manuscript that has been accepted for publication. This immersive project gave me the confidence and experience to pursue challenging and ambitious projects in the future, with the goal of reimaging a more effective and innovative healthcare system.