AIDS Education and a Volunteer Training Program for Medical Students MARy ANN ADLER COHEN, M.D. STEVEN CLIFFORD COHEN,
B.A.
The process ofAIDS education poses exceptional challenges for teachers and students. Medical students are in a unique position in the health care system. They are young enough to be ideal role models for high school and college students. They are mature enough to be responsible educators. We describe a special program designed and implemented by a medical student to train other medical students to become AIDS educators. This student-run program provides education for student volunteers who are able to educate other students and members ofthe community. The program is designed to educate a generation ofphysicians who will be well-equipped to combat the HWepidemic and who can serve the community as AIDS educators while still in medical school.
T
he process of education about the acquired immunodeficiency syndrome (AIDS) poses unique obstacles for educators and students. Although it is not difficult to present the basic information about AIDS to a given audience, it can be difficult to effect changes in the thinking, beliefs, and behavior of that audience. '-4 An individual can understand that casual contact will not permit transmission of the human immunodeficiency virus (HIV) and still be afraid to shake the hand of a person with AIDS. Though students may know that there is no evidence to suggest that HIV is transmitted through casual contact ordroplet infection,M students may nonetheless fear such transmission. Phobic responses to AIDS contribute to discrimination and can reduce the quality of care of all patients by causing avoidance, denial, and use of excessive and inappropriate precautions amongst caregivers. Fear of contagion, prejudices against gay men and drug users, homophobia, and fear of drug users (addictophobia) challenge AIDS educators. The volunteer program addresses these problems on several levels. The program seeks first to educate the participating medical stuVOLUME 32· NUMBER 2· SPRING 1991
dents. They learn not only the information necessary to teach in the community but also receive preparation to confront AIDS in their own professional and personal lives. These students will be able to serve as role models for their future colleagues as well as a resource for their classmates while in medical school. UNIVERSAL PRECAUTIONS By teaching universal precautions, we reduce the risk of infection for the caregivers and reduce the discrimination against patients. The concept of universal precautions is based on the assumption that all blood and body fluids are potentially infected with HIV and need to be handled with Received December 28. 1989; revised March 29. 1990; accepted April 6. 1990. From the New York Medical College and the Metropolitan Hospital Center. New York; and Wesleyan University. Middletown. Connecticut. Address reprint requests to Dr. Cohen. Metropolitan Hospital Center. Department ofConsultation-Liaison Psychiatry. 1900Second Avenue. Room 9M29. New York. NY 10029. Copyright © 1991 The Academy of Psychosomatic Medicine. 187
AIDS
Education
appropriate care. specific labeling
This of
eliminates beds,
the need for or charts, pre-
rooms,
serves confidentiality, workers from infection.
and
protects
health
care
make them ideal educators school age audiences. A first-year medical signed and implemented
for college
and
high
student (S.C.C.) dethe program to train
Use of universal precautions obviates any need to guess who is infected. Since infection with HIV may not be readily apparent, there is no
medical students the community.
sure
The students who came to the first meeting discussed the program and received literature on AIDS from a variety of sources, including a sum-
way
negative
of knowing HIV antibody
who
is infected. Even is not a guarantee
test
a
against the presence of HIV because there is a latency period between time of infection and the development of antibody response. RISK By teaching
about
BEHAVIORS
is summarized
mary
we avoid
stig-
1.
leader a. Student
through risk behaviors. “risk groups.” Labeling
b.
This concept has replaced of specific groups carries
of stigmatizing
providing
false
those
reassurance
in the groups
to those
outside
concept of “risk groups” crimination and the spread
encourages of AIDS.
Description Volunteer By teaching only equip them
both
2.
3.
Program
are trained not to be authorthe risks of sexual activity,
but they do not preach dangers and describe
against it. They the precautions
ish them.
They
explain
that it is more
4.
an individual to undertake precautions toxicated with alcohol or other drugs. presenter
acknowledges
the
reality
inthe
of drug
use
5.
Their
188
relative
youth
and
their
advanced
training
agencies for Disease
Medical
Association)
notices
and information
of all first-
Description
Date,
of the
c.
Form requesting information
time,
and program
and place
Introductory
medical
second.year
of the first
each
meeting
student’s
name
and contact
session
training
Discussion
of the program
b.
Distribution
of literature
c.
Establishment
of time
and place
for regular
Ongoing
training
Discussion Question Education
sessions-initial
stage
of literature and answer sessions of the student volunteers
Development of presentations-preparation a. Practice presentations before the group b.
Determination
c.
Pairing
of readiness
of students
who
by student
stage leader
are prepared
(male/female) 6.
Presentations community
7.
and explains how it compounds risky behavior by impairing judgement. The medical student AIDS educators serve both as teachers of and role models for a rational, informed approach to AIDS.
outside Centers
prepares
b.
for
while Again
faculty
contacts
leader
a.
a. b. c.
explain the that dimindifficult
appropriate
student
meetings
munity but also allow them to better protect themselves in their careers and their personal lives. The presenters itarian. They explain
train-
of Health, American
Student
AIDS students
of a medical
contacts
leader
Notification students
a.
the medical students, we not to provide a service to the com-
leader
members Student
later present.
packets
dis-
of the
Training
c.
of volunteer for medical
or emergence
Control,
the
groups. Those outside “risk groups” do not consider themselves at risk,do not change behaviors, and can therefore spread the virus to others. The
that they would
(Department
and
1.
Development ing program
1.Identification
matization and ostracism both in the hospital and in the community at large. HIV is transmitted
the danger
in Table
of the material
TABLE
risk behaviors,
as volunteer AIDS educators for The development of the program
Continued a.
Ongoing
b.
Feedback experienced
c. 8.
Continued
Identification the first-year
to high
schools,
colleges, and
agencies training
sessions
support
for trainers
by experienced
trainers
for less
trainers AIDS
education
of new medical class to perpetuate
student leader in the program
PSYCHOSOMATICS
rrr
Cohen
TRAINING
ing
APPROACH
or students.
staff
program
to the learning ence.
sues.
medical homes,
The
training
sessions
provide
a supportive
atmosphere. The meetings are generally held in as close to a circle as the space permits. No student’s
question
meets
with
disdain
or conde-
The
tions
The presenters
to the sensibilities
The meetings give students opportunities to ask questions, to discuss teaching techniques, and to voice their feelings about AIDS and related is-
levels
program
and maturity is flexible
pay no fee. The
local institutions as well tribute after presentations.
the leader
PRESENTATIONS The
pairs
emphasis
training
with
has already
par-
cost incurred
to train
the volunteers.
ment of health served affiliation, providing
COMMUNITY
This skills
in presentation
program
plemented continued
was
describes
what
is unique in its initiation (S.C.C.) and its supportive about AIDS. The training
unsafe
in a manner
The presentation anxiety appropriate without
is geared to instill a level of to mitigating the epidemic
generating
Presenters
paralyzing inform
ian. To avoid alienating giving them the feeling presenters
Instead,
interchange
and the question and follows it provide presenters tation
of the audience’s the presentation including national
response the audience
phone resources
being
authoritar-
the young audience or that they are being tested,
do not administer
posttests.
terror.
without
formal during
pretests the
and
presen-
answer period that with an assessment to the material. receives
After
32
#{149} NUMBER
numbers for local, state, and that range from information
2. SPRING
1991
any
The local
depart-
as contact
cards
to dis-
initiated,
and
a
im-
them as AIDS educators. The program at New York
reduction
as well
Medical
College
by a medical student approach to education emphasizes anxiety
as risk
reduction.
The
method
used is a small-group approach that is nonjudgmental and nonauthoritarian and tailored to the level of understanding of the learners. There is no way of quantitatively evaluating the effectiveness
or outcome
program We
at the present time. feel that medical
of the
student
make
ideal AIDS educators students and the community. as a model AIDS education help to develop a generation are well-equipped
volunteer
for both The
training volunteers their
fellow
program
serves
program that will of physicians who
to combat
the epidemic.
literature,
hotlines to phone numbers for medical assistance. The volunteer group also tries to establish resources within the host organization and to give presentations to administrators prior to address-
VOLUME
and
without
was photocopying
designed,
words such as Do, and to instead choose and
year
by a medical student in 1987 and has to educate students about AIDS and to
to eschew Shouldn’t
is safe
The group institu-
described an AIDS education and training program for medical students.
train
which is neither judgmental nor alarmist. AIDS is frightening enough without dire preaching.
mobile. schools, These
as the program’s first major important connections to
is a nonthreatening, non-didactic, interactive approach to each audience. The students are trained Don’t, Should, language that
audi-
DISCUSSION We have volunteer
IN THE of the
the student
The only
materials
the
are volunteers
its first
cerns in the realm of AIDS. The group works together to prepare to present. When the group leader feels that a given student is ready to give of the opposite sex who in a presentation.
and
students
operated
budget.
another ticipated
of each
students travel to local and other organizations.
the program
tailor
of the host in addition
scension. The group meetings strive to serve as a model for the atmosphere of the presentations to the community. This engenders frank discussion of an individual’s experiences, fears, and con-
a presentation,
and Cohen
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PSYCHOSOMATICS