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

References I. Imperato students in a high

PJ,

Feldman

attitudes incidence

JG,

towards area.

Nayeri

caring NY

K, et al:

for patients State

J Med

Medical

with

AIDS

88:223-227,

1988

189

AIDS

Education

2. Goldman

JD:

students

An

the social

elective and

4. Kelly students’ tients.

190

with

AIDS.

St

Lawrence

JA,

attitudes J Med

Educ

to teach

aspects

5. Friedland

first-year

of AIDS.

J Med

GH,

Klein

RS:

Transmission

virus. N Englf

immunodeficiency

of the

Med

human

317:1125-1135,

1987

Educ 62:557-561, 1987 3. Whalen JP: Participation of patients

seminar

medical

of medical J Med JS,

towards 62:549-556,

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Educ Smith AIDS

in the care

5, and

1987

et

transmission

1987 al:

homosexual

6. Friedland

Medical pa-

contacts plex

GH,

Saltzman

of patients with

B, Roger

of HTLV-Ill/LAV with

oral candidiasis.

M,

infection

AIDS

et al:

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PSYCHOSOMATICS

AIDS education and a volunteer training program for medical students.

The process of AIDS education poses exceptional challenges for teachers and students. Medical students are in a unique position in the health care sys...
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