Stephanie Welsh, a student at the Wright State University Boonshoft School of Medicine, has a penchant for pediatrics. She is completing a practice placement at Dayton Children’s Hospital, where she has learned more about the specialty.
Her placement with the pulmonary department at Dayton Children’s put her right where she wanted to be — at the frontlines of public health and asthma care. It also provided a launching point for research into asthma that may one day inform better treatments.
“I’m very interested in pediatrics, and asthma is the most common chronic disease of childhood,” Welsh said.
Unlike a typical third-year medical school experience where Welsh would have rotated in and out of different specialties, her longitudinal placement kept her in pediatrics throughout the academic year, letting her develop strong connections with patients and ensure continuity of care.
The longitudinal placement is part of the school’s Physician Leadership Development Program (PLDP). The PLDP is a dual-degree program through which medical students can obtain a master’s degree in public health or business administration while pursuing their medical degree over five years.
Welsh, who has completed her second year of medical school, earned a Master of Public Health through the PLDP over the past year. She will graduate with the degree this April and then continue through her final two years of medical school.
Being able to get an additional master’s degree in just one year was a no-brainer for the Charlotte, North Carolina, native. In addition, she found she had more time to study through the longitudinal clerkship than a typical block-style clerkship. She also was able to learn the material better and could focus on working with patients.
“One of the things that surprised me is how willing people are to open up to you,” Welsh said. “I find that’s a huge honor. I’m always pleasantly surprised and humbled when my patients open up to me.”
The practice placement also showed her the importance of community health workers, who help patients navigate the health care system in a variety of ways. Welsh gained additional insight through Upstream Medicine, a course that will soon be offered to first-year medical students that focuses on community health advocate training.
“I think a big value of the class is to teach us as future physicians how to work with community health workers,” Welsh said. “Say a patient needs help signing up for Medicaid. Now I know what community health workers do, and I can get our patients connected with them. It doesn’t matter what community you’re working in, because this class taught us how to identify the resources within any community that can help our patients.”
Working with children suffering from asthma gave Welsh important experience with interventions that can help patients fare better. She is studying an asthma program that has helped about 300 children patients, and she has visited many of the children in their homes. The visits have allowed her and others to see how patient surroundings impact their ability to cope with asthma.
“A lot of the patients whose homes we’ve visited have smokers in the home. The most common things we’ve seen that can trigger asthma attacks are items that give off strong odors,” Welsh said. “People really like candles, incense or scented cleaners.”
By making a visit, it’s possible to pinpoint the triggers and offer solutions. For example, Welsh and her team suggested replacing odorous cleaners with cleaning kits that use components like salt or vinegar that can be mixed in a spray bottle, providing an odorless alternative.
But it’s not always possible to make such visits. “Home visits make the biggest impact. The problem is that they’re so resource-intensive,” Welsh said. “Our challenge is determining who needs them the most. We want to see how they live and the relationship between the child and the parent. It lets us follow up with them to make sure they do what we recommend.”
Of the children she’s studying, about 300 have received personal education to help them manage their asthma, teaching them things like how to use inhalers. The parents of 65 patients have also been given counseling to help them care for their children.
Only about 20 of Welsh’s patients have had home visits. She is curious to see how they’re doing compared with the rest of her patients, and has designed a research project to find out.
“We expect to find that the more intervention patients received, the more they will have improved,” Welsh said. “We want to see if those who received home visits are the most improved.”
Welsh will present the results of her work at the Association for Prevention Teaching and Research conference in Savannah, Georgia, in April.
The Wright State University Boonshoft School of Medicine is a community-based medical school affiliated with seven major teaching hospitals in the Dayton area. The medical school educates the next generation of physicians by providing medical education for more than 444 medical students and 443 residents and fellows in 13 specialty areas and 10 subspecialties. Its research enterprise encompasses centers in the basic sciences, epidemiology, public health and community outreach programs. More than 1,500 of the medical school’s 3,229 alumni remain in medical practice in Ohio.