Experiential learning has advanced to new heights with a unique intensive program that teaches medical students the complexities of health systems before they begin clinical rotations—and this new program is proving effective. Here’s how the Brody School of Medicine at East Carolina University immerses future physicians in health care delivery science.
From ever-evolving payment models to health IT, it’s no secret that health care is undergoing a rapid transformation that requires medical education to adjust as rapidly. Educators at Brody understood this need and responded accordingly with Leaders in Innovative Care (LINC), a one-of-a kind advanced training program that allows up to 10 medical students from each class to dive into the principles of patient safety, quality improvement, population health and team-based care.
Instead of waiting until their third year to explore clinical settings, LINC scholars become adaptive learners from the very beginning of training as they explore an intensive eight-week immersion course in health care delivery science. During this program, students meet key stakeholders and health care professionals within Brody’s clinical arm, ECU Physicians, and Vidant Medical Center, the hospital that Brody partners with to serve 29 counties in eastern North Carolina, said Elizabeth Baxley, MD. Dr. Baxley is the senior associate dean for academic affairs at Brody.
The curriculum for the summer immersion program was beta tested with five students this summer, and “it was the most exciting thing to watch—it exceeded all expectations that we had for the experience at the outset,” Dr. Baxley said.
LINC is one way Brody is helping to transform the training of future physicians. Brody is one of 11 leading medical schools brought together as founding members of the AMA’s Accelerating Change in Medical Education Consortium, which was made possible by $1 million grants to launch innovative medical education projects.
How LINC scholars explore complex health systems
“We had 51 different faculty and health system leaders who worked with these five students over these eight weeks, covering the gamut of patient safety, quality improvement, interprofessionalism, population health, health disparities and changes in payment models,” Dr. Baxley said.
Scholars attended meetings with senior leaders in Vidant, allowing them to gain exposure to the infrastructure of a large health system. Scholars learned how health care engineers—including supply chain operators, administrators and even financial managers—operate in health systems and the roles that physician leaders fill within this larger complex framework.
“Scholars saw that while health care teams on the frontlines are made up of people who attended health care profession schools,” Dr. Baxley said. “These professionals would not be able to care for patients without administrators, managers and operational engineers who are designing, supporting and allocating resources in the health system that impacts the frontlines.”
These meetings “gave them the basics of health care systems science and opportunities to meet people who would be important for them to work with,” she said.
Scholars debriefed with their LINC course director, Donna Lake, PhD, every Friday to discuss what they learned and how to apply this newfound information in training. Dr. Lake is a faculty member in the ECU College of Nursing, where she teaches in the Leadership Concentration, and is also an Adjunct Faculty Member at Brody School of Medicine and a member of their AMA grant project team.
“Every week you could seem the students assimilating their observations and lessons and putting the pieces together,” Dr. Baxley said.
Putting on the patient lens
While scholars explored the health system from the perspective of physicians, other health professionals, and senior management, they also had a chance to navigate it through the eyes of the patient, which was one of their favorite activities in their eight-week experience, Dr. Baxley said.
Scholars shadowed patients through their health care encounters across various specialties—including the emergency department, outpatients primary care settings and even ambulatory surgery—beginning from when the patient parked their car and along every step of the encounter until the conclusion of their visit.
“They had to watch and record every ‘touch’ that happened with that patient and then talk to the patient and their family members, when present —not about their medical condition, but about their experience of navigating the system and receiving care. Whether the patient identified it or not, the students had to identify the factors that facilitated the encounter and those things that made the system difficult or less satisfying for the patient,” Dr. Baxley said. “Often, the latter are the things that prevent the patient from achieving a full understanding of what is happening in their care and limits their ability to fully engage as a partner in their care.”
Using these observations, scholars drafted a report featuring recommendations to improve the patient experience. They presented these findings to their faculty and to members of Vidant’s Patient Advisory Council, focusing each of their presentations on patient-centered solutions and quality improvement.
For instance, in a meeting with someone from health systems management, one of the LINC scholars explained, “‘I followed a patient through the emergency department, and here are the series of things that happened to that patient that resulted in them being there for an unnecessarily long time,’” Dr. Baxley said.
“These first- and second-year medical students weren’t being critical of the system,” she recounted. “They were just asking, ‘How can we work to make this better, and how can we be part of that?’ The experience allowed them to put on their ‘improvement goggles’ and see the system differently.”
Social determinants of health and LINC windshield tours
A simple drive or walk through a neighborhood can speak volumes about the health of the people who reside there.
Scholars put this concept to practice through “windshield tours” where they drove through various surrounding communities with an assignment to note barriers and facilitators to good health that they observed in each community. The exercise aimed to give scholars firsthand experience noting social determinants of health in real time from the patients’ perspective.
“There’s a whole series of things patients have to do outside of the healthcare setting – most of ‘health’ or ‘lack of health’ occurs outside of health care encounters,” Dr. Baxley said. “Too often students leave medical school thinking, ‘I’ve been taught to tell a patient what do, I’m going to do it and if they don’t follow it, they’re just not [listening]. But I want [students] to understand that you can tell somebody something they might be not be able to do,” especially if that very task is crucially linked to a lack of resources in the patients’ surroundings.
For instance, when a patient is late to an appointment, some physicians may think, “Oh well, you were late, and I’m not going to see you today,” Dr. Baxley said.
“But if you conduct a windshield tour and understand where the patient came from and that they probably had to change buses four times to get to you,” the physician may display more empathy, a quality students need to treat patients on the front-lines of care, she said.
For every negative environmental factor they noted, scholars also observed how certain neighborhood amenities—such as farmer’s markets, walkable parks and accessible public transportation—can foster greater community health.
Dr. Baxley said this exposure to both positive and negative social determinants of health can help spur LINC scholars to support their patients outside the exam room as they learn that improving patient outcomes may require physicians to become leaders and advocates in their patients’ communities.
- Follow one LINC scholar’s firsthand account of her experience in the program and with patient shadowing.
- Find out how Brody really puts the patient first in student training.
- Read how physicians are changing med ed by going back to school.
- Learn about the 11 medical schools in the Accelerating Change in Medical Education Consortium, the current projects they have underway and why the consortium is expanding.
