For future physicians preparing for the complexities of the 21st-century health care system, education beyond basic and clinical sciences can give them the tools they need to succeed in practice and in achieving positive outcomes for their patients. Some medical schools are incorporating the science of health delivery into their education curriculum to meet this need.
Most of the 11 schools that received grants in the AMA’s Accelerating Change in Medical Education initiative are investigating how to teach systems-based practice, a blanket term that can cover systems of care, quality improvement, population health and other competencies that would fall under the science of health care delivery.
“Systems” can be categorized as microsystems within a clinic or office, small macrosystems within a hospital or a state, or even large macrosystems, such as Medicare or the U.S. health care system. With so many elements of systems in play—including admitting and scheduling, ancillary services, referrals, insurers, community services, legal systems and more—it’s important that tomorrow’s physicians understand how to successfully navigate systems to optimize outcomes and cost, according to the Accreditation Council for Graduate Medical Education.
Pennsylvania State University College of Medicine launched its new systems navigation curriculum earlier this month with its first-year students. The first part of the two-pronged curriculum will incorporate systems-based practice topics over a 19-month period, beginning in the students’ first month of their medical school experience and finishing just before they enter clinical rotations.
The second part will make the students “patient navigators,” linking them with local clinics to give the students experience in actually dealing with systems-based practice. As navigators, students will help patients handle insurance, find community resources and coordinate complex care issues. They also will provide support and educate patients about their illnesses.
The patient navigator network is a new concept, both for medical schools and for clinical sites, said Jed Gonzalo, MD, assistant dean for health systems education at Penn State.
“Designing a model where students would be assigned to their clinic, learn about the workings of their goals and then perform a value-added component of their clinic’s work is a newer concept,” Dr. Gonzalo said. “This process has required building partnerships with these motivated and engaged professionals in these clinics to establish such a program.”
Mayo Medical School is taking a similar approach, implementing the “Science of Health Care Delivery” curriculum to cover six content domains: person-centered care, population-centered care, high-value care, team-based care, health policy, economics and technology, and leadership. The school is using blended learning, or a combination of face-to-face education and online modules.
The school is developing tools to document student achievement in these new topic areas, including surveys, quality improvement reviews, patient safety knowledge assessments and checklists. Mayo will work with the other schools in the AMA consortium—and medical schools nationwide—to create and share these tools, said Stephanie Starr, MD, assistant medical director of the Mayo Clinic Quality Academy and director for science of health care delivery education at Mayo Medical School
In contrast to Penn State, Mayo’s new curriculum will be slowly phased in over time. The school will simultaneously implement changes in other areas, such as technology use. For both schools, and the nine other schools that make up the consortium of schools in the AMA’s Accelerating Change in Medical Education initiative, there isn’t a “right” way to make these major changes—but there is agreement that change is necessary, particularly with systems-based education.
“We’re talking about a denominator of content that hasn’t been explicit before,” Dr. Starr said. “It’s kind of a new frontier, and it’s changing so fast. But it’s clear that these are the things physicians need in 2014. We can only guess what they’ll need in 2020, but it will probably be more than this.”
