A Patient-Centered Lens

By David Thill

First-year medical students get the bigger picture

Editor’s note: Sensing a gap between how physicians are educated and the future needs of the U.S. healthcare system, the American Medical Association in 2013 launched its “Accelerating Change in Medical Education” initiative. The association awarded grants to 11 medical schools to fund selected innovations in medical education, and then expanded the program in 2015 to an additional 20 schools. Here’s a look at one program shaping tomorrow’s physicians.


JHC-March16-iStock_000015707640_LargeWhen Jed Gonzalo, M.D., M.Sc., was a medical student, physicians were trained with an “out of sight, out of mind” attitude. “For decades we’ve been training physicians that were sovereign cowboys,” says Gonzalo, associate dean for health systems education at Penn State College of Medicine. The patient received the care they needed in the hospital, and when they were discharged, the physician’s job was done.

Now, though, physicians need to be team players who are active participants in all aspects of a patient’s path to wellness. “They need to understand the value that other players bring to that team,” including healthcare navigators, social workers, family members, etc.

Gaining the full picture of the patient’s care process outside the examination room is at the core of Penn State’s new Systems Navigation Curriculum, launched in August 2014 by Gonzalo and colleagues with funding from the American Medical Association’s “Accelerating Change in Medical Education” initiative.

The new program consists of two main components. The first takes place in the classroom, where first-year medical students learn the concepts of health systems sciences. This course includes traditional lessons in scientific principles, as well as new ones focusing on patient-centered clinical care, from communicating the care process to the patient, to learning to understand the patient’s perspective on it.

The patient navigator
The other component of the curriculum turns that abstract knowledge into concrete experience, when students work with individual patients in the role of patient navigator. In this curricular component, the roughly 150 first-year medical students in the program travel to 36 different sites throughout the central Pennsylvania region, where each student works with at least one patient over the course of about a year. This work might include visiting her prior to discharge to assess her plan and potential health obstacles going forward, calling on the patient at his home to learn possible factors preventing him from obtaining the medical resources or attention he needs, or joining him at an outpatient doctor visit.

Whereas yesterday’s medical students (who graduated only a few years ago) shadowed only physicians, students at Penn State might work with physicians as well as patient care coordinators, mental health professionals, and other medical specialists to gain a more holistic view of the healthcare system. This not only benefits the student, it also unites the various aspects of the patient’s care process and makes it more efficient and effective.

“With the Systems Navigation Curriculum, our students are the eyes and ears of our health system,” says Gonzalo. Rather than viewing it solely from the perspective of the provider, now they see it through a patient-centered lens.

David Thill is a contributing editor to the Journal of Healthcare Contracting.

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