By David Thill
Supply chain executives can expect to work with a new kind of physician in the coming years
“The work we’re doing…will directly impact the way that healthcare will soon be delivered to patients nationwide,” said Susan E. Skochelak, M.D., MPH, group vice president for medical education at the American Medical Association (AMA), in a March press release. Skochelak was referring to the AMA’s “Accelerating Change in Medical Education” initiative.
The initiative, now in its third year, provides grants to 32 medical schools across the country so they can reinvent their curriculums and ensure that tomorrow’s physicians are prepared to offer the quality of care necessary for tomorrow’s patients.
After reporting on a number of these programs, the Journal of Healthcare Contracting has identified five broad – and interrelated – themes:
- Patient-centered care
- Health systems science
- Team-based care
- Value-based care
“By serving as patient navigators, our medical students see healthcare and its challenges not only from the perspective of doctors, but also through the patients’ eyes,” said Penn State College of Medicine Vice Dean for Educational Affairs Therese M. Wolpaw, M.D., in the March AMA press release.
Jed Gonzalo, M.D., M.Sc., associate dean for health systems education at Penn State College of Medicine, and colleagues launched the Systems Navigation Curriculum in 2014. First-year students, serving as patient navigators, become active participants in all aspects of a patient’s path to wellness. This work might include visiting the patient 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.
The patient navigators, like many future physicians, are working with health specialists, mental health professionals, and patient care coordinators to gain a more holistic view of the healthcare system, uniting the various aspects of the patient’s care process to make it more efficient.
Patient safety is also an important component of patient-centered care. The VISTA program, instituted in September at the University of Chicago Pritzker School of Medicine, takes a unique focus on this concept, says Jeanne Farnan, M.D., MHPE, associate professor of medicine. VISTA stands for “value, improvement, safety and team advocates.”
Pritzker’s “horror room” gives medical students 15 minutes to identify roughly 17 potential hazards in a simulated patient environment. Depending on the theoretical patient in question, hazards might include a box of latex gloves near a patient who is allergic to latex, an empty soap dispenser, a urinary catheter that could put the patient at risk of infection, or a mattress that might lead to a pressure ulcer.
The patient experience is central to Pritzker’s program. “What are those things that are unique to [the] patient as an individual who is experiencing that disease, [who] has their own unique perspective and priorities they want in their treatment?” said Farnan.
Health systems science
Whereas doctors have traditionally focused on basic scientific and clinical factors in their practice, tomorrow’s graduates will also need a working knowledge of economic factors, social determinants of health, and population health. These concepts form the basis of health systems science, which is at the core of the Primary Care-Population Medicine curriculum at Brown University’s Alpert Medical School.
Students in the joint M.D.-ScM degree program at Alpert learn about health disparities and the intersection of population and clinical medicine, including subjects such as advanced biostatistics, epidemiology, and healthcare leadership. “These are the skills that are necessary to succeed as a physician in this rapidly evolving healthcare system,” said Paul George, M.D., MHPE, associate professor of family medicine.
These skills – social determinants of health, economics, and epidemiology – are also key parts of the new Longitudinal Core Curriculum at East Carolina University’s Brody School of Medicine.
“There are many [factors] that influence health outside the healthcare you receive,” said Elizabeth Baxley, M.D., senior associate dean for academic affairs at Brody. The Longitudinal Core Curriculum focuses on “understanding the patient from their perspective,” bringing together patient safety, quality improvement, and population health to give students a better understanding of health systems and methods to improve them.
Subhead: Team-based care
Brody’s program also focuses on interprofessional care: physicians working in teams with other healthcare professionals, rather than alone. Team-based care is a common theme among the schools in the AMA consortium.
Gonzalo, speaking about Penn State’s Systems Navigation Curriculum, observed that “[f]or decades, we’ve been training physicians that were sovereign cowboys.” But now, he says, physicians need to be team players who understand the value that other players bring to that team.
“The outreach worker is just as important as the doctor,” said Pedro “Joe” Greer, Jr., M.D., associate dean of community engagement and chair of the Department of Medicine, Family Medicine and Community Health, at Florida International University’s Herbert Wertheim College of Medicine. At FIU, interprofessional care and community health combine to form a unique program.
Medical students in FIU’s program spend three and a half years working in teams comprising doctors, social workers, educators, lawyers, and public health specialists to serve low-income, uninsured families at the families’ homes.
“No longer can we doctors be in isolation,” said Greer. “We have to fulfill our social contract with the country,” which means providing care that meets patients’ basic needs. “Instead of everybody coming to the mountain, maybe the mountain’s got to spread out.”
At University of Chicago’s Pritzker School of Medicine, first-year medical students shadow nurses to gain experience in the clinical environment, as well as to see the care process from the nurses’ perspective. Pritzker is also developing opportunities for medical students to work with peers in the physical therapy, respiratory therapy, and chaplain programs.
“We have moved away from the older paradigm of ‘doctor as leader,’” said Farnan. “We’ve started to recognize that the earlier you introduce students to other providers, the more they function as team members.”
“[W]e have a moral imperative to keep [communities] healthy,” said Isaac Kirstein, D.O., dean of the Cleveland campus of the Ohio University Heritage College of Osteopathic Medicine. Heritage’s “transformative care” curriculum, set to be implemented in the fall of 2018, emphasizes value-based care to reflect changing payment models and to keep patients from returning to the doctor – and to reduce their need to do so in the first place.
In order to accomplish their goal of keeping communities healthy, the Heritage faculty is also taking a team-based approach in the new curriculum. “Health outcomes are better when patients have access to a primary care team,” said Kirstein.
University of Chicago’s Pritzker School also emphasizes value-based care by focusing on patients’ financial needs. Students there will learn how to screen patients for cost-related underuse – failure to use medication or seek care due to inadequate insurance coverage – and will use screening tools to evaluate whether and how their patients have had to compromise their quality of life in order to get medication or care.
Across the board there is an emphasis on training tomorrow’s physicians to be leaders in the healthcare field. Some schools, such as Brody, have implemented programs for a select group of students considered to have the potential to become leaders in population and community health.
Other programs, such as those at Mayo Medical School and Brown University’s Alpert Medical School, have made leadership part of their degree programs. At Mayo, students can choose to pursue a master’s degree in Science of Health Care Delivery in tandem with their medical degree.
The M.D.-M.S. program will prepare students to become agents for healthcare system changes, said Stephanie Starr, M.D., assistant professor of pediatrics. “They will be uniquely positioned to close gaps related to healthcare delivery, lead change and affect policy.”
Similarly, at Alpert, “We hope graduates of the program will be practicing physicians who see patients, but also lead in some way,” said George. These leadership roles might range from leading a community health center, to being the chief medical officer at a large private practice, to leading a city or state public health department.
Tomorrow’s physician customer
The healthcare field is experiencing still other changes, which doctors and supply chain executives will need to be aware of. For example, Indiana University is using electronic medical records to study population health. Many of the other consortium schools are also focusing on population and community health in their own curriculums.
Many of the programs in the Accelerating Change consortium have already begun teaching students under the new curriculums, and others will soon be following. This means that by the year 2020, a new generation of doctors will be practicing medicine, and JHC readers will have a new generation of customers to serve.