The Third Science

By David Thill

A knowledge of anatomy isn’t enough for tomorrow’s doctors. How about economics, social determinants of health, biostatistics, and leadership?

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 21 schools. Here’s a look at one program shaping tomorrow’s physicians – and JHC readers’ customers of tomorrow.

As technology and education evolve – particularly with the growing use of the Internet as a vital source of information – the responsibilities of physicians are becoming more complex. They are being asked to play leadership roles in healthcare teams and quality improvement initiatives, and to know more about health than just basic scientific and clinical factors. Economics, social determinants of health, and population health are just a few of the factors that form the basis of a new “third science.” Informally known as “health systems science,” it forms the basis of the new Primary Care-Population Medicine (PC-PM) program at Brown University’s Alpert Medical School in Providence, R.I.

Tomorrow’s leaders
August 2016 marks the one-year anniversary of the implementation of the school’s joint M.D.-ScM degree program. Students in the program learn about health disparities and social determinants of patients’ health, as well as the intersection of population and clinical medicine. Subjects such as advanced biostatistics, epidemiology, and healthcare leadership are integral parts of the curriculum. “These are the skills that are necessary to succeed as a physician in this rapidly evolving healthcare system,” says Paul George, M.D., MHPE, associate professor of family medicine at Alpert.

Leadership is a core component of the new curriculum. “We hope graduates of the program will be practicing physicians who see patients, but also lead in some way,” says George. These leadership roles could 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. Some graduates might become leaders in health systems science research, and still others may become leaders in education.

To get a taste of leadership, students have the opportunity to teach elective classes in the medical school. George notes that almost all of the PC-PM students will lead these classes at some point during the year. Some of the courses include Health Care in America, which focuses on the United States healthcare system; Leadership in the Health Professions, focusing on working in interprofessional teams; and Sex Ed by Brown Med, a high school sexual education class taught by Alpert medical students.

Population health is a key aspect of health systems science, so PC-PM students also have the opportunity to focus on special populations of their choosing. Paired with faculty mentors who share similar research interests, they are able to work with and learn more about these populations through their work. Some students so far have chosen to work with incarcerated patients, pediatric patients, and patients from the LGBTQ community. “Ideally, the students will be able to continue working with that population in residency and beyond,” says George.

Patient care in the long term
Alpert Medical School is currently piloting its longitudinal integrated clerkship (LIC), a long-term practicum that will eventually become a standard part of medical students’ education in the PC-PM program. According to a paper co-authored by George published in the Rhode Island Medical Journal, students in the LIC will have the opportunity to follow up to 30 patients over the course of a year, in each of six core areas: internal medicine, surgery, family medicine, pediatrics, obstetrics and gynecology, and integrated neurology and psychiatry.

By giving students this long-term exposure to patients, faculty hope to promote continuity of care with patients and the integration of population health with clinical medicine. The clerkship culminates in student projects focused on quality improvement, patient safety, and population medicine. According to the Journal article, while most medical students learn only about the care of individual patients, students in the Alpert Medical School LIC will be exposed to the intricacies of panel and population management, as population medicine is a major part of their medical school curriculum.

Leading change in education

Working in the American Medical Association’s “Accelerating Change in Medical Education” consortium “has been a very unique and wonderful opportunity,” says George. “We’ve been able to work with other schools to learn best practices about how to integrate cutting edge curriculum [components] into our own.”

George and his Brown colleagues recently co-authored a chapter in the “first textbook on health systems science,” written collectively by the consortium schools, a book they hope will be used at medical schools throughout the country. “Without the grant,” he says, “we wouldn’t have this collective expertise coming together … to change how we educate students for the better.”

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