AMA 2017: Injecting health systems science into med school curriculums

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 - Jed Gonzalo MD
Jed Gonzalo, MD, Associate Dean for Health Systems Education at Penn State College of Medicine

Health systems have appeared eager to partner with medical schools on preparing medical school students for the value-based care world in which they’ll be practicing, though some educators are worried about being lost in that transition.

Richard Hawkins, MD, the American Medical Association’s vice president of medical education, led a session at the AMA’s annual meeting in Chicago discussing both why students shouldn’t only be learning these skills on the job and what progress the AMA has made in changing curriculums. Hawkins said hospitals and health systems have been complaining for years that medical students were graduating without being taught skills like care coordination, quality improvement and using electronic health records. Since their teachers would be the product of the same education system, they have often been equally unprepared.

“Our health systems have evolved significantly, while the fundamental ways we teach students really haven’t kept up,” Hawkins said.

The AMA began to address this gap with the release of its “Health Systems Science” textbook in November 2016, which Hawkins said has since sold more than 2,000 copies. Before it was widely available, Penn State College of Medicine had already added it to the curriculum. One of its goals, according to Penn State’s assistant dean for health systems education and co-author of the textbook, Jed Gonzalo, MD, is to get students involved much faster as part of care delivery teams—in “legitimate, peripheral, participatory roles”—which can add value to hospitals and health systems as well as helping future physicians learn.

“We’re locking students into a classroom for the first two years and there’s probably a detriment to that,” Gonzalo said.

The initial reaction from faculty and practicing physicians was decidedly mixed, according to Gonzalo. Some took the “if it ain’t broke, don’t fix it” stance on medical education (to which Gonzalo countered that it is broken), while others questioned whether younger students could make a worthwhile clinical contribution.

Healthcare leaders, however, have been more receptive. Hawkins mentioned having CEOs, CMOs and others in the C-suite enthusiastically involved in developing and evaluating health systems science curriculums. While physicians and faculty complained evolving health systems aren’t ready to work with schools instituting these programs, the medical school leaders have found this not to be the case.

“They have to spend all this retraining time (on graduates), so they’re actually hungry for this,” said Mamta Singh, MD, MS, associate professor of medicine at Case Western Reserve University. “They say the folks that we’ve been graduating, when they come out after residency, they’re not ready for the root-cause analysis and the discussions related to what the system is looking for, the Quadruple Aim. So I think they’re more on board than the educators think they are.”

The presenters agreed that educators will have to change their mindset about this new area of study and they may right to be somwhat worried, as medical education finds a balance between “discovery” and how to best deliver care.

“There’s a whole other camp of folks who feel the risk of an identity crisis and disenfranchisement if their role is now different as we shift to delivery,” Gonzalo said. “To bring the COOs in and the vice chairs quality into the classroom, something’s got to go from the curriculum.”