By David Thill
A patient’s health depends on more than her doctor’s scientific expertise. University of Chicago is teaching future doctors what “more” is.
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 Repertoire readers’ customers of tomorrow.
Traditionally, the doctor led the healthcare team. But today, many providers believe that the nurses, patient navigators, specialists, and, of course, the patient herself all play major parts in the care process. For that reason, some medical schools are training future doctors to play on that team, rather than take charge of it.
“We have moved away from the older paradigm of ‘doctor as leader,’” says Jeanne Farnan, M.D., MHPE, associate professor of medicine at the University of Chicago Pritzker School of Medicine. Pritzker’s VISTA curriculum, part of the American Medical Association’s “Accelerating Change in Medical Education” initiative, was set to begin in September 2016, and team delivery will be a key part of it. “We’ve started to recognize that the earlier you introduce students to other providers, the more they function as team members,” says Farnan.
An emerging field
VISTA (which stands for “value, improvement, safety and team advocates”) is intended to help students understand how healthcare delivery science improves medical care.
Healthcare delivery has traditionally focused on basic and clinical sciences, but healthcare delivery science is about value-based care, says Farnan. “How do we think about the ways in which we deliver care and improve upon those methods,” especially when it comes to safety, working on teams, and encouraging patients to be advocates for their own care.
Michael Howell, M.D., MPH, chief quality officer at the University of Chicago Medicine, has called healthcare delivery science a new and emerging field. “But it will be critical for our students and residents to be successful in the future,” he said.
As part of the emphasis on teamwork, first-year medical students will shadow nurses in high-functioning units, participating in activities such as team huddles, intake assessments, and discharge processes with patients. In addition to experiencing the clinical environment, shadowing will allow students to see the care process from the nurse’s perspective, to learn how nurses perceive their roles with the patient.
It will also serve as a model for future interprofessional interaction among students. Currently, second-year medical students work with pharmacy students and residents, and Farnan says the medical school is developing opportunities with the physical therapy, respiratory therapy, and chaplain programs.
The horror room
In the Pritzker School’s new curriculum, patient experience takes a leading role, from safety to advocacy. As part of its clinical skills curriculum, students experience the hazards of hospitalization in the “horror room,” an exercise Farnan describes as a sort of “I Spy” or “Where’s Waldo” for medical students.
Students will have 15 minutes to identify about 17 hazards in a simulated patient environment. With each scenario based on information about a specific theoretical patient – from child to adult – 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.
Farnan, who plays a role in coordinating the horror room experience, says it helps students become cognizant of the environment in which they work. “We have seen it persist with residents. The experience stays with them.”
Recognizing that a key concern for patients is finances, medical students will now focus on financial harm early in their first year. They will learn, for example, how to screen their patients for cost-related underuse – that is, failure to use medication or seek care due to inadequate insurance coverage. Students will practice using screening tools such as GOTMEDS to evaluate whether and how their patients have had to compromise their quality of life in order to get medication or care.
First-year students will role-play conversations with patients about financial issues. As Farnan notes, they experience this process again in their third year, when they work in patient discharge.
A worthwhile patient experience means the patient must understand their health and care options. This is why the University of Chicago’s new program strives to have students maintain a lay perspective on healthcare. Students “become acculturated very quickly to the clinical environment,” says Farnan. “We want them to maintain that perspective of what it’s like to be a patient.”
Pritzker students are reminded to use language that the patient can understand, and to value the patient’s role in the care process. As Farnan puts it, “What are those things that are unique to their patient as an individual who is experiencing that disease, [who] has their own unique perspective and priorities they want in their treatment?”
Working with the other 31 schools in the AMA consortium has been “eye-opening,” says Farnan. Referencing a saying that “if you’ve seen one health system, you’ve seen one health system,” she says the open spirit of sharing within the consortium has been fantastic: an opportunity to see “what people can do with the resources they have, and how you can take another idea and apply it in your system.
“It’s a collegial environment. People can talk about things that have worked well, and things that haven’t worked well,” and get ideas for new possibilities. “We get to see how we can take their big wins and make them our big wins.”
David Thill is a contributing editor for Repertoire.