From the 2021 HVPAA National Conference
Dharmini Shah Pandya (Temple University Hospital, Lewis Katz School of Medicine), Rachel Salas (Johns Hopkins School of Medicine)
Healthcare delivery models are more than ever focused on yielding high value care, improved patient experiences, and better population health while reducing costs. It is imperative that future physicians be familiar with health systems which includes high value care in the broadest definition that encompasses population health, health care policy, and interprofessional teamwork. The ACGME’s Clinical Learning Environment Review (CLER) provided six areas (i.e., patient safety, health care quality, care transitions, supervision, well-being, and professionalism) to provide safe, high-value patient care. Achieving this vision requires an understanding of health systems science (HSS) and the developing competencies by trainees so that they enter the workforce ready to practice patient centered care with the HSS framework, while also integrating innovation into practice. While HSS exposure has become of interest in the graduate medical education (GME) community with many training programs incorporating curricular efforts in interprofessional education, quality, safety, high value care, social determinants of health etc., questions remain about how to implement such opportunities in an already tightly packed curriculum effectively. Furthermore, and perhaps more important, is how to incorporate HSS-centric opportunities for trainees from various specialty programs of different sizes, at different levels of training, and in a variety of learning environments (e.g., outpatient, inpatient, surgical, etc.) in a meaningful and standardized manner.
We are studying two large academic institutions, and their approach to implementing a longitudinal, interdisciplinary GME track in HSS, grounded in experiential learning and adult learning theory. We are tracking learner goals as related to professional identity, career goals, problem solving ability, program survey, and HSS scholarly productivity.
Institution 1 recruited second year internal medicine candidates who had a focused interest in HSS, a total of 5 residents were recruited. The curricular design included asynchronous and group discussion didactic components during the PGY2 year; the PGY3 year will focus on individualized projects based on the residents interests and teaching opportunities. The foundation of the track includes exposure and linkage of system wide examples and applications of high value care, the economy of health care, resources related to social determinants, all while building a new professional identity that encompasses HSS. We utilize qualitative surveys for feedback.
Institution 2 recruited residents across multiple specialties for a majority asynchronous AMA module curriculum, with oversight and check ins with faculty mentors and individualized coaching. The goals are similar to the above institution.
Although we are in the beginning phases of development, the design of the curriculum is the first of its kind that engrosses the principles of HSS and its ability to compliment and enhance the traditional clinical reasoning pillars of medical education. The evaluation process of the curriculum is unique as we will are collecting qualitative responses from residents regarding their ability to problem solve and skill that will be tracked overtime, and their ability to teach HSS concepts including. They have set individual goals at that will be benchmarked, and ultimately linked to their professional mindset and identity.
As GME shifts their focus to individualized education for residents, becoming a health system citizen that complements robust clinical skills will be needed. High value care is often taught as a separated structure, and our curriculum addresses the deficits and framework needed to effectively incorporate the foundation of health systems sciences to make a more well rounded learner.