ChangeMedEd Initiative

How M1s, M2s are helping patients navigate complex medical systems

Timothy M. Smith , Contributing News Writer

Medical schools are increasingly looking for ways to build authentic learning opportunities into the pre-clerkship years, but many struggle to identify roles that add value to the health care system while enhancing the educational experience. A new instructor-directed textbook removes this uncertainty by exploring real-world examples of value-added roles and outlining models for implementing them.

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Following are highlights from “Students as Patient Navigators: The Penn State College of Medicine,” Chapter 4 of Value-Added Roles for Medical Students. In addition to presenting case studies, the textbook also lays out the historical background and conceptual foundations that underpin value-added roles.

Value-Added Roles for Medical Students is part of the AMA MedEd Innovation Series, which provides practical guidance for local implementation of the education innovations tested and refined by the AMA Accelerating Change in Medical Education Consortium.

Helping actual patients

Since 2014, in recognition of the profound impact of structural inequities on health outcomes, Penn State College of Medicine has been pairing each first-year medical student with a patient navigator mentor at a designated clinical site with site-specific needs for navigation. Before meeting with their mentors, medical students get one month of training in social history taking, communication, identifying and understanding social determinants of health, poverty simulation, the physician’s role and the core principles of professionalism.

The program is part of a curriculum on health systems science—an understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery.

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“In the coursework, students are asked to think broadly about how barriers to care—for example, health care disparities or financial challenges—may affect a patient’s health,” wrote the authors, who include Jed D. Gonzalo, MD, MSc, the school’s associate dean for health systems education.

“In the context of a patient-navigation program, the students are able to help actual patients overcome those exact barriers,” they added. “This experience not only helps facilitate the students’ learning of these principles, but patients in need also receive assistance.”

With guidance from their site mentors, students spend about eight to 12 hours each month performing tasks in three main categories:

  • Providing information and education to patients and their families, such as how to access community resources.
  • Giving emotional and psychological support.
  • Facilitating both care coordination and continuity of care.

By 2020, about 800 medical students had provided patient-navigation services to some 5,000 patients in South Central Pennsylvania.

“While explicit health outcomes for these patients are anecdotal (and under investigation), we have been able to identify the structural and social determinants of health that are prevalent in our five-county catchment area,” the authors wrote. This information has been valuable to Penn State Health in its discussions about improving care delivery and meeting the needs of patients across regions and demographic groups.

“As a result, the patient navigation program has been able to demonstrate its value not only to the individual patient who receives assistance, but also to the system as it strives to engage in population health management,” they wrote.

The chapter includes insights on learning goals, assessment techniques, program evaluation, required resources and implementation strategies.

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Value-Added Roles for Medical Students also explores the patient navigator project at Case Western Reserve University School of Medicine and features case studies of additional longitudinal experiences, as well as guidance for planning, launching, sustaining and growing value-added roles.

The first book in the AMA MedEd Innovation Series, The Master Adaptive Learner, is an instructor-directed textbook designed to help faculty engender the habits of mind for lifelong learning in medicine in their students.

The AMA also released the second edition of the Health Systems Science textbook. A companion, Health Systems Science Review, provides case-based questions followed by discussions of answers and suggested readings.

Read more about how value-added roles can transform medical education.