Medical schools are enhancing students’ experiences by embedding them into patient-centered medical homes and accountable care organizations (ACO)—two care models changing health care delivery. Explore the work some schools are doing with the AMA’s Accelerating Change in Medical Education Consortium.
Immersing students in these care models is part of the schools’ work with the AMA’s Accelerating Change in Medical Education Consortium. The consortium, working to modernize and reshape the way physicians are trained, brings leaders form schools together to share ideas and experiences with innovative programs designed to improve competency, leadership and patient care.
Navigating the system in Cleveland
First year students at Case Western Reserve University School of Medicine (CWRU) in Cleveland this year will have the chance to work directly with veterans and refugees, helping these patients navigate the health care system and assisting them in reestablishing themselves in society.
On a volunteer basis, medical students can go into patient-centered medical home practices through the VA Centers of Excellence in Primary Education. They can also go into the Neighborhood Family Practice, a group of community health centers in Cleveland that are seeing refugee families.
Students will guide refugees who are new to the U.S. in filling out forms and will educate the patients on the workings of the U.S. health system such as when it is best to use the emergency department. They will help veterans returning from deployments readjust to life in the U.S. and help them learn how to navigate the VA system.
“The idea is to get students to understand the system and to understand the patient’s perspective,” said Mamta “Mimi” Singh, MD, MS, assistant dean of health systems science at CWRU. “The best way is to have the students navigate the system themselves.”
The goal during the pilot phase of this program is for the medical students to work in teams of four, with about 20 students heading into the VA system and another 20 students working with refugees through Neighborhood Family Practice.
The medical school has a long history of embedding students in the community, including a student-run free clinic where second, third and fourth year students work with a nurse and a preceptor.
This new program “is a way to highlight the third pillar of medical education, health systems science,” Dr. Singh said. “It is important to give students the experience to navigate the system.”
Creating a six-year program in Cleveland
Ohio University Heritage College of Osteopathic Medicine in Cleveland, in affiliation with the Cleveland Clinic, is preparing a curriculum that will embed students longitudinally in patient-centered medical homes with strong ties to community services.
The program, scheduled to begin in two years, will be linked to a three-year DO program and a three-year family medicine residency program. The embed will begin the first week of medical school and continue through the last day of residency.
“The exciting part of our project is that the curriculum, the care model, and the community integration components are being developed together to ensure each component can inform the other two,” said Isaac J. Kirstein, DO, dean of Ohio University Heritage College of Osteopathic Medicine’s Cleveland campus. “Embedding students for more of their learning will create new ways to reinforce clinical education, while providing new opportunities to experientially learn the complexities of health care delivery.”
The medical school has a 40-year history of embedding students in the community which reinforces the basic sciences and clinical sciences traditionally taught in lectures and labs.
“The AMA consortium schools share the Heritage College’s belief that physician leaders must excel in a new third science--health systems science,” Dr. Kirstein said. “We are designing our program with the assumption that this new science requires embedded learning as a priority.”
Dr. Kirstein noted that embedding students allows their education to transform as the health care system changes.
“Students will be part of the evolution and not just reacting to it,” he said.
Helping patients manage disease at home in New Jersey
At Rutgers Robert Wood Johnson Medical School (RWJMS), medical students are teaming up with students from other disciplines to help care for patients with multiple chronic conditions in their homes.
As part of their curriculum, medical students--along with an interprofessional team of pharmacy, social work, nursing and physician assistant students–are embedded within teams led by nurse care coordinators. Medical students make visits to patients’ homes to help patients learn to better manage their diseases outside of office visits; help improve patients’ safety and preventive health at home; and track, assess and strategize on improving quality and cost.
“The experience of going into a patient’s home is eye opening,” said Carol A. Terregino, MD, senior associate dean for education at RWJMS and the associate dean of admissions. “They are learning about health systems sciences in vivo.”
The medical school and hospital have a partnership called Robert Wood Johnson Partners, an integrated care system where a nurse care coordinator manages patients in the system. The students join the nurse for a first visit to a patient’s home and after that, the student team members continue to make visits to the same home.
A pilot program was conducted in the spring and students identified safety issues and medication errors, including a loose rug that was a tripping hazard to the patient and a problem with the patient’s medicine that prompted calls to the nurse care coordinator and treating physician.
“A preliminary survey on the experience indicates that the students identify that there is much room for personal growth with regard to confidence in caring for patients with multiple chronic conditions and for working on interprofessional teams,” Dr. Terregino said.
This fall the entire second-year medical school class will be embedded in the real world ACO to learn about the Triple Aim of Care: better patient experience, higher quality of care and lower health care costs. Dr. Terregino said the goal is for the students to augment the care that patients receive and to improve the health of the population.
“What we are hoping is that patients look forward to the visits and that these experiences will be value-added for the patient and the care coordinators, as well as the students,” she said.
