Accelerating Change in Medical Education

Pivoting to a new way of training future physicians at Mayo Clinic

A Spotlight on Innovation post by Lotte Dyrbye, MD, Sherine Gabriel, MD, and Robert Nesse, MD, co-primary investigators of Mayo Medical School’s “Transforming medical education through the science of health care delivery” grant, funded by the AMA. This appeared in the December 2014 edition of AMA MedEd Update, a monthly medical education newsletter.

Mayo Clinic, the oldest and largest integrated, team-based health care provider in the United States, is at the forefront of designing and implementing new systems. These health care delivery systems better coordinate care, enhance communication and interprofessional teamwork, engage patients and families in shared decision-making, incorporate public health professionals, improve patient outcomes, and reduce costs.

Despite ongoing change in health care delivery, we recognize that very little of this innovation has made its way into undergraduate medical education.

As part of our work, Mayo Medical School and the Mayo Clinic Health System (MCHS) now are partnering to develop unparalleled educational opportunities for medical students to learn and work in diverse, value-driven collaborative practices. We are launching a new longitudinal clinical experience called PIVoT: Patient/population-centered, inter-professional, high-value, team-based.

PIVoT is designed to help students care for patients and populations while learning about how health care systems impact patient care, outcomes and costs. Students will gain experience with interprofessional health care teams, patients, families, communities, public health resources and professionals, and micro- and macro-health care systems. Within PIVoT each medical student is assigned to a MCHS care team and will have care-team related experiences at regular intervals throughout medical school.

Students will:

  • Participate in the delivery of team-based care to patients and populations
  • Apply population surveillance to improve patient outcomes
  • Participate in meaningful efforts to improve patient care and outcomes while reducing costs
  • Identify, assess and engage appropriate community resources to meet individual patient needs
  • Apply continuity of care to align resource allocation with optimal health outcomes

Beyond delivering care in the office, students will work alongside interprofessional team members to deliver coordinated care at the individual and population levels and across care sites. As members of a team held accountable for the total care of patients, students will take on an active role as panel managers for the team. Students will work with care coordinators, care transition nurses, pharmacists and public health professionals. They also will conduct post-hospital follow-up calls and participate in a home-bound palliative care program.

We are designing PIVoT experiences in collaboration with CEOs and senior physician executives at MCHS to help ensure our educational initiatives are congruent with the real-world needs of modern, large-scale health systems. This exciting new approach of embedding students within interprofessional teams to regularly provide and improve patient care will help close the gap between undergraduate medical education and the practice realities of today and tomorrow. It also will optimally prepare students to work in and lead change in an evolving health care system.

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