Accelerating Change in Medical Education

Real-world examples bring health systems science home

The early chapters in Health Systems Science—a 2016 textbook co-written by experts from the AMA and faculty from 11 of the 32 member schools in its Accelerating Change in Medical Education Consortium—focus on concepts that form the basis of the “third pillar” of medical education. The latter portion of the text, including a chapter entitled “Application of Foundational Skills to Health Systems Science,” examines what those concepts look like in action.

“It’s all well and good to have these theories, but what do they look like in the real world?” said Sara Jo Grethlein, MD, associate dean for undergraduate medical education at the Indiana University School of Medicine, who co-wrote the chapter. “We selected a couple of examples that we were closely familiar with in our work and that might be broadly applicable.”

Here is a look at a few questions related to the health systems science concepts examined in this chapter.

How are organizations and physicians accessing and applying the best data for treatment?

The theory: Health systems are using evidence-based medicine, loosely defined as the practice of identifying the best available science to treat patient populations and reduce variation in care.

The application: Programs implemented at the system level to keep care consistent and make use of the best available science include clinical pathways—standardized, evidence-based clinical decision tools—and formulary systems, which offer uniform guidance of medication and other treatment options throughout a health care organization.

Why it matters for medical trainees: The information repositories that practices create offer a baseline of data that physicians can draw from when treating patients. “Part of the skills we are trying to share are ways to manage the explosion of information,” Dr. Grethlein said. Physicians need to know “how to distinguish good information from poor or biased information, how to be efficient in gathering information.”

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What is the impact of new technology on patient-physician communication?

The theory: A generation ago, the phone and fax machine were the means through which patients and physicians conducted their remote communications. That is no longer the case. A 2009 study found that more than 80 percent of Americans seek health information online.

The application: Electronic patient portals and social media both present unique opportunities for patient engagement. They also can be landmines for breaching patient privacy and unprofessional behavior. The chapter recommends a brief set of do’s and don’ts that physicians should heed in both their personal and professional online communication: do respect patient confidentiality; don’t blur professional boundaries; do be open about conflicts of interest; and don’t make abusive or gratuitous comments about individuals online.

Why it matters for medical trainees: There are more ways for patients to contact physicians, and physicians need to contextualize those venues.

“Physicians need to be aware of the boundaries and that it is our responsibility to keep the patient information safe,” Dr. Grethlein said. “We can think about patients who reach out to their doctors on Facebook, and I try to compare that with the patient who comes and sits next to their doctor in church. That is not in the doctor-patient typical relationship, and if managed well with appropriate boundaries you might find a way for that to work. But you shouldn’t be conducing medicine in church and you shouldn’t be conducting medicine on Facebook. Those are not private venues.”

Why the renewed emphasis on teamwork in health care?

The theory: If health professionals across disciplines are not functioning as an effective team, a patient’s quality of care will suffer.

The application: Health systems have formed units, such as accountable care teams, that are designed to strive for the best clinical, service and financial outcomes for a patient. In addition to physicians, these teams consist of members from a number of different fields—such as case managers, pharmacists, nurse specialists and nutritionists.

Why it matters for medical trainees: While physicians are used to being at the top of the leadership structure in a hospital, that may not be the case in this type of structure.

“As a physician … the perspective of people other than me is important,” Dr. Grethlein said. “I may not know to think about the cost of something or that a certain medication needs refrigeration, but the social worker who knows that the patient doesn’t have stable electricity in their home or can’t afford the bus fare to get back to see me for a follow-up appointment is just as important in caring for that patient as I am for prescribing that right medication. I can prescribe it all I want. If they can’t get it because it costs too much money, then I haven’t really served the needs of the patient.”

Health Systems Science is now being used in 14 medical schools across the country, including seven that are not part of the AMA Consortium. The book retails for $59.99 and can be ordered from the AMA Store and the publisher, Elsevier, as well as from Amazon and other online booksellers. AMA members may order it from the AMA Store for $54.99. Individual chapters are available from Elsevier’s Student Consult platform for $6.99 each.