A Spotlight on Innovation post with Jesse Burk-Rafel, a third-year student at the University of Michigan Medical School.

AMA Wire®: Last February, you spoke with AMA Wire about your work with the University of Michigan Medical School’s curriculum redesign as a member of the AMA’s Accelerating Change in Medical Education Consortium. You mentioned that the previous curriculum didn’t “do enough to frame the issues facing health care, help with personal development of students’ existing leadership strengths or even break down barriers for students as future physicians.” How do you think Michigan’s new curriculum is helping students to better engage with these topics now?

Burk-Rafel: Many ways. Michigan’s new curriculum will equip students to be leaders in addressing health care challenges. One concrete way is inclusion of core curriculum in health policy, which students have—for many years—been craving.

In addition, students will develop expertise in other topics, like quality improvement and patient safety, that extend beyond the patient-physician interaction and require systems thinking. This training will be complemented by practical, longitudinal mentored professional development. Today’s medical students bring a wealth of skills and passions when they enter medical school, and we should be doing everything possible to cultivate those passions and develop leadership skills so that they might turn their passions into real impact. Thus, students will work with multiple coaches and mentors from day one.

The professional development focus of our new curriculum is tremendously exciting to me—I think it will provide students opportunities to better understand the landscape of U.S. health care and how they might make an impact while having a fulfilling career. In short, I expect future Michigan graduates to be in a better position to craft their dream career.

AMA Wire: What are some of the barriers students face when trying to create change in medical education, and how is Michigan’s work as part of the AMA’s Accelerating Change in Medical Education Consortium helping to break down those barriers?

Burk-Rafel: Students face many barriers in leading medical education transformation. Some of these barriers are common to their faculty counterparts: Namely, inertia—the “that’s what we went through, so you should too” mentality. Especially at a leading medical school like University of Michigan, it can be tempting to stick with the status quo—after all, it has worked well thus far.

I find that the status quo has incredible inertia hindering innovation. It takes remarkable perseverance to achieve hard-fought small changes. Moreover, changes are unlikely to benefit the students who work to make them a reality—it’s a pay-it-forward proposition.

Students also face unique barriers to engagement. They may be perceived to lack credibility, and they likely lack formal training in medical education. They may be asked to participate in a token fashion rather than as equal participants. They may lack mentors who will champion their vision, or they may not know where to start in leading change. Perhaps most critically, they may not speak the same “language” as faculty leaders.

At the University of Michigan, the Accelerating Change in Medical Education effort has jumpstarted a transformation effort that has broken down barriers to student engagement. From the first days of this effort, faculty leaders collaborated with student leaders to formulate a student representation structure. This was a critical step and led to broad, rich engagement of students. Most importantly, our institution created an atmosphere where students were embraced as equal participants, with an important and unique perspective to contribute. As students have done important work in the curricular change effort, they’ve established credibility and built professional relationships with faculty leaders, all while developing their own leadership competencies.

AMA Wire: Is there a particular project at your school or another school within the AMA’s Accelerating Change in Medical Education Consortium that has inspired you, deepened your passion for learning or helped spur new ideas or solutions among you and your fellow students?

Burk-Rafel: The change process—as a whole—has been an opportunity for me to re-envision my education. It’s been incredibly empowering. For example, one innovative aspect of our new curriculum are the “Branches”—two yearlong professional development pathways in the third and fourth years. As a rising M4, I’ve had the opportunity to pilot new Branch programs and rethink what my ideal M4 year would look like. It’s been a blast to be the designer and subject to my own folly!

AMA Wire: Have there been any instances when collaboration, especially peer-to-peer among students, helped foster a novel idea or project in your program?

Burk-Rafel: Students bring energy, a sense of urgency, raw insight and fresh ideas. Student involvement generates buy-in from peers.

Student-led innovations abound. For example, Michigan students led an effort to survey their peers—gathering over 450 responses—to better design a key component of our new curriculum in an evidence-based, learner-centric fashion. This work was instrumental in providing our curricular work groups empiric evidence with which to build an ambitious new program around. Other innovations include a new approach for incorporating science into our clinical training, which pilot students are helping to expand and improve.

The Accelerating Change in Medical Education effort has also led to student collaborations across institutions. Working with students from four institutions in the consortium, we’ve run seminars at national meetings and are disseminating in medical education literature the many ways in which students can help lead curricular change.

AMA Wire: What’s one aspect of the student perspective you think educators better understand now that they’ve worked with students at Michigan?

Burk-Rafel: At Michigan, educational leadership has always engaged students. What’s new is the breadth of engagement of both faculty and students in this curricular transformation. I’ve witnessed how front-line faculty—not merely educational leaders—have witnessed the exceptionally diverse, unique perspectives and experiences that students can bring to curricular change. I’ve seen how students’ infectious passion can inspire even the most reticent front-line faculty to embrace the transformation effort.

AMA Wire: What advice would you give students who are interested in sparking change at their medical schools?

Burk-Rafel:

  1. Organize student engagement into a cohesive effort.
  2. Gather evidence, through surveys and focus groups, that helps establish urgency and shape a vision for change that is learner-centric.
  3. Collaborate with faculty, forming partnerships around shared goals.
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