Long-established medical schools are taking big leaps in moving toward a curriculum focused on value and communities.
The A.T. Still University School of Osteopathic Medicine in Arizona partnered with the National Association of Community Health Centers to create a total-immersion training model. During years 2 to 4, students are sent to one of 12 urban or rural community health centers in the U.S., where they are able to experience, firsthand, what it’s like to care for patients.
During that time, students conduct needs assessments, complete projects around the social and economic determinants of health and undertake quality improvement projects.
“We are training our students to be part of that team that will look at things in terms of community-oriented primary care” and, as a result, complete the goals of the Triple Aim," says Fred Schwartz, D.O., professor and senior adviser to the dean and former clinical associate dean.
It appears to be effective. A 2017 ATSU survey of the class of 2012 found that 53 percent of graduates went on to practice in underserved areas. And of all graduates to date, at least 80 percent received placement in primary care and NACHC-identified needed specialties, according to Schwartz.
New York University School of Medicine, which was founded in 1841, created its Curriculum for the 21st Century to emphasize six essential pillars, including population health.
NYU’s Health Care by the Numbers initiative brings together de-identified patient data from NYU Langone Health's more than 200 practice sites and open data from the 2.5 million patients admitted yearly to New York state hospitals. That allows students to experience the same electronic health record system used by medical residents to examine specific populations and also allows professors to use the real-world data to feed back into the curriculum.
Quality, value and safety need to become mandatory for medical students so they have a firm grasp of those concepts when they move on to their residencies, says Steven Abramson, M.D., chair of the department of medicine at NYU Langone and vice dean for education, faculty and academic affairs. “The health system is forcing changes in the medical school for the good.”
One of the largest formal undertakings in medical school innovation has been the American Medical Association’s Accelerating Change in Medical Education Consortium. Beginning in 2013 with 11 schools, the consortium now includes 32 medical schools with $13.5 million in grant funding. The purpose is to bring together schools, share what’s working and explore new ways of teaching students.
Funding from the consortium helped to get the NACHC partnership and Health Care by the Numbers innovations off the ground. And many ideas that have emerged from the consortium have been embraced elsewhere. For example, Indiana University School of Medicine’s Regenstrief Institute's Electronic Health Record Clinical Learning Platform was adopted at Dell Medical School at the University of Texas at Austin as well as several other medical schools.
Supporters say the curriculum changes will teach students to adapt rather than react to changes not just in medicine and health care delivery but also in society at large. And hospitals won’t need to spend resources on re-educating new physicians about the demands of the real world. “You hate to take too much time to retrain these bright young people, and if we could get it right for them the first time, they would be ready to hit the ground running,” says Susan Skochelak, M.D., vice president of medical education for the AMA.