A View to the Future

AMA grant supports transformation of medical education with an early focus on the elements of health care delivery science

by Laura Ramos Hegwer
originally published in the Spring 2016 Medicine on the Midway

Faculty members at the University of Chicago Pritzker School of Medicine want the future physicians they teach to stop thinking of themselves as “just medical students.”

“Medical schools tend to focus on what medical students cannot do, but our goal at Pritzker is to focus on what they can do,” said Vineet Arora, MD, AM’03, assistant dean for scholarship and discovery.

Empowering medical students to be engaged members of the health care team is a key goal of a new program, VISTA: Curriculum and Culture Change to Cultivate Physicians of the Future. The acronym stands for value, improvement, safety and team advocates.

Today’s complex and evolving health care system calls for a new approach to training physicians, Arora said. “In medical education, we have traditionally imparted the knowledge of how to identify and manage disease to students first, and then we discuss how they can function in the health care system,” she said. “With VISTA, we aim to give students a core understanding of how the health care system works and how they can be effective in it early on in their training, at the same time they learn their medical knowledge.”

Most of this new training will be infused throughout the curriculum, particularly in clinical skills classes, starting in the first year.

Michael Howell, MD, MPH, chief quality officer at the University of Chicago Medicine, said the program will help students understand how health care delivery science improves medical care. “It’s a new and emerging field, but it will be critical for our students and residents to be successful in the future,” Howell said. “The University of Chicago is particularly well-positioned to help move this field forward.”

The VISTA program is supported in part by a $75,000, three-year grant from the American Medical Association as part of its Accelerating Change in Medical Education Consortium, which includes more than 30 medical schools across the country. Arora and Jeanne Farnan, MD’02, MHPE, Pritzker’s associate dean for undergradute medical education, are co-principal investigators. “Being a part of the consortium means that we can learn from medical education leaders of similar minds who want to rethink what it means to train a physician in the 21st century,” Farnan said. “At the same time, we will have an opportunity to share our experience and influence medical education across the country.”

Team effort

As early as Winter Quarter of the first year of medical school, and with the support of Debra Albert, MSN, MBA, RN, NEA-BC, vice president of patient care services and chief nursing officer, students will work under supervision alongside nurses in high-functioning nursing units, where they will assist with admissions, discharges and handoffs. “We know from the medical education literature that when students are exposed early on to other allied health professions, they become better at delivering collaborative care,” Farnan said.

“Our goal is to have students recognize that the physician is not the leader of the team, but rather a member of the team that is responsible for the patient,” Farnan said.

Pritzker students working in the interprofessional team setting, along with nurses, pharmacy students, and residents. Photo by Nancy Wong

Giving medical students earlier training in identifying and reporting safety concerns is another component. “Some people assume that students need clinical experience to understand patient safety,” Farnan said. “But in reality, students come in with the most important perspective — that of a layperson or patient.”

Medical students will identify safety violations in the “horror room,” a simulated patient room used in a safety boot camp initially developed for interns. In fact, the VISTA program will leverage some of the enhanced quality and safety training that has already been implemented by Arora, Farnan and others to better prepare entering residents at UChicago Medicine. “Because as many as one-third of our students choose to stay here for residency, we have a strong incentive to link our undergraduate and graduate medical education and make sure our students are going to be great residents,” Arora said.

From a value perspective, students will learn how to screen patients for financial harm, tailor their assessments and plans to incorporate patient preferences, and conduct value improvement projects.

The VISTA program, which will roll out starting in fall 2016, uses technology to help students understand the science of health care delivery and become better advocates for their patients. Students will receive an iPad mini with apps to help them track the hospital’s quality metrics, document potential safety issues and collaborate with other members of the care team.

Student buy-in

“Medicine tends to be a hierarchical field, and the sooner medical students learn how to speak up about a potential safety issue, the easier it will be for them to do it later on,” said Adam Vohra, MD'16, MBA'15. Vohra learned how to work on a team while in business school, and he believes VISTA’s focus on collaboration will be especially valuable for incoming medical students. “Although physicians may eventually learn these skills as they progress into leadership roles in their careers, the sooner you learn it, the more useful it is,” he said.

Mila Grossman, MS2, agrees. “As medical students, we don’t always realize how nurses and other medical professionals can be our allies in delivering patient-centered care,” said Grossman, who served on a multidisciplinary quality team as an undergraduate at Georgetown University. “Learning how to work and communicate effectively with other professionals will make a much better workplace and go a long way in improving the patient experience.”