Educating for Societal Needs Meeting Minutes

4/22/14, 2:00pm-4:00pm, Sackler 220


Committee: Peter Bates (co-chair), Scott Epstein, Greg Hardy (phone), Paul Hattis, Amy Kuhlik, Mary Lee, David Martin (co-chair), Jan Mathews, John Mazzullo, Richard Murphy, Tony Schlaff, Bob Trowbridge (phone), Robert Ward, Saul Weingart, Halina Wiczyk

Staff: Ann Maderer, Connie Wang


Next meeting: May 5, 2014, 9:30am-11:30am, Sackler room 320

General notes:

· The next meeting on will be our last. We will compose a brief summary of where we are now, a summary of where we want to be in 5-10 years (a list of goals), and list of resources needed to achieve our goals.

· June 6 Retreat

o We will leave time at the last session to prioritize our suggestions for the June 6 retreat.

o Those who haven’t done so yet, please let Mary Broderick in the Dean’s office know if you are attending the June 6 retreat.

· AAMC data was distributed and discussed.

o Question about interpreting these data. Do we know where we want to be? What is our target?

o We look at atmosphere and focus on the question, “Do students and faculty feel that we are diverse enough?”

o We should be cautious using absolute numbers, especially referring to the underserved in rural communities because of rapid changes.

· Minutes were approved. Committee members reintroduced themselves. Reminder of the Triple Aim framework – improve health of population, improve patient experience, lower costs of care.

Patient Experience/Quality of Care:

· A few specific skills we want students to learn:

o how to conduct a project

o how to work in interdisciplinary teams

o how to serve a variety of populations

o how to analyze/interpret and present quality and safety data

o how to generalize from patient experience to population

o how to influence complex organizations

· The MPH program teaches a lot of these skills (quality/safety + population health) except the patient component, humanistic element.

· We need to increase our focus on patient-centered outcomes.

· Training in these areas, in the clinical years, can be improved – there are opportunistic experiences for students but no systemic strategy or curriculum.

o Need for qualified clinical faculty to teach and assess students on these concepts.

· Many issues are well-covered during first and second year of med school (e.g., SFSBM), however we need to improve coverage the clinical years (vertical integration)

o One barrier, at least in the preclinical years is that students do not necessarily value these principles – they are under the mistaken impression that these concepts are less important, to the practicing physician, than basic science.

· The PA program does not have room to include these concepts into the curriculum, however, they do use the stealth approach and have students complete readings before school starts.

· Students should also complete a quality of care project before they graduate, which would also include their reflecting on their experiences.

o Practical concerns.

§ Overloaded curriculum – something needs to come out if more is added.

§ Who will manage student projects? CAP, in the original model, had included a QI project, but we didn’t know who would assess these projects.

§ It would be ideal if we were able to integrate this project with the CSL requirement.

o Students should have this type of requirement expectation early on.

o Perhaps this project can be done with teams.

o We would let them know that these experiences are the kind that residency programs are looking for.

· A few changes we need to make:

o Emphasize connection between student education and faculty responsibilities.

o Emphasize new regulations and the changing healthcare landscape and the need for students to understand them (e.g. ACA).

o Bridging the gap between curriculum during pre-clinical years and clinical years. Is there something basic we need to teach students in order to prep them for the wards?

o Train students to gather and question data.

o We need a core clinical faculty (with resources at each major Tufts teaching hospital) with increased protected time to teach, and increased faculty development to train those faculty; it’s not realistic to think that all clinical faculty who supervise/teach students will have content expertise in these areas (or the time to teach this content).

o Making sure we include quality and safety in each course, like the curriculum committee has recommended doing with palliative care.

· Culture change needed. What is our educational mission?

o If we want to change culture, we should build in the ideal culture.

o Our goal is to teach our students to help them change this culture.

o Change from bottom up.

Reduced Per Capita Cost of Care

· Teaching students both microfinance and macrofinance.

o With regards to personal finance, this is already done well as there are highly-rated financial literacy workshops throughout their four years at TUSM. They even have an exit interview with Tara Olsen, the Director of the Financial Aid office.

· Students don’t know how the practical aspects of how patients are charged/billed and what the costs of care are.

· Students are taught some of the latter in the PBL (and the ICR course presents an opportunity to enhance this as the course already focuses on appropriate utilization of imaging and testing); there is a need to integrate this into third year (e.g. should student analyze one or more of their patients from the perspective of charges/billing/cost of care, insurance coverage, etc).

· The concept of price vs. cost vs. value should be taught and reinforced in third year.

· Some global health projects may give students perspective on waste in the American system.

· The burden for teaching shouldn’t fall exclusively on the supervising attendings. Can we use other healthcare professionals to teach in these settings?

· The resource utilization notion goes back to the team.

Future Workforce/Professionalism

· One important goal is to teach students to understand how to work in teams and to train them in teams.

· We want our students to be clinician leaders of the future who can lead in various circumstances.

· Developing reflective learners. Students can learn from us to stop what they do and reflect about their experiences. They can have time to think about the problems and think of the solutions to these problems. “Don’t just do something, stand there.”

Next meeting:

· We will have a five minute overview of the LIC program. Is the LIC more efficient? For students, yes. For faculty and administrators, no.

· Discuss plan for the report.

· Is the curriculum as efficient as it could be? There will be very few lectures in the next five years, changing formats like TBL and Flipped Classrooms.

· Although some of what we have talked about can be integrated into the existing 3rd and 4th year MD program structure, changes will be required. Should 3rd and 4th year be restructured? The 2009 restructure of 3rd year, with increased elective time for career exploration, has proved to be very successful. Should the “clinical years” be increased in duration? Increasingly, schools are starting the core clerkships in January-March of 2nd year.

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