How med schools will spend innovation grants

Chicago Teaching medical students by using virtual electronic health records. Embedding students in clinical care from their first weeks in medical school. Training tomorrow's physicians to be leaders of interprofessional teams and deliver safer, higher-quality care. Giving students pursuing primary care the opportunity to speed their path to practice and averting dire physician shortages.

These are among the ambitious goals set forth by the 11 medical schools that won approval from the American Medical Association's expert advisory panel. The $1 million grants awarded to each recipient over five years will give the schools the time and resources to implement changes that the AMA, physicians and educators hope will spark the biggest transformation of U.S. medical education since Abraham Flexner's 1910 report set the standard for modern physician training.

In February, 82% of the nation's 141 accredited medical schools — 119 in all — outlined grant proposals to the AMA. A 16-member panel narrowed the field to 28 in March, and those schools entered their final proposals in May. The grantees were announced June 14 at the opening reception of the AMA Annual Meeting, a festive occasion held under the Chicago Cultural Center's Tiffany dome. Amid the celebratory mood, it was clear the bar had been set high for what the 11 schools are expected to accomplish.

“They will help identify changes in medical education that will enable students to thrive in the evolving health care environment and that can be applied across medical schools,” said then-AMA President Jeremy A. Lazarus, MD, a Denver psychiatrist. “To facilitate that, the AMA will form a learning consortium so that participating schools can share best practices and structural innovations. Ultimately, our goal is to showcase successful innovations and promote their adoption in medical schools nationwide.”

Schools will work together

Leaders from the 11 medical schools will have in-person, two-day meetings at least twice a year to share best practices in formulating new methods of teaching and evaluating students. They also will collaborate on an ongoing basis through email lists and conference calls, and get access to outside consultants in technology and informatics who will help them set up the systems to put their proposals into action.

“What this consortium does is really provide a forum to knit together all the innovative approaches from the different schools,” said Sherine E. Gabriel, MD, dean of one of the grant recipients, Mayo Medical School in Rochester, Minn. “When you look at what each of us has proposed, they're all very different and each addresses a different aspect of medical education that is not being optimally addressed. If we can come together and pull together those innovative ideas and create a vision for a new kind of medical school, that's potentially much more powerful than any of us can do alone.”

Boosting technology's educational role

Indiana University School of Medicine in Indianapolis and New York University School of Medicine each will explore how to better employ technology in teaching medical students. The schools will create virtual EHRs specifically to aid in teaching clinical decision-making in an era when mouse clicks and drop-down menus are rapidly replacing paper charts and prescription pads.

The IU system will be a clone of an actual EHR used in clinical care, while NYU's system will include deidentified patient data from NYU Langone Medical Center to train students how to manage both a virtual panel of patients and overall population health.

Meanwhile, some of the schools are aiming to integrate medical students into the mainstream of clinical care much earlier. At Pennsylvania State University College of Medicine in Hershey, students will help patients navigate the complicated health system. That will serve a dual purpose, helping improve the patient experience while teaching students what the real care delivery system is like.

At Vanderbilt University School of Medicine in Nashville, Tenn., students will work at a single clinical site for the entirety of their undergraduate medical education. The program is under way, and the AMA's grant will help greatly, said Jesse M. Ehrenfeld, MD, MPH, co-investigator of the school's grant proposal. He also is associate professor of anesthesiology, surgery and biomedical informatics at Vanderbilt and an alternate delegate for the American Society of Anesthesiologists.

“We were able to get about 90 medical students to see 6,000 patients in their first year of medical school, which is an unprecedented number,” he said. “We've never had that kind of clinical experience available in the first year, in the seventh week of medical school.”

Quality improvement and patient safety training also are getting a big push as a result of the AMA initiative. The Brody School of Medicine at East Carolina University in Greenville, N.C., is planning a new core curriculum in patient safety, while the University of California, San Francisco School of Medicine's proposal aims to evaluate students based on their progress on quality improvement topics and team-based care.

A faster finish

Several recipients will use the AMA funding to shift from time-based evaluation to competency-based assessments, offering faster-moving students the opportunity to graduate in less than the traditional four years. The University of California, Davis School of Medicine in Sacramento is going even further with a program designed for students who know they want to be primary care doctors. Through a partnership with the Kaiser Permanente health system, UC Davis students will get the opportunity to complete medical school and residency training in general internal medicine in six years rather than the traditional seven.

“Once we figure out how to do this well in internal medicine, we plan to move on to other [shortage] needs such as family medicine, pediatrics and, in California, that also includes general surgery, general psychiatry and other specialties,” said Tonya L. Fancher, MD, MPH, associate program director in UC Davis' Dept. of Internal Medicine.

The AMA initiative to accelerate change in medical education is one of three major elements that make up the Association's strategic direction outlined in June 2012. Earlier in 2013, the AMA announced a multiyear, multimillion-dollar project to improve health outcomes in two target conditions: type 2 diabetes and cardiovascular disease. The Association is partnering with YMCA of the USA for the diabetes portion of the effort and the Johns Hopkins Armstrong Institute for Patient Safety and Quality in Baltimore for work related to cardiovascular disease.

The third element of the strategic plan focuses on ways to improve physician satisfaction within various models of payment and care delivery. Details about findings from field research done in partnership with RAND Health are expected to be announced in fall 2013 and will inform the Association's advocacy efforts as well as the tools it provides to doctors across the country.