Development and Implementation of an Experiential Longitudinal Health Systems Science Thread Into an Existing Medical School Curriculum.

IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES
Academic Medicine Pub Date : 2024-09-01 Epub Date: 2024-06-12 DOI:10.1097/ACM.0000000000005784
Tanios Dagher, Julie Oyler, Valerie G Press, Tia Kostas, Joyce Tang, Robert Hight, Mark Saathoff, Marie McKinnon, Jenna Ford Jackson, Michael McGinty, Korry Schwanz, Jeanne Farnan, Vineet Arora, Irsk Anderson
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引用次数: 0

Abstract

Problem: Medical school graduates enter a complex health care delivery system involving interprofessional teamwork and multifaceted value-based patient care decisions. However, current curricula on health systems science (HSS) are piecemeal, lecture based, and confined to preclinical training.

Approach: The VISTA program is a longitudinal, immersive learning curriculum integrated into the University of Chicago Pritzker School of Medicine curriculum between 2016 and 2018. Key components include a unit-based nursing interprofessional team experience, a discharge objective structured clinical examination (OSCE), a patient safety simulation, and the implementation of a Choosing Wisely SmartPhrase. Graduates before 2016-2017 and after 2018-2020 VISTA implementation completed a Likert-style survey assessing attitudes, knowledge, and behaviors on HSS topics. A free response question solicited improvement areas. The Association of American Medical Colleges (AAMC) Graduation Questionnaire (GQ) was also examined.

Outcomes: The overall VISTA survey response rate was 59%, with 126 fourth-year medical student respondents before VISTA and 120 after VISTA. Compared with pre-VISTA graduates, post-VISTA graduates reported a significantly higher rate of competence on the HSS questions, with the greatest increases seen in effective communication at discharge (n = 73/126 [57.9%] to 116/120 [96.7%], P < .001), knowledge on safety event reporting (n = 53/126 [42.1%] to 96/120 [79.8%], P < .001), and considering costs in making health care decisions (n = 76/126 [60.3%] to 117/120 [97.5%], P < .001). All were directly addressed through experiential learning interventions, and 2 were intended practice behaviors. VISTA graduate responses to free-text questions demonstrated a more nuanced understanding of HSS compared with pre-VISTA responses. The AAMC GQ data showed increased agreement with an item that mapped to HSS understanding.

Next steps: The VISTA program provides a model for institutions to enhance HSS education between curricular overhauls. Next steps include implementing value-added roles and additional immersive learning exercises.

在医学院现有课程中开发和实施体验式纵向卫生系统科学课程。
问题:医学院毕业生进入的是一个复杂的医疗保健服务系统,涉及跨专业团队合作和多方面的以价值为基础的病人护理决策。然而,目前关于医疗系统科学(HSS)的课程都是零散的,以讲授为主,而且仅限于临床前培训:VISTA 计划是一项纵向的沉浸式学习课程,于 2016 年至 2018 年期间纳入芝加哥大学普利兹克医学院的课程。主要内容包括:以科室为单位的护理跨专业团队体验、出院客观结构化临床考试(OSCE)、患者安全模拟以及 "明智选择 "SmartPhrase的实施。VISTA 实施前(2016-2017 年)和实施后(2018-2020 年)的毕业生完成了一项李克特式调查,评估了他们对 HSS 主题的态度、知识和行为。一个自由回答的问题征集了改进领域。此外,还对美国医学院校协会(AAMC)的毕业问卷(GQ)进行了检查:VISTA 调查的总体回复率为 59%,其中 VISTA 之前有 126 名四年级医学生回复,VISTA 之后有 120 名四年级医学生回复。与 VISTA 前的毕业生相比,VISTA 后的毕业生在 HSS 问题上的胜任率显著提高,其中出院时的有效沟通(n = 73/126 [57.9%] 到 116/120 [96.7%],P < .001)、安全事件报告知识(n = 53/126 [42.1%] 到 96/120 [79.8%],P < .001)和医疗决策中的成本考量(n = 76/126 [60.3%] 到 117/120 [97.5%],P < .001)的胜任率提高幅度最大。所有这些都是通过体验式学习干预直接解决的问题,其中 2 项是预期的实践行为。与 VISTA 前的回答相比,VISTA 毕业生对自由文本问题的回答表明他们对人文社科的理解更加细致入微。AAMC GQ 数据显示,对与人文社科理解相对应的项目的认同度有所提高:VISTA 计划为院校在课程改革之间加强人文社科教育提供了一个模式。下一步措施包括实施增值角色和额外的沉浸式学习练习。
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来源期刊
Academic Medicine
Academic Medicine 医学-卫生保健
CiteScore
7.80
自引率
9.50%
发文量
982
审稿时长
3-6 weeks
期刊介绍: Academic Medicine, the official peer-reviewed journal of the Association of American Medical Colleges, acts as an international forum for exchanging ideas, information, and strategies to address the significant challenges in academic medicine. The journal covers areas such as research, education, clinical care, community collaboration, and leadership, with a commitment to serving the public interest.
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