Interdisciplinary Programming and the Pathway to DifferentiationPaul George | Director for the Dual Degree Program in the Warren Alpert Medical School, Brown University
The medical education marketplace is immensely competitive and the number of institutions participating grows every academic year. While demand for medical education is growing annually, it’s becoming increasingly difficult for institutions to set themselves apart. At Brown University’s Warren Alpert Medical School, they developed an interdisciplinary, two-credential track that provides students with their MD and an MSc in Population Medicine. In this interview, Paul George discusses some of the reasoning behind developing the program and provides a behind-the-curtains look at the process he and his colleagues went through to take the PC-PM from concept to reality.
The EvoLLLution (Evo): Why did you and your colleagues decide to launch the dual-degree program at Brown?
Paul George (PG): As we began planning the Primary Care-Population Medicine (PC-PM) program in 2012, there were several factors influencing its inception and current status.
The first was related to the rapid changes in healthcare. The days of the solo physician working independently were coming to an end. In its place, teams comprised of healthcare professionals (such as physicians, nurses, pharmacists, social workers) were working together to care for individual patients. The second change was the passage and implementation of the Affordable Care Act (ACA), in which millions of additional individuals would have health insurance and yet there was a deficit of primary care physicians (PCPs) to care for them (by some accounts, up to a 40,000 to 50,000 shortage of PCPs in the United States). Third, physicians, as part of the ACA and as a result of other reforms in the healthcare system, needed to demonstrate that they provided quality care to their patients and were paid, at least partially based on the outcomes of their patient panels. No longer could a physician simply take care of the patient in front of them; physicians now have to manage their population of patients. Finally, the medical education system was in need of an overhaul. Future physicians were being trained for the healthcare system of the 20th century, not the 21st century. Skills such as teamwork, leadership, data mining to provide the best outcomes for individual patients and populations—what we are terming the “third science” (besides basic science and clinical science) of healthcare delivery—was not being taught.
This combination of factors led our team at the Warren Alpert Medical School of Brown University (AMS) to develop the PC-PM program, in which students earn both a Doctor of Medicine degree and a Master of Science in Population Medicine.
Students in the program will take nine integrated courses across four years of medical school—in addition to the regular MD curriculum—focused on topics such as health disparities, social determinants of health, leadership, healthcare systems, biostatistics/epidemiology and research methods in population medicine. This aims to prepare our students for a career in the rapidly evolving healthcare system. In addition, students will do research to complete their master’s degree in an area related to population medicine.
Evo: What were some of the most significant roadblocks you encountered in launching and managing this program?
PG: Fortunately, there were not many significant roadblocks. Of course, launching a new degree program of any type presents challenges. We believe that we are the first integrated dual degree program in the United States that merges clinical and population medicine. Our team at AMS spent a large amount of time researching other programs, including Master of Public Health programs. We talked with key stakeholders at Brown and all over the United States to get input about our planned curriculum, as well as mining their expertise about what our students should learn. One of the things we realized very early in the process, especially as we went through committees reviewing our proposal, was that everyone had an opinion about what we should include. That was a good thing and allowed us to have input from those not involved day-to-day in healthcare, but who had expertise in public policy, economics, anthropology and other areas. All of their input greatly strengthened the program.
The other aspect of the program was the development of a Longitudinal Integrated Clerkship (LIC). Unlike the master’s program we created, however, we can’t take credit for the LIC. This is the model in which third-year medical students in in the PC-PM program will train during their clerkship year. Unlike traditional clerkship models, in which students rotate through various disciplines in block rotations (such as internal medicine for 12 weeks and Pediatrics for six weeks), students in the LIC do all of their third year rotations together in which they spend a half-day per week over the third year with a mentor in each of our seven core clerkships (internal medicine, family medicine, pediatrics, general surgery, obstetrics and gynecology, neurology, and psychiatry). This model has been used in about 30 other United States medical schools (and in schools in Canada, Australia and elsewhere as well). The benefits of this model are that students can form longitudinal relationships with their patients and their mentors. Studies show no difference in outcomes between students who do an LIC and students who do the more traditional clerkship model, but students who do an LIC are more patient-centered and less cynical about being physicians.
The main roadblock in the development of the LIC is that it is very labor intense—we have had to recruit seven preceptors per student and align schedules, which can be challenging.
Evo: What kind of reception has the program received from the medical education community?
PG: The reception from the medical education community has been incredibly positive. When we first proposed the program, we applied for funding through the American Medical Association’s Accelerating Change in Medical Education grant initiative. Approximately 120 medical schools in the United States applied for grant funding, in which schools were tasked with finding ways to change the paradigm in which future physicians are educated. We were one of 11 schools selected by the AMA to receive a $1 million grant. We, along with the other 10 schools, are now part of a Consortium to improve medical education so our graduating students are well prepared to succeed in the current healthcare environment. There has also been interest within the Consortium about the specific aspects of our program and I’ve talked with faculty at a number of schools who are looking to implement curricula around health disparities, social determinants of health and the US Health Care System. I’ve also talked with faculty at several schools about our LIC model and how we are modifying it to make it uniquely Brown (such as integrating two of our master’s degree courses into our LIC).
I think one reservation that other schools potentially have is the scope. As I mentioned earlier, it takes significant resources to implement a new degree program. Having faculty resources, such as expertise in population medicine and medical education, is difficult. That being said, effectively teaching health disparities and social determinants of health has piqued the interest of medical schools, as has the integration of master degree courses within the LIC. We’re also teaching knowledge and skills around important topics such as quality improvement and leadership that is of interest to other medical schools.
Evo: How have students responded to the availability of this more interdisciplinary program?
PG: The response from students has been strong. Admission to the PC-PM program was quite competitive and we enrolled 16 students in our first class, which began just a couple of weeks ago. The students who enrolled in the program are a diverse group, many of whom have done amazing things even at this early stage of their careers. We have one student who worked as a financial analyst for 10 years, another who has done significant public health research, and still another who was in the Peace Corps. We also have several students who are interested in working with the prison population.
One of the interesting things we’ve encountered, as a result of the development of this program, is that students not enrolled in the PC-PM program have expressed interest in certain elements of the program. Therefore, our first course on health disparities and social determinants of health is now part of the curriculum for all of our medical students. In addition, we are currently piloting our LIC with students not in the PC-PM program (as our first cohort of PC-PM students will not reach third year until 2017). We had 20 students who applied for eight available positions; based on the positive feedback, we have students who are not in the PC-PM program, but still want to do the LIC.
Evo: What do you think the future holds for interdisciplinary education in the medical education field?
PG: I personally think we are going to see more interdisciplinary endeavors in the medical education field. Out of necessity and based on the need for graduating medical students to be patient-centered, all students are going to need more education in the third science of healthcare delivery. Physicians are going to be expected to work in and lead inter-professional teams. They are going to need to understand payment systems and the determinants of health in the communities in which they work. They are going to need to initiate quality improvement projects to improve the care they provide to individuals and their population of patients. Teamwork with groups of healthcare professionals will be essential to achieving important goals in ensuring health and wellness.