News and Commentary Preparing Health Care Professionals for Population-based Care

Tyler Reimschisel, MD, MHPE, of Vanderbilt University School of Medicine, on preparing health professions students to deliver comprehensive, team-based care to patient panels in which all patients in the panel have similar medical conditions.

The Current State of Health Professions Education
Most of the health care provided through academic centers in the U.S. is highly specialized for individual patients with severe, complex, or rare conditions. Since many medical schools are administered through these academic centers, health professions education too frequently lacks meaningful training and experiential learning in population-based practice. Furthermore, the rotations and other educational interventions are often brief and cursory; therefore, students and residents lack genuine experience in longitudinal patient care and interprofessional team-based practice.

A Call for Change
Recently, academic health centers (AHCs) across the country have begun to transform their care models in response to the national call for integrated systems that focus as much on disease prevention and population health as they do on highly specialized inpatient services. This shifting paradigm creates a mandate: AHCs must fundamentally change their education models so that future professionals are equipped to provide comprehensive yet personalized care to patient panels in which all patients in the panel have similar medical conditions. To this end, I am implementing an innovative working-learning health system (WLHS) pilot in which students from multiple professions will work as an interprofessional health care team to provide individualized, cost-effective, comprehensive health services and care navigation to patient panels.

Making a Difference through Innovative Health Professions Education
What is a working-learning health system? A WLHS is a multigenerational, interprofessional team of health care professionals who are learning together while they provide comprehensive longitudinal care to patient panels through direct care and care navigation across multiple settings, including clinic visits, home visits, work or school visits, ER visits, communication with inpatient services if patients in the panel are admitted, following up with patients after discharge from the ER or inpatient setting, and connecting patients with community partners and resources. Importantly, patient interactions will extend beyond the traditional care settings to allow students to engage with patients in any setting that influences health and well-being. Each patient in the panel will also have a care plan that will guide the care that the team provides. Depending on the needs of the patient, the team will conduct care navigation by contacting the patient approximately every one to two weeks to check on the status of the patient and determine if the team can help facilitate services to the patient.

Each health care team will include faculty in medicine, advanced practice nursing, pharmacy, and social work; residents in pediatrics or the combined internal medicine-pediatrics programs; and students in medicine, advanced practice nursing, pharmacy, and social work. Students and residents will be immersed in the WLHS for an extended period of time - daily for one to three months.

Each morning the team in each WLHS will huddle to review its panel of patients to discuss individuals who are scheduled for upcoming appointments and any patients who have come to the team’s attention via alerts, messages, study results, or admissions. During the huddle, tasks will be assigned in a way that matches the care needs of patients with competencies and learning needs of team members.

Curriculum and Evaluation
The curriculum for the WLHS will include three levels of content: core knowledge such as health systems science, population and public health, health policy, socio-cultural determinants of health, and interprofessional communication skills; specialized medical knowledge that is specific to each clinical system; and just-in-time content that will be identified on an on-going basis by the health care teams as care is being provided to each patient panel.

A critical component for the success of this project is the comprehensive evaluation of each WLHS pilot. The Institute of Medicine has defined quality health care as service that is patient-centered, safe, timely, efficient, effective, and equitable. We will use this conceptual framework to conduct ongoing quality improvement measurements to ensure that the care being provided is having a positive impact on patients.

Looking Ahead
This two-year pilot experience will guide how we scale the model and disseminate it to additional patient populations and academic partners. We envision that this collaborative learning approach is the future construct of health professions education. As the emphasis turns to population health and health maintenance, students today need to spend less time in inpatient settings, and the WLHS could become a new “rotation” model in medical school and residency programs. What we learn through this pilot will enable us to inform how health professions education can respond to the imminent changes facing the U.S. health care system while enabling learners to work together to maximize the health and well-being of their patient populations.

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