Background: Systems-based practice (SBP) is critical to physicians’ work and is gaining emphasis in medical school curricula.
Purpose: In this hospitalist-led pilot curriculum for first-year medical students, we developed a novel didactic and experiential approach to teaching SBP skills, seeking to help students apply newly-acquired SBP concepts to inpatient improvement projects to add value to the clinical environment.
Description: For the 12 first-year students assigned to Hospital Medicine preceptorships, we developed a 17-session curriculum to teach traditional clinical skills alongside novel SBP concepts. We presented didactics and workshops around QI terminology and methods, healthcare costs/value, health IT, and patient experience. Sessions were developed and facilitated by hospitalist junior faculty with SBP interests, and emphasized real-world examples of translating SBP skills into improved quality of care. Students used their growing QI skillset to contribute to four inpatient projects: reducing unnecessary phlebotomy, improving patients’ sleep, improving the EMR’s interface with primary teams, and humanizing patients through personal photos at bedside. We surveyed students on knowledge and skills learned after each session, as well as globally at the end of the curriculum. Response rate was 100% and revealed that students felt they could define QI terms (mean 4.2 on 1-5 Likert scale of “strongly disagree” to “strongly agree”), develop goals for QI projects (mean 4), and describe factors driving healthcare costs (mean 3.8). Students felt the curriculum was relevant to their professional development (mean 4.3) and that they would apply the learned SBP concepts and skills to their future work (mean 4). Content analysis revealed that students particularly valued SBP experiences that involved direct patient interactions, and further showed that students engaged in critical thinking related to effects of SBP on authentic clinical practice, controversies surrounding SBP issues, and consequences of current approaches to SBP. Faculty analysis of project outcomes demonstrated a significant positive impact of the students’ work on QI outcomes.
Conclusions: Our results show that curricula integrating clinical and SBP learning can effectively teach pre-clinical students the basic concepts and skills of SBP. Furthermore, students’ feedback indicates that the ability to tie SBP content into clinical skills and contextualize it with real patients may even be necessary for maximum learning and retention of SBP for learners with minimal prior clinical experience. Even without significant clinical experience, however, students were able to use this fairly brief exposure to SBP to propel them into high-level thinking about key systems issues. Finally, dedicated SBP curricula with close faculty mentorship can empower students to contribute meaningfully to systems improvement projects in clinical settings, even at early stages of training.