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

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.

The Impact of a Scholarly Concentration Program on Student Interest in Career-Long Research: A Longitudinal Study.

PURPOSE: Concerns remain regarding the future of the physician-scientist workforce. One goal of scholarly concentration (SC) programs is to give students skills and motivation to pursue research careers. The authors describe SC and student variables that affect students' career plans. METHOD: Medical students graduating from the University of Chicago SC program in 2014 and 2015 were studied. The authors measured change in interest in career-long research from matriculation to graduation, and used ordinal logistic regression to determine whether program satisfaction, dissemination of scholarship, publication, and gender were associated with increased interest in a research career. RESULTS: Among students with low baseline interest in career-long research, a one-point-higher program satisfaction was associated with 2.49 (95% CI 1.36-4.57, P = .003) odds of a one-point-increased interest in a research career from matriculation to graduation. Among students with high baseline interest in career-long research, both publication (OR 5.46, 95% CI 1.40-21.32, P = .02) and female gender (OR 4.83, 95% CI 1.11-21.04, P = .04) were associated with increased odds of a one-point-increased interest in career-long research. CONCLUSIONS: The impact of an SC program on change in career plans during medical school was analyzed. Program satisfaction, publication, and female gender were associated with increased intent to participate in career-long research depending on baseline interest in career-long research. Two ways to bolster the physician-scientist workforce are to improve satisfaction with existing SC programs and to formally support student publication. Future work to track outcomes of SC program graduates is warranted.

Problems after discharge and understanding of communication with their primary care physicians among hospitalized seniors: a mixed methods study.

BACKGROUND: Communication and coordination with primary care physicians (PCPs) is recommended to ensure safe care transitions for hospitalized older patients. Understanding patient experiences of problems after discharge can help clinical teams design more patient-centered care transitions. OBJECTIVE: To report older patients' experiences with problems after hospital discharge and investigate whether PCPs were aware of their hospitalization. DESIGN: Prospective mixed methods study. SETTING: Single academic medical center. PATIENTS: Hospitalized patients and PCPs. MEASUREMENTS: Telephone interviews of frail, older general medical patients conducted 2 weeks after discharge to elicit patient problems after discharge, such as: (1) obtaining medications, or follow-up appointments; and (2) perceptions of hospital physician communication with their PCP. For each patient interviewed, their PCP was faxed a survey 2 weeks after discharge to assess awareness of hospitalization. RESULTS: Forty-two percent (27) of patients reported 42 different post-discharge problems. The most frequently reported problems were difficulty with follow-up appointments or tests (12). Other reported problems included readmission and return to the Emergency Department (10), problems with medications (8), not-prepared for discharge (8), and hospital complications or questions (4). Thirty percent of PCPs were unaware of patient hospitalization. Patients were twice as likely to report a problem if their PCP was unaware of the hospitalization (31% PCP aware, vs. 67% PCP not aware; P < 0.05). CONCLUSION: This study suggests that many frail, older patients reported problems after discharge and were twice as likely to do so when the patient's PCP was not aware of the hospitalization. Systematic interventions to improve communication with PCPs during patient hospitalization are needed.