Threads

Leader: Douglas Char, MD

Background

Physicians must know more than biomedicine to be effective practitioners in the 21st century. Advances in medical science are allowing patients to live longer more productive lives. A patient’s sociocultural background informs their health beliefs and behaviors. Physicians-in-training must be prepared to deal with an increasingly diverse patient population. Exposure to patients of varying races and ethnicities, physical abilities, sexual orientations, religions, and socioeconomic backgrounds, coupled with information gathering tools will provide students a framework within which to form effective patient-doctor relationships. Social determinants of health include not only individual behavior, but environmental exposures, and social circumstances. Factors such as culture, education, work environment, living conditions, access to health care services, lifestyle factors, and general socio-economic conditions all contribute to health, wellness and disease. Physicians must understand how these system issues influence their patients, at both the individual and population levels, and be prepared to apply this knowledge to deliver and advocate for excellent patient-centered care.

Goals

The goal is to prepare physicians-in-training equipped to understand patients in the context of their lives who can provide culturally sensitive health care to diverse populations, and are comfortable working with patients and families of varying abilities, socioeconomic, educational and lifestyle backgrounds.

Implementation

Development of these skills, and the emotional intelligence to apply them, is introduced early and continued across the four-year curriculum. Providing culturally appropriate care to a diverse population of patients is one of the School’s primary educational objectives. Activities to help students achieve these objectives are woven throughout the curriculum both during specific IDEA focused sessions and integrated into general coursework. IDEA focused session are highlighted in the Practice of Medicine (1st-3rd year) in small group discussions and exercises that provide a forum for open dialogue aimed at raising awareness of students’ pre-existing concepts and biases, and sets the stage for reflection and self-discovery.

Year 1: Preclerkship courses

Where appropriate, efforts are made to include information that provides a foundation and awareness of perspectives as it relates to IDEA (Inclusion, Diversity, Equity and Advocacy) beyond Practice of Medicine in preclerkship subject matter.

Practice of Medicine I

• The value and impact of IDEA (Inclusion, Diversity, Equity and Advocacy) are specifically addressed during WUMP and the Diversity Retreat during orientation.
• IDEA session:  The Impact of Social Identities and Implicit Bias is explored in the winter.
• Information about the impact of health care inequity, the needs of special populations and the impact of culture, education, religious beliefs, lifestyle and socioeconomic differences are also interwoven into other sections of Practice of Medicine; Clinical Skills ( History & Physical Exam, Advanced Communication Skills, Standardized Patient Sessions), Patient, Physician and Society (Ethics and Humanities), and Clinical Knowledge (Scientific methods and public health).

Year 2: Preclerkship courses

Where appropriate, efforts are made to include information that provides an introduction of principles in clinical care as it relates to IDEA (Inclusion, Diversity, Equity and Advocacy) beyond Practice of Medicine in preclerkship subject matter.

Practice of Medicine II

• IDEA session:  Providing Culturally Appropriate Medical Care.  Students are given the opportunity to address differences in patient’s worldview and how this may impact their understanding of health and disease.
• Information about the impact of health care inequity, the needs of special populations and the impact of culture, education, religious beliefs, lifestyle and socioeconomic differences are also interwoven into other sections of Practice of Medicine; Clinical Skills (History & Physical Exam, Advanced Communication Skills, Standardized Patient Sessions), Patient, Physician and Society (Ethics and Humanities), and Clinical Knowledge (Scientific methods and public health).

Year 3: Clerkships

Direct hands-on patient centered interaction is central during Clerkship rotations. Students are invited and challenged to understand disease processes and treatment options in the context of the patient’s socioeconomic, ethnic, religious, lifestyle background.

Practice of Medicine III

• IDEA session:  Dealing with Incendiary Patients. Toward the end of the third year, students gather to discuss how best to address patients whose attitudes and behaviors challenge the physician-in training’s personal and professional identity.

Year 4: Capstone

Students given the opportunity to engage in discussion about what patient advocacy is and looks like, in terms of patient-physician interactions.

Leaders: Ellen Binder, MD and Lenise Cummings-Vaughn, MD

Background

Aging and associated disease and disability are increasingly important given the shifting demographics in the world’s population. According to the United Nations Department of Economic and Social Affairs’ 2002 report, World Population Aging 1950-2050, the number of older adults has tripled in the last 50 years and is expected to triple again over the next 60 years. Population projections from the Centers for Disease Control indicate that by 2030, one in five people in the U.S.A will be aged 65 or over.. The public health significance of this demographic transformation include a substantially increased burden of chronic disease and disability to be managed by our health care system and providers, and socioeconomic impacts on care giving. Therefore, all physicians and health care providers will need to understand the impact of aging on health and disease.

Goals

Systematically introduce students to the basic physiology of aging, develop an understanding of geriatric screening, assessment and syndromes, and cultivate skills for implementation in practice.

Implementation

Year 1: Preclerkship courses

Concepts of aging physiology and pharmacology will be introduced in preclerkship courses such as cell and organ systems, neural sciences, and practice of medicine. The focus will be primarily on normal aging processes. These experiences will focus on increasing the student’s understanding of aging physiology, normal cognitive aging, and general principles of geriatric practice.

Practice of Medicine I — Home visits
As part of the Home Visit module students will have the opportunity to interact with older patients. They will gain an understanding of the impact of social, psychological, and economic factors on health, chronic disease, and functional status. The students will work in small and large group to develop important communication and observational skills for this module.

Year 2: Systems courses

During the second year, the physiology, pharmacology, and pathology that are altered by aging processes are integrated into many of the organ system and clinical blocks, Diseases of the Nervous system, Psychiatry, Infectious Diseases, Pulmonary Diseases, Nephrology, Cardiology, Obstetrics and Gynecology, and Clinical Topics in Otolaryngology.

Year 3: Clinical clerkships

With the background of the first two years, our goal is for students to be more adept at recognizing geriatric syndromes and atypical presentations of disease in older adults, and apply this information in a variety of clinical settings. While on the internal medicine and psychiatry clerkships, students will be expected to perform screening assessments for geriatric syndromes, in order to gain more experience in this area.

Year 4:  Capstone

Capstone sessions offer geriatric focused materials such as hospice and palliative care, falls, altered mental status and preventable harm.

Elective Clerkship in Geriatric Medicine
Third and fourth-year students have the opportunity to take a 4-week elective in Geriatric Medicine. The primary goal of this clerkship is for students to gain proficiency in the principles of geriatric evaluation and interdisciplinary team management, including medical, psychological, social, and functional assessments of older adults. Students work in a variety of settings, including the outpatient Geriatric Assessment Clinic, in-patient Geriatric consults, nursing home, home care, and hospice rounds, and at the Rehabilitation Institute of St. Louis (TRISL).

Leaders: Emily Fondahn, MD and Tom De Fer, MD

Background

Quality Improvement and Patient Safety (QuIPS) have been recognized as important topics for physicians to understand how to provide excellent patient care. The growing complexity of medical health care systems and the recognition of providers’ roles in addressing and improving these systems has led to the incorporation of patient safety and quality improvement (PSQI) curricula in the undergraduate medical education curriculum. Medical errors were recently reported as being the third cause of death in the United States (Makary and Daniel 2016). Medical students need to learn about how and why errors occur in healthcare and how to help design systems to make medical care safer for patients.

The longitudinal PSQI curriculum for Washington University Medical School serves as the launching point for a continuum of training that extends into residency and beyond. This curriculum includes a variety of elements throughout the four years of medical school that incorporates focused “QUIPS weeks” as well as the recognition of these topics that are integrated throughout the existing core curriculum. The sessions include a variety of didactic lectures, small group sessions, and online modules.

Goals

The PSQI curriculum will introduce students to the basic fundamental principles of patient safety and quality improvement, including models for improving healthcare quality, culture of safety and error reporting.  Students will be able to apply these principles to prevent patient harm and identify opportunities to improve healthcare.

Implementation

Year 1

First year students will be introduced to patient safety.  Students will have two hours of didactic lecture, followed by two hours of small group sessions.  During the small group sessions, the students will complete a fishbone diagram outlining how a medical error occurred, brainstorm solutions for preventing errors from occurring, and discussing the impact of medical errors on providers.

Year 2

Second year students will be introduced to quality improvement.  Students will have two hours of didactic lecture followed by two hours of small group sessions. During the small group sessions, students will brainstorm how to improve patient care at the Saturday Neighborhood Health Clinic (SNHC) and determine how to initiate a quality improvement project using the Institute for Healthcare Improvement (IHI)s Model for Improvement.

Year 3

Third year students will revisit the concept of patient safety through didactics during POM III.  During their Internal Medicine Clerkship, they will have a didactic lecture focusing on the fundamental aspects of patient safety in the context of clinical care.  They will also complete a Quality Improvement Log Book to assess gaps between actual care and recommended care.

Year 4

Fourth year students will learn how to prevent patient harm, including DVTs, falls, pressure ulcers and healthcare associated infections during Capstone.  Other Capstone sessions will also address informed consent, communication skills, and handoffs.  These sessions are design to provide practical skills to for graduating students to provide safe and effective care as interns.