New AMA textbook schools students on EHRs, emerging medical practice

Curriculum underscores effort to update education to better prepare future docs, says Susan Skochelak.

The American Medical Association on Tuesday launched a new “health systems science” textbook designed to provide medical students with a modernized curriculum that properly prepares future physicians for a 21st century healthcare system, including the successful use of electronic health records.

“Emerging technologies are rapidly changing the world and the practice of medicine. And, yet, for all of these advancements, the way we train and educate new doctors actually hasn’t changed that much,” said AMA CEO James Madara, MD.

According to Madara, the “focus and overall structure” of the curriculum currently taught at U.S. medical schools is essentially the same as what it was in the early 20th century. As a result, he contends that there is an “ever-widening gap” between how physicians are educated and trained, and the “practical realities of the modern healthcare environment.”

Working with a consortium of 11 medical schools nationwide, AMA developed the textbook to “help medical schools across the country teach their students the knowledge, skills and behaviors they will need to deliver care in the rapidly changing healthcare environment while also understanding how patients receive and access that care.”

Among the topics that the textbook focuses on are value in healthcare, patient safety, quality improvement, teamwork and team science, clinical informatics, population health, socio-ecological determinants of health, as well healthcare policy and economics.

“The EHR is the No. 1 tool for physicians nowadays. We wouldn’t let our young, future physicians graduate without knowing how to use a stethoscope, yet we’ve not been that careful about electronic health records,” said Susan Skochelak, MD, AMA’s vice president for medical education outcomes. “As part of our medical school consortium, we’ve been doing deep work in this area, including how to train students in electronic health records.”

Also See: AMA supports EHR training for medical students

Skochelak noted that the AMA has been collaborating over the past few years with its 32-school Accelerating Change in Medical Education Consortium to identify the innovations needed to create the “medical school of the future.” In particular, she pointed out that the Indiana University School of Medicine has piloted the teaching of EHRs to ensure competencies in system-, team- and population-based healthcare, as well as clinical decision-making, using de-identified patient data.

“It teaches students across three years of medical education ways in which to enter data specifically within the EHR, rather than just train on the EHR when they enter into their residency program,” according to Skochelak.

Jed Gonzalo, MD, assistant professor of medicine and public health sciences at the Penn State University College of Medicine, said one of the challenges in teaching students how to use EHRs is the multiple systems from a plethora of vendors implemented at various healthcare organizations that future physicians will encounter during their medical careers.

“I’ve written orders at six or seven different hospitals in the past eight years, and I’ve used six different EHR platforms,” noted Gonzalo, who is also the associate dean for health systems education in the Penn State College of Medicine and leads the design and implementation of curriculum related to Health Systems Science.

According to Gonzalo, the new Health Systems Science textbook helps to train medical students in EHR core competencies so they have the requisite skills in clinical informatics. “It’s not about a specific EHR and more about the skills that we want them to acquire as they transition to be systems-ready physicians as interns,” he said.

Jeff Borkan, MD, assistant dean for primary care-population medicine program planning at Brown University’s Warren Alpert Medical School, added that educating medical students also includes training them in how to “mine the EHR data” for population health management. Borkan contends that EHRs have the capabilities to aggregate information so providers can achieve better health outcomes.

AMA provided $11 million in “seed money” to participating consortium medical schools to “push the boundaries of traditional medical education,” said Madara. For instance, Warren Alpert Medical School received a $1 million AMA grant to create its Primary Care-Population Medicine program, the goal of which is to “provide students with the knowledge, attitudes and skills to understand health and disease in context and to be able to enlist system and inter-professional teams and resources in the pursuit of improved population health.”

At Brown University, Borkan said the medical school is “beginning to train the students in how to look at panel-level data—something which has never been taught before,” awarding graduates both a Doctor of Medicine and a Master of Science in population medicine. According to Borkan, Warren Alpert Medical School ‘s Primary Care-Population Medicine program is the first in the nation designed to develop physicians who—with training focused on population health—can be “future leaders in community-based primary care at the local, state or national level.”

Overall, Skochelak said that many of the medical schools within AMA’s consortium have already begun implementing the new textbook into their curricula, including Penn State College of Medicine and the Warren Alpert Medical School. However, the textbook—published by Elsevier—will not be officially available to all medical schools until mid-December.

“It’s our belief and our hope that Health Systems Science will soon be a cornerstone of medical school curricula across the country, giving our doctors of tomorrow insight into not only how to deliver care in this increasingly complex world but how our patients experience it,” concluded Madara.

“Health Systems Science has emerged as the third pillar of medical education that should be integrated with the two existing pillars—basic and clinical sciences,” added Skochelak. “We look forward to continuing our efforts to accelerate change in medical education to ensure our future physicians learn about the newest technologies, healthcare reforms, and scientific discoveries that continue to alter what physicians need to know to practice in our modern health system.”

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