Health Systems Science: What is it and Why is it Important to Medical Education?

Representing you all right it looks like it's 12 o'clock good afternoon and welcome to the introductory session for health system science so we realize that any time any big change is introduced at any point on the medical education continuum especially when it impacts all points on the spectrum it can be a little bit unnerving and while health system science is being integrated within the medical school curriculum it will impact us all in the way that we learn we teach and or practice so we started the discussion last year when dr jed gonzalo visited us and introduced us to the overall concept and after what i think we would all agree is uh a was a pretty tumultuous year we are back to discuss what health system science will mean to us all on a more localized level so look forward to more sessions seeing more sessions like this interspersed with uh with throughout our curriculum as we explore what health system science will mean to us all so now i'm going to just turn it over to um dean lehrman to get us to get our discussion started take away dean thank you dr wicker and it's great to see everybody here some familiar faces and others who i haven't seen in a little while uh what a year it's been my goodness you know a year ago it was sort of a gleam in the eye that we were talking about health system science a little bit more than a gleam we had done some good work on a task force and figured out an innovative way to integrate it with our previous domain of interprofessionalism and here we are having launched it in july and really working hard to anticipate the needs for future years i recruited a wonderful team of co-leaders who we were blessed with having today dr samara and carp and also our new chair of interprofessionalism dr sarah parker who's going to introduce uh the the overall topic before throwing it to dr parker um i just want to say that this this faculty development effort is so important we're really going to be uh in many ways co-learning even even after we grasp the concepts and the importance of the concept we're all going to be learning together around how optimally to implement educational components here and ultimately there may be other programmatic components and research and and other important areas of focus that come out of this effort i was really pleased to see health system sciences mentioned in some of the the drafts of the korean clinic 20 vision 2025 strategic plan and it does represent absolutely an area of shared um interest for the medical school and for carillion so um it's wonderful to see you here today um we are going to be on this journey together i look forward to hearing the presentation that we're all about to hear together and launching a what we'll call in our spiral curriculum of coming back around health system science diving deeper than we have in the past through our curricular offerings in the coming year with respect to this very important innovation in our medical school so with that um i will throw to dr parker our chair who is going to set the stage for the rest of the discussion thank you sure thank you dean lehrman so good morning afternoon i'm not sure everybody my name is sarah parker and i'm really excited to get to talk to you all about this today along with doctors carp and morrow we're going to be discussing exactly what we mean when we say what is health system science and then we're going to talk a little bit more specifically about what does that look like to execute here within the virginia tech korean school of medicine and as uh as dean lehrman said you know we're really um kind of at the beginning stages of this journey so we are excited to learn with you and alongside you um and to figure out the best way uh or ways to kind of integrate this into the medical education uh curriculum as we stand right now as well as into our research curriculum so um i wanted to take a quick moment and introduce the the speakers for today um so first is dr cynthia morrow um before joining the faculty at virginia tech creating school of medicine dr morrow was the learner chair for health promotion at syracuse university and professor of practice at the maxwell school of syracuse university and she served as commissioner of health for owen dega county in new york um during which time she was awarded a number of different uh she received a number of different awards from community-based organizations here in in her role at the vtc som she serves as a pbl facilitator and um is our block or kind of our m1 m2 our phase one curriculum lead for interprofessionalism and health system science in addition to being a wonderful educator she's written extensively she has five different books published on public health and administration and she's a consulting editor for the journal of public health management and practice and importantly right now especially she is also serves as the health director for renault city and allegheny health districts and so we're super fortunate to be able to have her to be one of our experts in health systems science curriculum i also wanted to introduce dr natalie carp dr carp joined carillion in btc som in ob gyn after completing residency at uva and a fellowship at university of michigan in urogynecology she has received a number of awards for outstanding teaching and during her residency she received an award for outstanding professionalism granted to her by the uva nurses in addition to being the ob gyn clerkship director he's also um our co-leader of health system science and interprofessional practice for phase two or the m3 and m4 experiences so with that it is my delight and pleasure um as i've gotten to interact more with both of them to learn from doctors morrow and carp and i hope you all will enjoy the presentation today on health system science and why it's important for medical education all right well hello everyone um thank you so much for joining us today we have no disclosures um i will go ahead and start off with just our goals and objectives so as promised we're going to explain what actually is health system science we will identify the functional foundational and linking domains of health system science and review their application medical education and health care we'll be going over our new four-year health system science and inter-professional practice curriculum and dr parker is going to take us through systems thinking and its importance in health care so what actually is health system science well the textbook definition is that this is the study of how healthcare is delivered how healthcare professionals work together to deliver that care and how the healthcare system can improve patient care and healthcare delivery um and as one of our national colleagues put it a little bit more succinctly um we can think about it as how healthcare is delivered to and received by patients and populations so when we think of our sort of traditional two pillars of undergraduate medical education we think about basic science and clinical science but now we're adding health system science formally as a really vital third pillar for medical education and i mean we really can't underestimate the need for health systems things right now we it would be hard to ignore how the pandemic and structural racism have really exposed some of the large flaws in our health care system um and have really illustrated this need for formal health system science education in medical education another way that i like to think about defining health system science in a really simplistic manner is what are all of the things that we didn't learn in medical school that we then had to grapple with or figure out as trainees um and attending so i asked some colleagues around the country in all different specialties across institutions at all levels from you know trainees through to attendings what were the unexpected barriers to patient care that you faced in training or beyond that you really didn't have an understanding of or didn't learn about in your undergraduate medical education and so here's a sampling of what they told me limited connection of care between specialties and imaging under the same roof creating barriers of care and just an overall lack of equal access to care insurance transportation being a huge barrier for patients consultations being difficult to abstain obtain and no clear consult pathways for different specialties being with systems that don't value support staff who can do non-physician-level tasks to support and improve patient care medical literacy of patients one of my colleagues said that they were surprised at how some of their patients didn't really have a good understanding even of how pharmacies or prescriptions work the electronical medical record one of my colleagues said that when they started fellowship they knew a patient needed a blood transfusion and clinically knew that from their training but they couldn't actually make it happen because they couldn't find the right order in the electronic medical record communicating medical knowledge and science to patients in a clear manner and making treatment plans with them with everything else their patients are seeing or reading on the internet and on facebook cynthia is going to take us a little bit through why all of this change is needed okay great thank you well i think that we really heard the compelling reasons why change is needed and here at virginia tech curling school of medicine you know we've done a great job with education with our four domains basic science clinical science research and interprofessional education however we have to face the reality that all of us are learning to work in an increasingly complex environment and i think that those quotes really um accentuated that and that we need to prepare both ourselves and our learners for for this incredibly complex world in which we're living um and health system science provides us with that framework of building off clinical science basic science and research it provides us with the the ability to to have tools to teach ourselves and our learners um to do better with the ultimate goal of achieving quadrupling which i would expect that everybody on this call is very familiar with but really if we look at quadrupling we look at things like the patient experience provider experience costs um and outcomes we need all of all of us to be on the same page with how do we get to the core of how we improve the way we perform in complex health systems and the way we educate students in these complex systems so i just mentioned that um we we here at the school of medicine have been talking about four domains and one thing that dr carp and i are going to focus on now is that there's a different we have a different interpretation of domain and so dr carpenter couple of minutes is going to walk us through each of the domains in health system science um and what we think we think that looking through each of these will have the ability to to show how we take an increasingly complex system and apply it to the one-on-one patient situation so if we think about our one-on-one clinical experiences with our patients as just being the tip of the iceberg another way for us to look at their domains is to look at everything else that is happening underneath the surface and that's that's really where health systems science comes in it's really helping us navigate this water um where there's so many influences affecting our patients lives and affecting our ability to provide care for those patients um and again with respect to education making sure that all of our learners understand all how all of these hidden factors beneath the surface are affecting their one-on-one patient care so dr karp's now going to walk us through each of these domains through our wheel after going through a clinical example so let's go through just sort of a quick case to help us understand this a little bit more so if we have a 35 year old man with right lower quadrant pain who comes into the emergency room in our traditional medical education model with our students looking at sort of our traditional pillars of basic and clinical science we would of course want to make sure that our students can get an appropriate history that they can form a differential diagnosis that they understand what lab studies we need to order to make a diagnosis in this patient what imaging we need and ultimately what is the appropriate treatment plan for this patient whose diagnosis happens to be as some of you might have guessed acute appendicitis and here we see that this is sort of our tip of the iceberg picture of just our care that we're providing to this individual patient but when we look at this case also through a health system science lens we can start to see all of the other things under the surface that might in fact influence this patient's care that we need to be able to explain to our learners both trainees and medical students so when we think about health information technology and the electronic medical record well this patient came into the emergency room had antibiotics ordered but then when he was transported up to the pre-op area the antibiotic fell off in the transfer orders so he actually in fact didn't receive the antibiotics that were ordered when we think about teaming and interprofessionalism as often happens with these urgent or emergent presentations we have a night on call or surgery team they're not very familiar with laparoscopic cases and so there's a pretty significant delay in setup and delays during what turns out to be a pretty difficult case so why is this case for this patient so difficult for just you know a young patient with acute appendicitis well as many of our patients are in the same scenario this patient does not have employer sponsored health insurance he is uninsured and self-pay and he delayed seeking care due to fears of health care costs so by the time he gets to the operating room the appendix has ruptured which increases the case difficulty increases his length of stay and ultimately increases the risk of complications after surgery and so these are some of the behavioral and social and policy factors under the surface that are going to influence this patient's care and influence his health outcomes so as promised we're going to go through all of these functional and foundational domains so of course when we start we're starting with a patient at the center so who is the patient and what are their values when we think about health system improvement we're thinking about really teaching our learners how do we improve performance in any and all of the components of our healthcare system when we're talking about value in healthcare we're looking at how our system performs in terms of cost waste and our healthcare outcomes for population public and social determinants of health what are all of the other factors that are influencing our patients health we have pretty significant evidence now that a lot of these social and public health factors play a very large role in health health outcomes and likely even a larger role than the immediate care that we're providing for patients for clinical informatics and health technology how are tech and data used in healthcare so this is when we're thinking about our emr telehealth big data all of those things healthcare policy and economics how is healthcare consumed and who is paying for it and for healthcare structure and process how and where is healthcare being delivered are we at a large academic medical center our rural community center a public health center private imaging center and how do all of those different healthcare organizations interact for our foundational exam domains we have teaming so this is where we get into inner professionalism how do we collaborate and communicate effectively for change agency management and advocacy how do we as a healthcare provider level impact systemic change and advocate for our patients and what are the ethical and legal factors that are impacting healthcare delivery to our patients and populations and then what leaders do we have in health care um so how are we leading our clinical and assistance teams not only do we have leaders at the top you know our cmo ceo um department chairs etc but there's also leaders just on a more micro level of the clinical teams where we have leadership in the trauma bay leadership on inpatient services as chief residents so cynthia's going to take us through another case which she is very familiar with in our current context just just a little familiar um so just as we had a clinical example we thought that it would be helpful to send which the domains with clinical example in a public health example and so since covet vaccine seems to be on everyone's mind we thought that it would be helpful to go through an example with um coded vaccine delivery so we have an 87 year old female who would like to get vaccinated um she lived by herself in public housing and she's not particularly comfortable with technology so what systems are at play here that that influence her ability to get vaccinated but the first thing we need to understand this gets to health policy really is where's the vaccine coming from so the vaccine is a federally purchased vaccine that's distributed from the federal government to the state health department from the state health department to local health departments in a parallel process there are there's a federal retail pharmacy pathway where pharmacies are getting vaccine themselves so how does this older woman who has limited proficiency with technology access vaccine well we need to understand okay we have the vaccine but how is it getting to individuals um is there a target population and we all know that with a limited resource we we have to triage so where where is the state with respect to the different phases of vaccine eligibility is she eligible certainly in february um of this year she is eligible so that shouldn't be a barrier but how does she notify anyone that she wants vaccine where is the vaccine that's not at this point with primary care providers or or with other physicians within the or providers within the healthcare delivery system it's really either at pharmacies or it's with the in the healthcare delivery system i mean with the public health system so how does she access it what kind of system is in place currently the state has a centralized pre-registration process but you need technology to get to it or at least until last week you needed technology to get to it now there's a centralized call center so with cooperation and partnership with the media and why dissemination of information now she knows that she can actually call a number and someone on the other end of that phone can register her um but so she's pre-registered how does she then get to the vaccine site if she receives if the caller says okay i can actually schedule you how does she get to that vaccine site well it depends if she has transportation if she has someone who can if she doesn't have her own transportation does she have someone who can get her to that transportation or is the local health department arranging um what we would call a strike team to go into particularly vulnerable communities so in this particular situation um in a public housing unit that that is housing for people who are older there was a specific event in her community um but she does she know that what was the outreach of that community um when she gets to the site is there accessibility if she has if she has mobility impairment does she speak the language of the people who are vaccinating and registering her you can start to see that there's so many layers of complexity and so many different ways in which the health system or the public health system absolutely plays a role in whether she has access to vaccine or not and you can imagine that there's so many other factors at play but that's just another example of all of the systems in place that ultimately end up in a clinical intervention and that's a vaccine i just want to give one other really concrete example of health systems and this this is happening this week so last week if we received a tray of pfizer vaccine of 195 vials of pfizer vaccine we were told to expect to get 900 [Music] 975 vaccine doses out of that tray well that's assuming five doses per vial the cdc and um pfizer felt that six doses for most most files could contain six doses so they changed that allotment and as of this week if you get a tray of pfizer you're expected to be able to deliver 1170 doses the challenge is that you have to have the right syringes to be able to extract six doses out of every bile so over the weekend um carilion was doing their vaccines on saturday and i got a call asking whether we could provide some vaccine from our ultra cool freezer which is another systems issue because this particular lot number they were not able to extract five doses out of every vial without the right syringes and with variation in the lot numbers which are all systems issues predicting the amount of vaccine that we can get on in a given trade becomes a huge issue and that can compromise our 87 year old woman's ability to get vaccine if we've planned for a certain number of vaccines per vial and we don't get it because we have not been given the correct syringes so it's just a very concrete example of how you have to go through every part of the system in order to get to that clinical intervention of a vaccine um for this 87 year old woman who may have multiple barriers and at all times we try to look through the lens of our health systems using equity as our as our foundation so given those examples and now hopefully having a clear understanding of health system science and interprofessional practice what is the curriculum what are we doing here if we think about the the short legacy but a very important legacy of our school of medicine we know that we have an incredibly strong interprofessional education system for which our health system science um curriculum is built and so we we've done a really good job at building that and now how do we layer on top the health systems component that we've talked about so i'm just going to walk through what we're doing in the first couple years in the first year in block one what we've done is we've really tried to make sure that this is an introduction to health system science so all of our learners need block one knowing or at least having some level of familiarity with what the core domains that we just went through here are in block two that's what we've traditionally focused our interprofessional education on and that's what we continue to do as we have different learners we have our accelerated bachelor's of nursing students our pa students and our medical students all working together on interprofessional education in block three we've been focusing on what is public health what is the healthcare delivery system really helping our learners understand the core components of what a health system is that includes um organizational ethics and and it includes just understanding what social determinants of health are what what equity is and then in block four we really transition to the concept of patient safety and quality improvement and that's where we are you know we're about to enter block four right now and so we're really trying our first years to provide the students um the interprofessional students with a broad range but a superficial range of of experiences in health system science using both didactics and small group sessions in blah and year two and this is definitely a work in progress we're continuing to build off the existing structure um we'll have experiences for the students to apply what they've learned in interprofessionalism in in the clinical setting we also will build on our our ethics which i think has has been a really strong point for our our school of medicine students um and what we've what we're doing moving forward is expanding our focus on public health to public health and health policy and really trying to get into the weeds a little bit about some of the questions that natalie brought up earlier of what is insurance what is high value care how do we teach our learners how they can transition into um a new new health system uh as they get into their clinical rotations uh and then the other thing that we're going to be doing this coming year for ms2s is a longitudinal experience um and this is going to be really interesting you know dean merriman and dr carpen dr parker and i are really invested in making sure that our learners all leave with a sense of what leadership and change agency is so we'll be having our our learners and this still has to go through the process um but what we hope to develop is a longitudinal experience in year two that really capitalizes on leadership at the local level both within the health care delivery system within the public health system um and in the community so having examples um in with carilion's community outreach learning how they can how how medical students and physicians can participate in the community health assessment process the community health improvement process and see what carillion's outreach program is doing boots on the ground like fallon park and the food rx program see how leadership impacts that and really addresses some of those iceberg components under the surface so we're really excited about that it is definitely in development and the beautiful part about having a new curriculum is that we get to explore new ways of teaching our learners um of doing faculty development so that we're all on the same page moving forward and with that i'm going to transition to your years three and four with dr kirk all right so for um our third year curriculum that will really be fully launched in academic year 2022 when our current m1s who have already had some of have already had the m1 hssip curriculum will then become m3s and um we as part of this we'll have a new m3 hssip longitudinal curriculum um which will essentially be replacing our domain days so we will still have that great time on friday afternoons where the whole class gets to come together and a lot of the topics are still really applicable to health systems science and we'll just be reframing and adding some content that's really centered on health system science topics to um again continue this teaching of all of these things high value care ethics and legal that they've learned m1 and m2 and then help them better understand it when they're in the clinical setting with us and m3 we are recruiting health system science clinical champions so these are faculty members physician faculty from each core clinical clerkship um who will go through a phenomenal longitudinal faculty development course run by teach and they will be helping us develop full curricular content um for um especially for m3 and m4 but they will also be helping to teach our m1 m2 students to really help bring home some of these clinical examples um we'll be just generally trying to incorporate health system science into clerkship curriculus so through didactics other interactive sessions and also likely through some new assessment tools and then for our fourth year students we'll be working to develop fourth year electives around all of these really important health systems science domains and ultimately hope to have an m4 capstone course where the class can come together and really solidify from m1 you know through m4 what they've learned with health systems science and again just as cynthia just said we really want to focus on that good professional identity development in terms of leadership and change agency and really creating and helping to develop our future healthcare leaders who are going to grapple with all of these systems issues so that is our four-year curriculum overview and now we have dr parker who's going to take us all through systems thinking so as dr morrow and carp have introduced you to health system science generally and the curriculum as it stands at btc-som i want to focus on this outer ring this idea of systems thinking um that's kind of highlighted here so i think for the purposes of understanding this what we've affectionately called the wheel um the the the systems thinking is kind of the thing that encompasses all of these other kind of core and then functional domains within health system science so um there's a lot of different ways that people define systems so i just wanted to kind of set the stage so for the purpose of the rest of of this talk i'm going to define systems as a set of interconnected parts that influence one another and that when working together create something larger than the independent or discrete parts so it's it's you know exactly dr morrow's example of the syringe plus the lot number plus uh the the ability to predict plus these particular patients needing something at this immediate point in time it's it's those are all independent discrete problems but when they come together in concert it creates a much larger um kind of an ecosystem is is how i'm going to refer to it so um when i think about systems and when when i'm you know trying to do research on them or try and kind of understand and describe them to me it's much more ecosystem than it is airplane so an airplane while is it is incredibly complicated and certainly there are parts that are interconnected it interacts in a relatively predictable and somewhat controlled way even even the most recent uh issues that we've all seen in the news where the one engine failed most airplanes are still designed to fly on one engine and get to the ground safely those are that's a relatively hopefully never will happen but it's a relatively predictable failure mode whereas an ecosystem is incredibly complex not just complicated um it responds to large and small changes in perhaps not an always predictable way something new can emerge from connections within this kind of ecosystem so i for me that's a bit more of an apt uh kind of metaphor for being both a patient and a provider in the ch in a health care system than the airplane given that there are so many changing and interconnected complexities so in previous literature um basic science skills and clinical science skills have been presumed to account for clinical outcomes as we can see here this presumes that your system works in a relatively linear and predictable way kind of like a set of dominoes so one thing kind of leads to the next thing however an ecosystem is a little bit more like a perfect storm so there's any number of things that can influence the outcomes of a system at any given point in time so if we think about a health care system and thinking about health system science particularly we want to answer the questions or at least at least provide some insight into how these different discrete parts discussed by doctors morrow and carp influence each other and influence the whole and in addition you know if this kind of complex set of variables sits with it all sits within an environment of care so we want to better understand how that hole is influenced by the environment in which it sits so therefore your another way to envision this wheel might be something like this next picture um where you've got yeah you know basic science skills this is kind of your overlapping then the dr uh that dr carp showed you've got your basic science skills you've got your clinical but you've also got all these other things that are influencing your actual patient outcomes so this is kind of the wheel just formatted in a slightly different way actually i would think in reality it probably looks more like this next picture which is a real ecosystem of of craziness influencing craziness but all you know that there's tons of loops there's tons of feedback there's tons of dynamics and and change that are occurring maybe at one end of the system that actually impact the other and so what i think one of the most important things that we can take away from this kind of outer part of the wheel is acknowledging that while we might be able to list off all the variables the ways that they interact with one another is not always predictable and so if we can help our students medical students or or anybody who's integrated into the interprofessionalism uh domain if we can help them to understand that and to walk in with this type of perspective it might hope i i believe that it'll help them be able to function and and move through that system um with a little bit more uh facility uh than than perhaps they might have thinking oh if as long as i interact with my patients in this way and apply the appropriate skills we have had a great interaction and maybe you have but there's so many other things that influence that experience so we intend to build both teaching and research enterprise to explore these more complex concepts and to better understand the influence of systems on both health and health care and focus on how to implement the best evidence within these kinds of really complex systems um can you go to the next slide so as as dean lehrman has said here we are hoping to continue to grow the impact of our interprofessional education domain and hoping that our students and our goal is that our students will emerge with a better understanding of the way healthcare is actually delivered and how evidence-based best practice can actually be implemented within this con complex system of care we're also really curious about how we can innovate and implement new um new interventions to help that health system work uh more efficiency efficiently and and fluently for our patients um so with that um we have i think plenty of time for questions um if if anyone on the zoom we can either sherry i'm not sure how you would like to run this if you would prefer people put questions in the zoom or what works best for you sorry if um whatever you all feel comfortable with if you are all comfortable just unmuting and um turning your cameras on that is fine or you can type something in the chat and we will um repeat it for our presenters so let's see we have one i have a question may i may i lead off that hit parade thank you uh paul skolnick here thank you for that wonderful wonderful presentation it's really looks great and it's going to be great and and there's so much to do and so much to learn so i i i want to focus on sarah's slide that looked like a metabolic pathway a complex network of domains and yeah that that one and i just want to make the point and i think you all have this in mind for me when i look at that slide and and so many important domains there's so much it's not so much what's in each domain i mean obviously you have to have a familiarity with what what is in each domain but there are experts with each of the within each of those little boxes that the crucial thing is for people to know that this is all that this all exists that it's all important that really to holistically care for our patients and communities properly you have to know these things exist and are important and the interprofessional part here's how you access these various things because for any one person to do you know everyone's going to have their strengths whether it's a diagnostic ability or therapeutic ability or public health or operational expertise and cynthia and i have got to work together a little bit on the vaccine stuff i mean it it truly takes a village so my question is i know that was a long preamble um how what about the curriculum will allow the students to really get their fingers and hands on the elephant and understand how best to approach it because it's so vast so you know other than saying here's this aspect or is the intent for all the public health offerings to fall under health system science um that's what i'm trying to understand so so i'll um start with that and then turn it over to natalie i think that one of the things that's critically important for us is that we're very intentional about this being a four-year built curriculum so just as an example your analogy of the elephant in the introduction in the very first couple of i think it's actually the very first day um they they see the elephant and the whole concept of systems thinking and how if you only look at one part you're going to get it wrong um so what i we know that we're not going to create experts in every each of the domains i mean that's just not a possibility but what we're hoping to do is get broad-based exposure in the first year get dive into a little bit more detail in the second year and then really build on what they're experiencing in the third year and of course provide elective opportunities for the fourth year but were well i think that it would be um irresponsible of us to pretend that that they're gonna get into the boxes but it's it's helping them see all of the boxes so that at least there's that level of awareness and then as part of their professional identity formation helping them find the right people in the boxes that they might want to dive deeper into does that does that make sense natalie do you want to add to that no i completely agree i mean i think a lot of these things we sort of have traditionally thought of as being in our hidden curriculum so it's what when you came to the words you like might have sort of gotten a little bit about and then certainly by the time you got to your internship or residency um you're you're really needing to grapple with them but without you know just like you said that baseline understanding so it's not as if you know all of our students believe and the healthcare policy experts but they should have an understanding of how these factors link together to affect care across different systems and then you know in addition to just not only being able to understand that and operate effectively in those systems you know hopefully some will really be inspired to be to potentially pursue you know maybe more education health policy fellowships or additional education beyond in their training to you know go through that in a leadership capacity maybe they'll really you know want to get into quality and patient safety work so um i think that cynthia really described it really well and our goal is for this to be an intentional build and any redundancy that we have and there will be some will be intentional for the students to sort of under get the baseline knowledge and then apply that clinically as they move really throughout their careers not just in medical school thank you um and i sure and one more layer that i want to add to that is that to the best of our ability and we will continue to grow this program and and hopefully get some of you who are currently in the audience um on the other side of the screen so in the beginning in in the introduction we had um dean airman speak to our students we had um i'm trying to remember we did we had different experts we had dr rice speak to um our students for clinical informatics we're having dr morgan speak to our students for our patient safety and quality improvement dr parker's team is taking that and running with it um of course for our ipe we had [Music] we had our wonderful partners at ruc provide a lot of the support for teaching the students and of course running the small groups um so we're trying to make sure that we're not pretending to be the experts um that that we're bringing in those experts i don't know if that adds at the layer that i didn't share earlier thank you and i think i see the krebs cycle in the lower right of this slide now i'm just teaming up website go someplace i'm seeing a few comments and questions within the chat jc simon has offered being that nutrition is so foundational to the health of the patient family and the community offered to be involved in this curriculum as we begin to integrate it dr simons asks are you working with other medical schools and systems to coordinate this effort it is such a broad complex universe that it would be ideal for there to be true cross-system understanding and approaches otherwise i worry that we may have multiple systems all trying to invent the wheel independently and like the original emrs be unable to truly interface i can speak to that a little bit um so this is definitely an issue an initiative of the ama um they have um you know and i and dean nierman and parker parker we've definitely done a lot of outreach to our colleagues around the country who have launched this and there is a consortium of schools that we are not formally a part of yet but we are hoping to be a part of in the future and we have definitely learned a lot from our colleagues who are launching this there's also a health system science scholars academy that i'm currently taking part in right now and david music one of our deans also took part in last year so i think our school is very well connected to the national ama initiative and we're really excited about that and i've been really impressed with the level of national um collaboration from people at all of these schools from kaiser to dell to penn state um where judd gonzalo came to speak to us from so great from dr paulie do you have plans on extension or inclusion of gme possibly through an hssip research day i certainly think that there's there's tons of opportunity especially from a research perspective to um you know to really emphasize different ways that we can be exploring um some of these health systems science principles via research projects and things like that so you know maybe that's that's some focus on implementation science or focus on you know additional um more public health type research projects um you know whether that becomes kind of its own day or is is part of existing research days i think is a great conversation to have i know gme already has some extensive curriculum and things like patient safety and other places and so i think that there's probably opportunity for us to learn from all the success that they've had and as well as maybe integrate more deliberately some of the language around health system science into into some of that great work that they've already done that's true and also i see um trainees is sort of falling in the middle so they're they're learning it this they're similar to faculty in this in this respect where they're learning it but they're also expected to teach it um and model it so um we really strongly encourage them to take part in our open forum sessions um this being the first of those sessions um anything related to health system sciences that is designed for faculty we usually on our little calendar we include who the intended audience is and we will make sure to include that residents and fellows are a part of that so we please strongly encourage them to attend these types of sessions as well dr preston asks until things shift at the national level local leadership is essential um this example shown by vtc could lead the way we agree i agree thank you for that comment um dr edwards um dr hawford examples uh examples are one way to learn what works in real life um has been my experience at uva vcu and evs so yes these exactly critical to that they are and one yeah one thing that i should say i mentioned um in patching that for for the pre-clinical curriculum we do both didactic didactic sessions and small group sessions the small group sessions are really based on examples of what this looks like so whatever we're talking about in the um in the didactic we then break it down as a case study real life example of um what's happening for the small group discussions because we find that to be a nice complement to the didactic session so we are definitely using examples and any examples that you have that you want to share we'd love to try to incorporate into our curriculum other questions or comments feel free to unmute and speak up or um oh all right right here in the comment section um [Music] and you're not allowed to unmute anymore add them right here in the comment section or yes speak up with questions comments check paget hi chuck hey um one what i suggest we talk about examples but i would say especially for medical students and after doing the diversity initiative i think they want to hear mistakes we've made and i think three big ones try to clean up that floor so gross uh i think a couple of mistakes have been made sort of systemically were like the use of beta blockers which we believe were gonna cut cardiac events which they did but provide stroke that were outweighed in that um things like uh the treatment how we used to treat people with mrasa in their nares and even um and other and the opioid epidemic that we can partially trace back to the fifth vital side all those become very i think potent messages to students in that we admit our failures over the last several decades would anybody like it to make any comments on that or i i think i i'd like to make a comment um first of all just in in the big context of what we're trying to do um we're being very innovative in how we frame this in the pre-clinical cliqueman phase one as an outcome growth of interprofessionalism as a as a core domain and that that i think is is different for us um but where we really have the power to lead nationally amongst the other schools that are already involved and in many cases have more experience than we do is how we make this come to life in the clinical environment most medical schools really can only control the pre-clinical curriculum and then things get really talk about systems things get really complicated in trying to look across different specialty experiences in order to build upon that curriculum i think because of of who we are and where we are and what we do what we care about with respect to our service to our communities of patients that we have an opportunity to really bring these principles to life in ways that we can partly understand now and plan plan for but partly in ways that we don't even understand and that's where your help is going to be so powerful how to involve our gme learners how to be able to create a systems lens for looking at medical error that becomes like a different kind of m m in terms of looking at systems rather than other drivers of of error and really there's a it's a bit uncharted and exciting to think about how each department and each discipline each clinical specialty is going to find its own unique way to highlight the aspects of health system science that are the most important most mission critical and the most relevant to their particular practice this is where our students learn what really matters to the provision of outstanding health care through the role models that you will be for them in the clinical environment so we're really excited to hear more of these ideas coming forward and i really appreciate the start that we've been able to to have today with with a good 15 to 20 minutes of discussion but a lot more interchange to come will really get us to have a really spectacular experience for our students so i hope we have a couple more minutes for those final questions before we wrap up we do and i think uh there are a couple more comments in the chat box so this amanda anderson says this is an important component for all healthcare providers collaboration between medicine nursing and ancillary services is essential to the success of this program so true um [Music] the that speaks to the interprofessional aspect of the program absolutely um jessica parton says the obesity systems side slide illustrates how difficult it can be for providers to identify all the partners in care it would be wonderful to have access to networks of our non-medical community partners to identify support groups for patients anybody want to make any comment about that just here through the curriculum we will all become more familiar about these networks as we grow as learners and educators as well and i think yeah oh go ahead sorry go ahead cynthia well i think that one you know one specific example um is that for this longitudinal experience i'm not sure how many people are familiar with community health assessment so for example with carillion their community health needs assessment and their community outreach it just provides an incredible example of how you can work with multiple partners within the community and we're really hoping that the longitudinal experience in their second year will help develop the at least the understanding of how complex the networks are outside of the health system itself and how putting a little judgment here but really outstanding responsible health systems work within those networks um to optimize the health of the communities that they serve absolutely sarah did you want to add to that i was about to say almost the exact same thing not nearly as eloquently but on the same page so nancy agee says so excited about this curriculum curriculum and think we can really pop out nationally given our organizational focus lots of opportunity to identify innovation and health systems delivery as well i couldn't agree more and i'm just going to be opportunistic here that i think that it is really important for us to have this curriculum i think it's even more important for the learners to see and for the providers within our network to see it in action and i think and this is totally promotional so forgive me but i think that that the level of cooperation and the level of partnership with a medical school a health department and a health system can really put us on the map and i think that we've really done that with um our local vaccination efforts where it's really all of the systems working together with the community based organizations to achieve a good outcome for our community so so i think that there are lots of opportunities for us to put this curriculum on the map um and i of course agree with the sentiment um that that we've just expressed um but but this is an amazing opportunity for us to show our learners and ourselves what we can do when we work together so thank you so much for that for that comment absolutely i have one more comment um in the 30 seconds or so that we have left so from uh cheryl and david hartman highly agree that studying intercon connectedness of all systems that influence prevention early intervention treatment and recovery of addiction would be a rich productive lens for understanding the importance of health system science very excited about the broader understanding of medicine and the role of physicians so this has been a wonderful session thank you to all of our presenters for sharing their wisdom look forward to hearing more from them and from others we will have some internally facilitated sessions we'll also have some deans forum over the next a couple of the years that will will bring in some national level experts to help share their wisdom with us and it with them an insight so enjoy the rest of your day if you didn't have a chance to complete the form that will allow you to get cme and faculty development related to teaching please go ahead and click on that link that sandy sent out in the chat really quickly and you can do so right from there have a great day and the rest of the week folks.