Eastern Virginia Medical School (EVMS) has implemented a new CareForward curriculum that aims to ultimately improve 1) the patient experience of care and 2) the health of populations, while 3) reducing per capita cost of health care and 4) providing a foundation for resiliency in clinical practice (IHI Triple aim and Quadruple aim). The new curriculum incorporates a case-based, integrated approach utilizing a virtual community of culturally-diverse families. The virtual families are woven together by stories that bring clinical scenarios to life and highlight patient- and family-centered, cost-conscious care for the unique needs of the elderly and those with multi-morbidity/multiple chronic conditions (MCC), as well as a host of social determinants of health. The virtual families represent diverse patient populations (e.g., age, gender, sexual orientation, ethnicity, race, culture, belief system, literacy level, socioeconomic status and geography), and through them, we also introduce variables such as veteran affairs, family dynamics, financial turbulence within families, health equity/disparity, roles within a care delivery team, access to community resources, interactions of organizations and complexities of care in specific patient populations. Using the same structure, students also learn topics such as shared duty of care using a team-based care model and in the same context explore interprofessional practice as a solution to physician burnout.
Each organ system module in the preclerkship years and 3rd year clerkship will use longitudinal clinical cases that are drawn from these families to accomplish the goals and objectives of the longitudinal themes, i.e. (i) cost-conscious and high-value care, (ii) caring for elderly and patients with MCC.
For e.g. Osteoarthritis is discussed in the context of 86-year-old Ms. Christine Pascual, who has unique personal needs and family circumstances and is suggested non-steroidal anti-inflammatory drugs as an option to manage pain. Another case with the same person is introduced four months later in the GI and Metabolism module when Ms. Pascual presents with upper GI issues to discuss drug induced gastritis/peptic ulcer. The students are tasked to suggest alternative and cost-effective approaches to manage the disease in this case.
These clinical cases use a carefully chosen vocabulary that eliminates verbiage that blames the patient. Below are some of the examples:
Instead of "patient complains of..." we state, "patient reports.." or "patient shares his concerns as..."
Instead of "patient is non-adherent to..", we state, "patient was not able to ...due to competing priorities"
Instead of saying, "it was decided", we state, "after discussing options with the patient the following plan was created.."
Each case has explicit language on patient preferences and values. Cases are discussed using the biopsychosoical framework and our students, in addition to finding value, have thoroughly enjoyed this aspect of our curriculum and have consistently asked for more of such sessions.
While this approach is currently used in an undergraduate medical education setting, it is scalable and applicable in both graduate and continuing medical education settings.
For its innovative curricular design and timely focus on longitudinal themes, EVMS received the AMA grant to join the AMA’s Accelerating Change in Medical Education Consortium.
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