Developing a Transitions of Care Elective for Medical Students during the COVID-19 Pandemic and Beyond.

OBJECTIVES: Health care in the United States is costly, fragmented, and often ineffective. Transitions of care (TOC), particularly from the inpatient to the outpatient setting, is an especially complicated time and one that is potentially fraught with errors that contribute to negative outcomes. The coronavirus 2019 pandemic exacerbated many of these challenges. In particular, vulnerable patient populations have experienced more barriers to successful care transitions. Effective care transitions should include interprofessional teamwork, robust patient education, and seamless communication among the various healthcare team members. Increasingly, medical schools are working toward graduating systems-ready physicians who demonstrate competency in the health system sciences and are able to operate effectively within the healthcare system, including being able to navigate complex transitions of care issues. Undergraduate medical education, however, continues to provide experiential learning in the traditional silos of inpatient versus outpatient medicine, so that learners do not have the opportunity to directly participate in transitions of care. Although transitions of care is a pivotal part of patient care, it is rarely taught at the undergraduate level, and when it is, it is typically relegated to the classroom setting. METHODS: We used the disruption of the coronavirus 2019 pandemic to develop a TOC elective. The aim was to fulfill an acute educational need and to develop competencies around care transitions for students while concurrently providing support for patient care and teamwork. The elective was offered to second-, third- and fourth-year medical students. Our educational innovation was initiated within our safety-net hospital where we care for a high percentage of uninsured patients, with a high language discordance. In addition, our city has multiple care systems without a single or connected electronic health record system, further complicating patient care transitions. The work of the TOC elective crossed inpatient and outpatient silos, with close collaboration with our local federally qualified health centers. This remotely conducted elective includes three main pillars: participation in team activities, including virtual participation in interdisciplinary rounds and care coordination; discharge planning; and communication, including goals of care and end of life communication. RESULTS: Medical students successfully integrated into team structures to directly counsel families, facilitate goals of care conversations, and engage a multidisciplinary team for discharge planning. Students found this experience valuable in their reflections. In addition, there was a value-added component from a patient care and teamwork perspective. CONCLUSIONS: Participation of students in TOC is a valuable educational experience and contributes a value-added component to patient care and interprofessional teamwork. Moreover, an appreciation of the failures of the current system is pivotal as learners start to reimagine, explore, and design improved patient-centered systems in the future.

From Knowing to Doing: Integrating Systems-Ready Physician Competencies in the Clerkship Setting.

There are increasing calls to graduate physicians with a strong understanding of health systems science (HSS). Many schools have incorporated didactics on health systems science content such as quality improvement, patient safety, or interprofessional education. Creating a systems-ready physician requires more than teaching content in classroom settings. Using Miller's pyramid of assessment of clinical performance, we have developed strategies to move our learners from the cognitive-based "knows" level to the behavior-based "does" level of understanding of the HSS competencies. Our medical students begin learning HSS in classroom settings. Next, the students apply this knowledge during their core clerkships. This gives them an opportunity to get feedback increasingly from high-fidelity clinical settings. We embedded assessment strategies and tools in the clerkship year to facilitate the demonstration, observation, and assessment of HSS competencies in the setting of our core clerkships. We also have students self-assess their competence in our graduation competencies at the end of each year. Student self-assessment from the beginning of the clerkship year to the end showed significant increases in the HSS competencies. Our clerkship student assessment data from our first cohort suggest that faculty had difficulty observing and assessing some of the competencies unique to health systems science. The clerkships have developed multiple projects and assignments to allow students to demonstrate HSS competencies. Faculty and resident training to prompt, observe, and assess these competencies is ongoing to close the assessment gap. In the area of professionalism, student self-assessment and faculty clinical assessment correlate strongly.

Everyday Leadership: A Combined Resident and Faculty Workshop.

OBJECTIVES: Historically, physicians have always been viewed as leaders in the healthcare field. Whether they embrace this role, physicians often find themselves in a leadership role, from the clinical setting to an institutional setting. In most cases, this leadership role is taken on without prior training on even the most basic concepts required for effective leadership. METHODS: We created a combined leadership workshop for both faculty members and residents in training. The topics included an introduction to leadership styles, emotional intelligence, and negotiation skills. The leadership workshop was conducted as an interactive training session for faculty and resident physicians and was embedded during routinely scheduled teaching time for residents. RESULTS: We present survey data from two annual workshops, demonstrating a clear improvement in participants' perceived understanding of leadership skills in the areas of leadership style, emotional intelligence, and negotiation skills. We have found that fairly simple measures may be taken to embed this training into the busy schedules of medical faculty and residents in training and that tapping into local expertise was an effective and efficient approach to this. CONCLUSIONS: We believe the results from our experience can help inform other programs about practical approaches to teaching leadership skills.