Educating for a changing health-care environment
Educating for a changing health-care environment
By Mark Kuczewski
“The only constant is change.” Especially today, in health care. Policy analysts, academics and health-care providers have all been trying to grasp the implications of the Patient Protection and Affordable Care Act, while, at the same time, watching health systems buying physician groups and mergers happening across systems. As our own experience at Loyola University Health System has shown, health-care organizations increasingly see the advantages of consolidating resources and aligning mission across very different kinds of institutions.
Many people feel a sense of unease, perhaps even loss, at these developments. Tradition is about continuity and preserving and stewarding the fine things in our history. Naturally, Stritch alumni, proud of our tradition as a Jesuit and Catholic medical center and medical school, ask whether things they valued in their medical education and professional formation are still available to today’s Stritch student. Alumni also often tell us that they fondly recall the ethics education they received and ask if Stritch still teaches ethics. The answer is a resounding “yes”: Stritch’s commitment to ethics education and fostering medical professionalism has never been stronger. Of course, the forms that this ethics training takes have evolved to help students address contemporary challenges.
At Stritch, we continually ask ourselves how we can best prepare our students to be effective leaders today and what skills will enable them to thrive decades from now in an environment whose challenges are, by nature, somewhat opaque from our present vantage point. Our deliberations have led to evolving required and elective curricula. We believe that there are three dimensions in which our students must be prepared. First, physicians-in-training must acquire a working understanding of medicine’s business aspects — the financial aspects of delivering care. Second, they must understand the need to consistently improve the quality of the care they deliver. Finally, they need the skills to serve culturally diverse patient populations.
The Business of Medicine and the Medicine’s Leadership Role
A number of years ago, Stritch introduced a required curriculum known as Business, Professionalism, and Justice to help medical students understand health-care financing, including the major forms of health insurance and the factors contributing to large numbers of uninsured people in the United States. It also explores the approaches to ameliorating these problems incorporated into current federal health-care reform legislation. We also have students construct a small group practice budget and make resource-allocation decisions, helping them to understand the quandaries that “payer mix” can cause. These exercises prepare students to analyze the social justice implications of our health-care system, especially the systemic incentives that exclude some populations from a decent minimum of care.
Leading to Improve Patient Care
Perhaps the single most striking recent development in health-care delivery has been the demand that care be delivered in an accountable manner —a manner that guarantees quality and patient safety. Stritch faculty have long held that leadership requires that physicians understand how to work within a health-care team to improve patient care. Campus units are united in encouraging leadership for change to come from all levels. The Neiswanger Institute partners with the Department of Family Medicine, the Marcella Niehoff School of Nursing, and LUHS clinical departments to offer the Innovations in Leadership program. This program brings together the “best of the best” medical student leaders, staff nurses, faculty physicians, and residents to develop their interpersonal skills and work in teams to create a project that improves the quality of care delivered at LUHS. A variety of impressive projects come out of this program each year and are deployed in our clinics and hospitals. Through the Innovations program, our medical students come to understand that saying “everyone is a leader” is not a platitude. Working to bring about improvements in patient care is a moral imperative that begins in medical school and must permeate their professional lives. We have begun to couple these efforts with didactic sessions on such innovations as pay-for-performance and other quality-based incentive programs that tomorrow’s physicians must understand in detail. Such policy developments must not be understood merely for how they will influence the physician’s paycheck, but also how they impact the service patients receive.
Understanding our Neighbors
As recent census data made clear, U.S. demographics are changing and we may become a “minority majority” nation before our current students’ careers come to a close. Stritch students are, by their values and leanings, very engaged both in the community and internationally, often coming to Stritch with a variety of skills that serve them well in these encounters. For instance, many students bring with them Spanish proficiency. A number of them created a peer-led Medical Spanish training program to help their fellow students develop these skills. We have created additional opportunities to develop cultural sensitivity and serve the community like our Just Healing Conferences, held at Cristo Rey Jesuit High School and at Christ the King Jesuit College Preparatory High School. Stritch students mentor these high schools' students for several months leading up to the conference to create a health fair. The high school students learn a good deal about various health topics and gain insight into the possibilities of a future in health care while Stritch students learn about the community from their interaction with the high school students. Simultaneously, we hold discussions of directed readings with the medical students to help them understand the experiences of those they serve.
The Tradition Remains
As we assess Stritch’s evolving curriculum, we must conclude that change is not the only constant. The Jesuit and Catholic ideals of Magis, service, and promoting justice now and always have infused the curriculum. So, in answer to concerns about whether our valued traditions persist, we have unequivocally good news. When it comes to fostering physicians who embody the highest ethical ideals of our Jesuit and Catholic legacy, we’re still the “same old Stritch.”