The Continuity Clinical Experience (CCX), an initiative of Vanderbilt University School of Medicine’s Curriculum 2.0, was recently selected as the Association of American Medical Colleges (AAMC) Clinical Care Challenge winner.
The course, launched in the fall of 2012, is a part of the four-year Foundations of Healthcare Delivery program that integrates students into clinical teams to learn about the larger care delivery system while contributing value to patient care.
Primarily, the course provides a learning lab for systems of care with an emphasis on quality, safety, improvement and outcomes, said Jesse Ehrenfeld, M.D., MPH, one of the course directors.
“One of the challenges we face in medical education today is that graduate medical education is so focused on teaching the details associated with a particular specialty,” said Ehrenfeld, associate professor of Anesthesiology. “Residents don’t often pause, step back and recognize that there is a larger system issue creating a specific problem.
“We are trying to train our students to have the vision to recognize systems-level problems so that when they go into residency and practice they will be able to approach the delivery of health care with that mindset.”
CCX allows for students to spend a half day a week with a faculty preceptor. Since the start of the program, students have had nearly 8,000 patient interactions.
Previously, students saw just a handful of patients in their first two years of medical school.
By having continuity with a clinical setting, students are able to follow patients through the entire health care experience so they can witness how patients interact with the larger system and see the various challenges associated with delivering care.
The curriculum also allows students to observe the health system from the perspective of a patient by accompanying them to visits, across care settings, and even visiting their homes. This creates opportunities for students to develop quality improvement projects related to patient work flow and quality of care.
Within the first 18 months of the course, students identified more than 200 potential areas for improvement across the Medical Center’s clinical sites.
“From the first weeks of medical school, students are engaging with patients in really novel ways,” said Bonnie Miller, M.D., senior associate dean for Health Sciences Education at VUSM.
“Through health coaching exercises, developing education materials and participating in home visits, students are able to achieve course objectives while providing real value to patients.
“Students are not in clinics to learn to be infectious disease physicians, gastroenterologist or pulmonologists,” she said. “They are there to learn how the system impacts the care of patients.”
Ehrenfeld expects the program to serve as a model of care for other medical schools.
In June, Ehrenfeld and CCX co-directors Jennifer Green, M.D., assistant professor of Medicine and Pediatrics, Morgan McDonald, M.D., assistant professor of Medicine and Pediatrics, and Heather Ridinger, M.D., assistant professor of Medicine, will receive the award and present their work at the AAMC sponsored conference, “Integrating Quality Meeting: Improving Value through Clinical Care, Education and Science.”
