A practical guide for implementing and maintaining value-added clinical systems learning roles for medical students using a diffusion of innovations framework

  • Jed D. Gonzalo
  • Deanna Graaf
  • Amarpreet Ahluwalia
  • Dan R. Wolpaw
  • Britta M. Thompson
Article
  • 88 Downloads

Abstract

After emphasizing biomedical and clinical sciences for over a century, US medical schools are expanding experiential roles that allow students to learn about health care delivery while also adding value to patient care. After developing a program where all 1st-year medical students are integrated into interprofessional care teams to contribute to patient care, authors use a diffusion of innovations framework to explore and identify barriers, facilitators, and best practices for implementing value-added clinical systems learning roles. In 2016, authors conducted 32 clinical-site observations, 29 1:1 interviews with mentors, and four student focus-group interviews. Data were transcribed verbatim, and a thematic analysis was used to identify themes. Authors discussed drafts of the categorization scheme, and agreed upon results and quotations. Of 36 sites implementing the program, 17 (47%) remained, 8 (22%) significantly modified, and 11 (31%) withdrew from the program. Identified strategies for implementing value-added roles included: student education, patient characteristics, patient selection methods, activities performed, and resources. Six themes influencing program implementation and maintenance included: (1) educational benefit, (2) value added to patient care from student work, (3) mentor time and site capacity, (4) student engagement, (5) working relationship between school, site, and students, and, (6) students’ continuity at the site. Health systems science is an emerging focus for medical schools, and educators are challenged to design practice-based roles that enhance education and add value to patient care. Health professions’ schools implementing value-added roles will need to invest resources and strategize about best-practice strategies to guide efforts.

Keywords

Undergraduate medical education Implementation science Curricular development Value-added medical education 

Notes

Acknowledgements

The project was performed with financial support from the American Medical Association (AMA) as part of the Accelerating Change in Medical Education Initiative and the Josiah Macy Jr. Foundation. The content of this paper reflects the views of the authors and does not necessarily represent the views of AMA, the Josiah Macy Jr. Foundation, or other participants in this Initiative. We acknowledge the clinicians in collaborating health systems for piloting educational experiences.

Compliance with ethical standards

Conflicts of interest

Dr. Gonzalo is co-editor of a textbook on Health Systems Science (Elsevier, 2016). There are no other conflicts of interest to report.

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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Jed D. Gonzalo
    • 1
    • 6
  • Deanna Graaf
    • 2
  • Amarpreet Ahluwalia
    • 3
  • Dan R. Wolpaw
    • 4
  • Britta M. Thompson
    • 5
  1. 1.Medicine and Public Health Sciences, Health Systems EducationPenn State College of MedicineHersheyUSA
  2. 2.Office of Medical EducationPenn State College of MedicineHersheyUSA
  3. 3.Penn State College of MedicineHersheyUSA
  4. 4.Medicine and HumanitiesPenn State College of MedicineHersheyUSA
  5. 5.MedicinePenn State College of MedicineHersheyUSA
  6. 6.Division of General Internal MedicinePenn State Hershey Medical Center – HO34HersheyUSA

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