NYU School of Medicine Expands Population Health Education in Medical Curriculum

Population health pillar will enable tomorrow’s physicians to make meaningful contributions to prevention, value, policy and community health

Thursday, August 11 2016
Students
As part of the current population health curriculum, incoming NYU School of Medicine students met with NYU Langone’s government affairs office and visited the Capitol in July, during an eight-day health policy intensive.

NYU School of Medicine is establishing population health as one of the core pillars of its Curriculum for the 21st Century (C21), with the goal of giving future doctors the skills they need to understand and engage with upstream influences on their patients’ and population health.

Beginning in the fall of 2017, population health topics will be integrated into all stages of the three and four-year medical degree programs, including expanded opportunities in coursework, online modules, patient interactions, clerkships, discussion panels, and multiple research opportunities. The core themes of the pillar will include socioeconomic determinants of health, health behavior, public health, healthcare policy and economics, value-based care, clinical informatics and health system improvement.

“Twenty-first century physicians need to be outstanding clinicians for individual patients while embracing accountability for populations of patients in their practice, community, and region,” says Mark D. Schwartz, MD, FACP, Professor and Vice-Chair for Education and Faculty Affairs in the Department of Population Health, who will lead the new pillar. “Traditional medical knowledge and skills must be complemented by the competencies needed for physicians to integrate population- and systems-oriented approaches into their work.”

Reuniting medicine and public health in medical education

The Population Health pillar responds to the changing practice of medicine, encouraged by healthcare reform’s push toward value-based healthcare over volume and a growing recognition of the importance of “social determinants of health.” The pillar will seek to close the historical schism between medicine and public health, producing cadres of physicians who can make meaningful contributions to prevention, increased value, and bridging healthcare with other sectors to improve the health of populations.

In his influential 1910 report on medical education in the U.S. and Canada, Abraham Flexner wrote: “Physicians have societal obligations to prevent disease and promote health, and medical training should include the breadth of knowledge necessary to meet these obligations.” He believed that “collaborations between the academic medicine and public health communities result in benefits to both parties.”

While not a new idea, this aim to integrate health system approaches to improve individual and population health requires new skills and knowledge. The Association of American Medical Colleges and U.S. Centers for Disease Control and Prevention formed an academic partnership in 2000, which led to the development of 12 core competencies for medical students. They include: identifying community assets and resources to improve population health, describing the organization and financing of the U.S. health care system, and how it affects access and quality of care, and discussing the role of socioeconomic, environmental, cultural, & other population-level determinants of health.

In a 2003 report on educating health professionals, the Institutes of Medicine called for a shift to a more ecological model of health, one that addresses non-medical determinants of health in individuals and populations. The report recommends drawing on sciences of education, behavioral economics, work conditions, built environment, and public policy.

The population health pillar in C21

NYU School of Medicine students are already able to take population health courses, including popular and successful 4-week selective courses in Health Policy and in Population Health, and take advantage of many research opportunities, including the Population Health Fellowship in the summer after first year and the Population Health Concentration as juniors or seniors.

Students will benefit from a significant expansion with the new pillar. For example, during the students’ first 18-months, their Core Principles in Medicine course will include an exercise on modeling population strategies for managing multi-drug-resistant tuberculosis or doing a utility analysis of new types of screening strategies for colon cancer that may reduce current disparities and improve health equity.

In the Practice of Medicine module, they will learn about the role of health behavior in health equity, do a survey of neighborhood food environments in New York City, and learn about health system structures and how they impact patient care.

In the clerkship year, in which students are transitioning from the classroom to the patient care arena, they will complete a module on health disparities and an exercise on population health reasoning and management, using deidentified but actual data from NYU Langone Medical Center’s practices.

Finally, in the interclerkship intensive (ICI)—one-week blocks during the clerkship year that are structured like a scientific medical conference with lectures, workshops, and panel discussions—students will learn from a panel of physician leaders from NYU Langone, NYC Health + Hospitals/Bellevue, and the VA NY Harbor Healthcare System about how the three healthcare systems compare in costs, safety, and quality for complex medical illness such as sepsis.

Faculty from the Department of Population Health who will teach the courses are experts in core fields including healthcare delivery science, medical ethics, health behavior change, comparative effectiveness research, epidemiology, biostatistics, health policy and evaluation, early childhood development, community health work and health equity, and tobacco, alcohol, and drug use and treatment. This broad-based expertise will allow NYU School of Medicine to go beyond its peers in offering population health across the medical school curriculum.

Students respond positively to population health focus

The population health pillar responds to a growing interest by medical students in training in subjects like health policy, community medicine, and economics, subjects that they see as fundamental to their ability to benefit their patients as practicing physicians. Past NYU School of Medicine graduates speak in glowing terms of their experiences with population health.

Yale-New Haven Hospital primary care internal medicine resident Sumit Kumar, MD, MPA, ‘16 discovered a passion for health policy after taking a selective in the third year of medical school with Dr. Schwartz: “[He] emphasized how physicians can play a broader role in healthcare, and encouraged us to push the limits of our expectations.”

Because of that experience, Dr. Kumar decided to pursue a master’s in public administration at NYU Wagner and worked on a capstone project with NYC Health + Hospitals to assess the long-term financial sustainability of an emergency department care management program.

Brent Dibble, MD, MBA ’15, now an emergency medicine resident at NYU Langone, took the Healthcare Policy and Systems Innovation course with Dr. Schwartz during his third year in medical school.

“It was through this course that I had my first glimpse into the inner workings of healthcare, discovering how the various stakeholders interact with each other to form the dynamic backbone of our country’s healthcare system,” Dr. Dibble says. “I walked away a better doctor because of that knowledge.”

After the course, Dr. Dibble chose to pursue an master’s of business administration at Stern School of Business. “Now, five years later as an emergency medicine physician interested in administration, I can truly appreciate how that invaluable experience transformed the way I thought about the medical field, taught me to practice smarter medicine and enabled me to more effectively advocate for my patients,” he says.

By Elaine Meyer