Right Tools

Mayo Clinic Alix School of Medicine has a bold plan to train the next generation of physician leaders

By Mayo Clinic Staff

Mayo Clinic Alix School of Medicine is equipping students with the tools they will need to fix the nation's health care system.

When Jack Jeng graduates from Mayo Medical School, he'll enter an uncertain U.S. health care system: unsustainably high health care costs; deep complexities that keep patients from getting the right care at the right time; an aging population and increasing burden of chronic diseases; a precarious political environment.

"It's an interesting time to go into health care because we don't know what the future holds," says Jack, 27, who is a fourth-year student.

Many experts wonder if medical schools across the country are doing enough to ready graduates like Jack. The traditional education model is often criticized as being woefully inadequate for 21st century needs.

"The reality is that most medical schools are teaching the same way they did 100 years ago," Wyatt W. Decker, M.D., CEO of Mayo Clinic's campus in Arizona, said in a recent Wall Street Journal story. "It's time to blow up that model and ask, 'How do we want to train tomorrow's doctors?' "

One tool the school is targeting for change is the Science of Health Care Delivery. Jointly developed with Arizona State University, this four-year curriculum teaches subjects such as systems engineering, health care policy and biomedical informatics so that students can understand the health care system and have the tools to fix it.

Mayo Medical School is the first program in the country to jointly confer a certificate in the Science of Health Care Delivery along with a medical degree. By completing additional credits, students can choose to earn a master's degree in the field from Arizona State University.

"We need physicians to learn things that have not traditionally been taught in the medical school curriculum," says Michele Y. Halyard, M.D., the Suzanne Hanson Poole Vice Dean of the Mayo Medical School who is serving as interim dean. "We want to lay these principles right from the beginning so that we're training and cultivating our students with the skills and abilities that they need to not only heal patients and advance the science of medicine but heal the health care system as well."

But impacting health care will take more than teaching the Science of Health Care Delivery to 200 students. (Mayo Medical School in Rochester, Minnesota, is one of the most selective medical schools in the country, with 50 students accepted per class out of over 4,750 applicants.) With the support of Mayo Clinic and benefactors, over the next two years Mayo Medical School will establish a national footprint and more than double its student body.

At the same time, with a grant from the American Medical Association (AMA), it will transform its curriculum so students like Jack will have the training they need to provide the best care possible in the 21st century — with a curriculum that can be replicated across the U.S.

"We're taking advantage of all of the expertise that we have across Mayo, along with the support of our benefactors and the unparalleled support of the AMA, and bringing them to medical education," Dr. Halyard says. "No other medical school in the country has a national presence like ours will have."

More diverse opportunities

Mayo Clinic Alix School of Medicine students Jack Jeng and Quincy Nang are entering a medical field that is changing quickly.

To provide opportunities across the U.S. nation, Mayo Medical School will expand in 2016 to include complete third- and fourth-year programs in Jacksonville, Florida. The following year, the school will launch a four-year campus in Scottsdale, Arizona, enrolling 50 additional students per class.

Mayo Medical School will preserve its high faculty-to-student ratios, which is a key Mayo Medical School advantage.

Using a singular, unified curriculum across campuses, the school will also employ many online learning modules that integrate educational aids such as video clips, interactive animations and assessments. Developed in partnership with Arizona State University, the modules give students personalized flexibility in learning and give professors better student interactions and the ability to adjust the curriculum if assessments show students need further discussion on a topic.

"It's not just a slideshow or a videocast of a lecture," says Darcy A. Reed, M.D., Mayo Medical School's senior associate dean for Academic Affairs. "This is really innovative education that's created to provide flexibility for students and ensure better long-term subject mastery."

With a national school structure, students will gain experiences across a broad spectrum of patient populations in multiple practice settings. Up to eight Rochester students per year will be able to complete their final two years in Florida. Arizona- or Rochester-based students will be able to do a number of rotations at other Mayo campuses.

Mayo Medical School is also collaborating with health organizations near each campus and Mayo Clinic Health System, which is Mayo's family of clinics, hospitals and health care facilities serving over 70 communities in Iowa, Georgia, Wisconsin and Minnesota.

"Students will experience different patient demographics, but we'll also give students exposure to different parts of the country and unique health care challenges in those areas," Dr. Halyard says. "Some students may prefer to be closer to home or to see the different way health care is practiced or a different patient mix, the different cultural mix of the Southwest versus the Midwest or Southeast. Part of the national expansion is also that we really have the ability to take advantage of all of the expertise across Mayo. Our students will have experiences like no other."

The leaders of tomorrow

Starting this year, the Science of Health Care Delivery will be the first subject for first-year Mayo Medical School students. It'll expand beyond the classroom so students can learn in real-world environments.

"When you put the Science of Health Care Delivery upfront, it emphasizes the importance of this to their training," Dr. Reed says. "It's core. It's integral. Coupled with the right clinical experiences, it can transform careers."

First-year students will shadow patients trying to acquire appointments to learn about their experiences in terms of what is working and what can be improved. They'll visit community health clinics off campus to gain a broader understanding of the patient experience and resources available.

During their third and fourth years, students will dive deeper into the various factors that influence the value and cost of care. For example, through a computer program called Checkbook, they will look critically at diagnostic tests to see if they are necessary, evidence-based and of high-value.

"Just letting them see those numbers helps them get a better understanding of costs," Dr. Reed says.

Mayo Medical School's new curriculum is already gaining national attention. In 2013, the school's proposal to create an educational model based on the Science of Health Care Delivery earned it a grant from the American Medical Association's Accelerating Change in Medical Education Initiative. Mayo Medical School was one of only 11 schools selected across the nation for this five-year initiative.

As part of this grant, Mayo Medical School and the Mayo Clinic Health System are partnering to develop novel educational opportunities beyond the classroom for first-year medical students to learn and work in interprofessional teams providing high-value care — a cornerstone of the Mayo patient experience.

In another learning experience, students connect with patients having challenges managing their diabetes in order to understand the often complex situations that make it difficult for them to complete lab tests or get blood sugar or blood pressure under control.

After personal interviews with patients, students follow up with the patients' physicians to understand the decisions leading up to the treatment plan.

"The students reach out to get the patients' perspectives on their diabetes and why they are struggling to get it under control, what their goals are and what their barriers are to accessing health care," Lotte N. Dyrbye, M.D., principal investigator on Mayo's AMA grant, says. "From the patient's primary care doctor, students gain perspective on how the doctor works with the patient, what systems are in place to encourage the patient or facilitate care for the patient. Then the student analyzes opportunities for improvement. So the learning incorporates patient, provider and system improvement perspectives."

Additional experiences are being developed for students to use data analytics to identify opportunities to improve patient care outcomes while reducing cost. The experiences help prepare Mayo medical students to thrive in a changing, highly regulated health care environment and still improve the health of patients.

Finding their passion

While hands-on learning across the country will become more common after the Arizona and Florida campuses open, Mayo Medical School students have already started taking advantage of these opportunities.

For third-year student Quincy G. Nang, a hands-on experience during a recent rotation in Jacksonville showed him what he might want to do with the rest of his life. He was on a general surgery rotation and was called in to help a urologist.

"I got to work directly with the chair of the department, and he is amazing," Quincy says. "What an experience! Just like that I started considering pediatric urology very strongly."

Quincy also gained experience with a Mayo Clinic partner organization in Arizona — the Maricopa County Jail. There he observed the psychiatric practice, which broadened his outlook.

"It was invaluable being exposed to that environment — think of something outside of the Mayo system," Quincy says. "I really wanted to be prepared to handle everything that is thrown on my plate in my career and to be able to adapt to many different scenarios and ways of providing care, and I've been able to do that through experiences like these."

Jack Jeng also spent time with a Mayo Clinic partner in Arizona, the Phoenix Children's Hospital.

"Not only did I get to see a lot of bread-and-butter things, but I also saw rare pediatric diseases that I may not have seen in Rochester because of the high pediatric patient volume at a Mayo collaborator — Phoenix Children's Hospital," Jack says. "There were many Spanish-speaking families and patients who were uninsured or on Medicaid. Those are issues I didn't really deal with before because the patient population in Rochester is a bit more homogeneous."

"Coordinating care was a challenge because patients might not have a primary care physician or access to specialists. Hospitalized patients that were uninsured or did not have in-network providers in their area covered by their insurance had a very difficult time getting the follow-up care they needed after discharge."

Dr. Halyard says these varied experiences across the country combined with the Science of Health Care Delivery curriculum will position Mayo Medical School students to be even stronger leaders in the future.

"They're entering into a world where medicine is changing," Dr. Halyard says. "We are creating the next generation of empowered physicians. We want physicians to have a voice in that change. We want them to improve the quality of medicine — continual improvement — and we want our future physicians to be at the table with the skills to be able to implement change."

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