Concurrent Session C03 - Beyond...

Community, Diversity, & Equity

Concurrent Session C03Mission Critical: Educating the Future

Health Care Workforce in Social Mission

Presented at the Beyond Flexner Conference | April 9-11, 2018 | Atlanta, GA USA

All Rights Reserved, no forms of dupblication nor distribution allowed without author's consent.

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The Morehouse School of Medicine Adheres to ACCME Essential Areas, Standards, and Policies regarding industry support of continuing medical education. Disclosure of the planning committee and faculty’s commercial relationships will be made known at the activity. Speakers are required to openly disclose of any limitations of data and/or any discussion of any off-label, experimental, or investigational uses of drugs or devices in their presentations.



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Disclosure(s):VitreosHealthStock optionsHygieacareStockholder



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©2017 MFMER | slide-4

Mission Critical: Educating the Future Health Care Workforce in Social MissionBeyond Flexner: Community, Diversity & EquityApril 10, 2018

Natalia Wilson, MD, MPHSwapna Reddy, JD, MPHSarah Umar, MD



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Outline

• Introduction Science of Health Care Delivery ASU • MS SHCD* degree program ASU• MCSoM**-ASU SHCD Certificate Program• MCSoM focus on Education in Health Equity & Health

Care Disparities• Mayo Clinic-ASU Health Care Disparities Initiative for GI

trainees

*SHCD = Science of Health Care Delivery **MCSoM = Mayo Clinic School of Medicine



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Science of Health Care DeliveryArizona State University

Natalia Wilson, MD MPH, Clinical Associate Professor College of Health Solutions ASU,

Adjunct Assistant Professor Mayo Clinic School of Medicine

Swapna Reddy, JD MPH, Clinical Assistant Professor College of Health Solutions ASU,

Adjunct Assistant Professor Mayo Clinic School of Medicine



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IntroductionScience of Health Care Delivery ASU

GOALPrepare current and future health care workers to systematically address the

critical and complex needs of the health care system

FRAMEWORK



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IntroductionScience of Health Care Delivery ASU

EDUCATIONAL CONTINUUM

Future: BS & MS Population Health

Executive Education

Mayo GI Health Care Disparities

InitiativeMCSoM SHCD

CertificateMS SHCDBS SHCD



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Science of Health Care Delivery CurriculumFoundational Themes



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Science of Health Care Delivery ASU Partnerships

• HEALTH CARE SYSTEMS• Mayo Clinic• Dignity Health• HonorHealth• Maricopa Integrated Healthcare System• Steward Health• Phoenix Children’s Hospital• Mountain Park Health Center

• FOUNDATIONS• RWJF• Vitalyst Health Foundation• United Way

• COMMUNITY• MCDPH• SHOW Clinic• PACH Clinic• Esperanca• Hospice of the Valley• Arizona Legal Center

• ELECTED OFFICIALS• Phoenix Vice Mayor Kate Gallego• AZ Representative Heather Carter• U.S. Senator John McCain



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MS SHCD Curriculum

HCD 520 Population Health Framework• What & Why• Key Influencers• SDOH • Disparities, Inequity, Vulnerable populations• New models driving change• Strategies & tools• Generation of evidence• Themes: SDOH, Social Justice, Integration



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MS SHCD CurriculumHCD 520 Population Health Final Paper

• Identify a population health challenge supported by data/literature• Address contributing factors, population health significance & impact • Delineate ongoing strategies/solutions• Propose new model/solution to address challenge• Examples:

• High School Dropout in the Hispanic Population• Community Education Workers

• Postpartum Depression• Model to bridge gap between obstetric & mental health care

• Children with Complex Health Needs• Identification profile for CCHN including clinical, social,

environmental, behavioral factors• Dental Caries in Children & Adolescents

• Development of community dental care teams



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MS SHCDStudent Capstones-“Ambassadors in Equity”

• Students placed in offices of elected officials• Identify health disparities in constituencies• “Buy in”/commitment from policymaker on front end

• Health Equity Model• Academic Researchers• Policymakers• Community Leaders• Health Care Delivery Systems



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MS SHCD Student Capstones: Office of Vice Mayor Kate Gallego: Pediatric Asthma & Food Deserts



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MS SHCD Assessment

• Survey under development• Population=MS SHCD alumni medical students• Aims

• Assess attribution of health competencies to MS SHCD

• Assess impact of SHCD curriculum on involvements & choices in medical school

• Assess impact on residency choices• Foundation for future MCSoM Survey



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MCSoM-ASU SHCD Certificate Program

Basics of program

• 18 credit certificate in SHCD• 6 domain areas• Online modules• Classroom 2x/year • Majority in Year 1

Students have option to complete 12 additional credits for full MS SHCD in 3rd year

The Science of Health Care Delivery Open Access Course, https://www.coursera.org/learn/science-healthcare-delivery

High Value Care

Population-Centered

Care

Team-Based Care

Health Policy,

Economics,Technology

Person-Centered

Care

Leadership



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https://www.coursera.org/learn/science-healthcare-delivery


MCSoM-ASU SHCD Certificate ProgramPopulation Centered Care Domain

• Key Topics• Clinician role in population health improvement• SDOH• Disparities• Barriers to access• Health inequity• Cultural competence• Communication• Community engagement • Global Health

• Delivered through online didactics, interactive exercises, reading, & applied classroom sessions



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MCSoM-ASU SHCD Certificate ProgramPopulation Health Classroom 2017

Utilized CDC’s “Health and Well-Being for All”

CDC Foundation. Health and Well-being For All. https://www.cdcfoundation.org/health-in-a-box



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https://www.cdcfoundation.org/health-in-a-box


MCSoM-ASU SHCD Certificate ProgramPopulation Health Classroom 2017

1. Consider population health - definition & factors affecting2. Discuss SDOH3. The case - Carmen

• How to consider population centered care• Identify impact of SDOH• Move beyond the provider silo

4. Know your population• Each group read a clinical vignette (e.g. STI, teen births, smoking)• Each group used County Health Rankings to find county data on issue in clinical vignette • Each group researched public health initiatives for the issue

5. Identify stakeholders to engage6. Develop a future vision & focus on implementation

• Model for improvement• PDSA Cycle• Communication



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A Shift in Medical Education Curriculum:Health Equity Focus



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MCSoM-ASU SHCD Certificate ProgramHealth Equity FocusInfusing Health Equity Into CurriculumPrior to 1st Year & Orientation- Setting Expectations

■ All students receive “Blind Spot” + letter by Dean■ All faculty receive “Blind Spot” ■ Required reflection■ IAT for students and faculty

First Year- SHCD Blocks 1 & 5: A Continuous Thread● Introduction to Population Health● Health Disparities & SDOH● Quality Gaps● Cultural Humility● Global Health● Implicit Bias● Trust/Mistrust ● Rural Health● Cross Cultural Communication● Community Engagement● Health Policy



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GI Healthcare Disparities Initiative: A Collaboration Between Mayo Clinic

Arizona and ASU CHSSarah B. Umar M.D.

Associate Program Director, GI/Hepatology Fellowship Program

Mayo Clinic, Arizona



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GI Health Disparities Initiative: Why?

• GI trainees receive no formal training in health disparities, cultural humility, bias or social determinants of health

• Trainees (and staff!) operating in a system not in keeping with the ‘outside’. Resources seemingly unlimited.

• Lack of understanding of non-medical determinants of health impairs optimal delivery of care



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GI Health Disparities Initiative: Goals‘The best interest of the patient is the only interest to be considered’ -W.J. Mayo

• To train not only good doctors but good medical citizens

• Broaden clinical exposure

• To improve trainees’ understanding of factors contributing to inequity in the healthcare system

• To give trainees the necessary tools to address the above factors in a resource-limited setting



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GI Health Disparities Initiative: How we’re going to do it

Curriculum Establishment

ASU CHS Collaboration

• Disparities of health & health care delivery

• SDOH

• Implicit Bias

• Cultural Humility

Curriculum Delivery

Multi-modality

• Didactic in-person

• Online modules

• Group discussions

• Problem-based learning

• Reflective exercises



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GI Health Disparities Initiative: How we’re going to do it

Efficacy

Pre & post-educational assessments

• Validated Instruments

• Reflective Evaluations

Putting It to Use

Establishment of GI clinic at a federally qualified health care center serving underserved, vulnerable populations



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Assessing outcomes

Validated Instruments

• Jefferson Scale of Empathy

• Cross-Cultural Competence of Health Care Professionals (CCCHP)

• Implicit Association Test (IAT)

Assessments

• Pre- and post-lecture questions

• Reflective Exercises

• Research/publication



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Where we are, Where we’re going

Present

• Developing & finalizing curriculum & online modules

• Establishing GI Clinic at Adelante Healthcare Mesa, AZ

Future

• Applications for grants to expand scope of project

• Endoscopic Clinic at Adelante

• Clinical research projects

• Fellow publication, attendance national meetings



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Discussion



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Contact

1. Natalia Wilson, MD MPH, [email protected]. Swapna Reddy, JD MPH, [email protected]. Sarah Umar, MD, [email protected]

THANK YOU!



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mailto:[email protected]



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