APMA News - January/February 2023 - 20

In 2013 the AMA launched the Accelerating
Change in Medical Education initiative to address
these complex changes in health care and
medical education. The original objectives of the
initiative included
* promoting exemplary methods to achieve
patient safety, performance improvement and
patient-centered team-based care; and
* improving medical students' understanding of the
health-care system and health-care financing.[4]
As a result of these recommendations, at least
half of the 32 consortium schools involved in this
initiative have created new HSS curricula, and the
National Board of Medical Examiners developed an
HSS assessment for students, first offered in 2019.
[5][6]
Our plans to create an HSS curriculum were
validated by these initial steps taken by the allopathic
medical education community.
Within the HSS stream, a breadth of topics are
addressed. The current components include:
* health-care structure and process;
* health system improvement;
* value in health care;
* population health;
* public health;
* social determinants of health;
* clinical informatics;
* health-care technology;
* health policy;
* health economics;
* leadership;
* teaming;
* ethics;
* legal issues;,
* advocacy; and
* systems thinking.
Most medical programs include some or all
of these subjects, but rarely are they taught as
a stream of curriculum with a set of common
objectives and outcomes. We believe that formally
and intentionally teaching the subject of HSS will
prepare our graduates for residency.
Dr. Shih: Health care has become very complex.
Many policy-driven changes require providers
to adapt quickly. Otherwise, there are not
only financial consequences, but suboptimal care
results in suboptimal outcomes. I recall how confused
I was when I first heard terms such as MIPS
and quality measures for MACRA. As a young
physician, I was already nervous about Medicare
audits, getting a job, and paying student loans.
However, none of these subjects was covered
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JANUARY/FEBRUARY 2023
in the podiatric medical school curriculum, but
they were affecting my daily life. Thus, Dr. Choate
and I recognize the need to prepare our students
beyond basic science and clinical skills so they
will be ready to function in residency and to
advocate for their patients. HSS covers and fills in
the knowledge gaps in health-care policy, finance,
and communication while maintaining a focus on
the ideas of patient-centered care and population
health. I think the three-pillar system will prepare
our students to become well-rounded physicians
and surgeons. In turn, they will represent our
profession well and continue to advance podiatric
medicine and surgery.
Because podiatric medical program
curricula are already tight on space,
how did you approach the addition of
a new stream of teaching?
Dr. Choate: Adjusting curriculum is challenging,
but we approached it from all sides. We used a
textbook by Susan Skochelak, Health Systems
Science, as our foundation for creating a framework[3]
.
Secondly, we created a " crosswalk " between
the established HSS objectives and matched
them to current learning objectives in our basic
science and clinical sciences courses. This " crosswalk "
allowed us to ascertain which topics we were
already addressing in our curriculum. Next, we sent
a survey to all faculty who had HSS objectives in
their courses and rotations to assess the level of
teaching and assessment in these areas. Lastly, we
created two different curricular plans to expand
the health system science curriculum over all
four years of the program, which we presented to
program and university leadership. By late spring
2021, we had developed our first course, which Dr.
Shih and I co-taught in fall 2021 to our first-year
students. Our leadership teams were fully supportive
of the project and continue to support us as we
implement our next steps.
Dr. Shih: The overall HSS curriculum includes
the " quadruple aim, " which highlights physician
wellness as the fourth aim in addition to the " triple
aim " : population health, experience of care, and
per-capita cost. Therefore, when we introduced
the HSS curricula, Dr. Choate and I intentionally
spread the topics throughout the four-year
curriculum. We also selected existing courses and
rotations where many of the subjects in HSS were
already covered. This way, we did not increase the
workload for the students, and our students would
be discussing the subjects of HSS at different
stages of their training as they move from basic
APMA News - January/February 2023

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