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Aug. 17--HERSHEY -- In a small conference room at the Penn State College of Medicine, medical student Sean Nutting asked patient Marcie Warner of Hummelstown what prompted her frequent trips to the emergency room.
"Sometimes I'm just so worn out. I can't see right. I get a headache," Warner responded.
Nutting continued his questions to learn as much as he could about her social situation as well as her symptoms. Warner, however, is not a real patient; she is an actor helping Nutting and other medical students in the room reshape medical education.
The College of Medicine introduced a new and unique curriculum this year -- Science of Health Systems -- as part of a national project initiated by the American Medical Association to improve medical education. The ultimate goal is to train doctors so that patients have better health outcomes and a less impersonal experience that takes into account both their social situation and economic means.
Last fall, the College of Medicine received a $1 million grant from the AMA to design the new curriculum that would reshape medical education. Penn State was one of 11 medical schools out of 120 whose projects were selected by the AMA for funding.
"We decided to start this initiative because we could see there were gaps in training that aren't related to the medical care that physicians give but that are related to the way health care is delivered today," said Dr. Susan Skochelak, AMA vice president of education.
So, the AMA invested in medical education "because we wanted to influence outcomes," Skochelak said. "It's not that medical education is broken. But we know that the students have to function in the health-care system that's evolving."
Skochelak said the 11 chosen schools are also working together, sharing ideas, and they have modified their individual projects based on what the other schools are doing.
"We are a coach for them. We monitor what they're doing, but each school has far surpassed what we expected their projects to be," she added.
Skochelak pointed out that medical students receive the majority of their training in hospitals, even though the majority of patients are seen in out-patient settings by physician-led teams. And, medical schools don't provide students with enough instruction about the business of medicine and the workings of health care systems.
What is impressive about Penn State's program, she said, is that it has integrated the local health system leaders and has a unique approach -- called the patient navigator -- to teach students how health systems work. The patient navigator helps patients and their families work through the health care system.
Ivana Marji, a medical student from New York, said the new curriculum is one of the reasons why she decided to apply to the Derry Township medical school.
"It's an integrated curriculum, so you learn about your patient in the first two years. That better equips us to handle the clinical aspect of their care."
Marji said doctors need to learn about their patients in order to treat them.
"You need to know about them past just their symptoms. You need to know who they are as a person, what kind of environmental stresses they endure. And, this curriculum really allows you to get to know your patient as more of a person and not just a set of symptoms."
Dr. Robin Wittenstein, chief operating officer of Penn State Hershey Health System, helped write the grant for the AMA.
"We've developed a curriculum that over the first 19 months of the student's educational experience lets them get involved in the health care system, not in providing medical care, but in really beginning to understand all of the different pieces and how they impact that patient's journey through the process."
Dr. Jed Gonzalo, assistant dean of health systems education, said that students still learn the basic sciences and the scientific principles of medicine, but the curriculum has been streamlined to add system sciences. Classes include study in health care insurance, health care policy, teamwork, collaboration, population and public health.
"We're trying to engage students in a way that makes it very student directed," he added.
Students spend at least two hours a week in small group activities, such as questioning patients, to help them learn to work in teams.
For now, the curriculum covers the first two years of the medical student's education. But it will be expanded.
"As we transition into the third and fourth years, it's part of our grant, that we will be integrating health systems in other clinical experiences and other educational modalities to carry on the developmental model of the system sciences," Gonzalo said.
Students meet once a week for eight to 10 weeks, with 80 percent of the classes being in small group sessions and the remainder in large group sessions.
"We're going to be developing a new type of physician leader, who can help us all improve the system," said Skochelak. "We really believe that by virtue of what they're going to learn that they're going to think about care differently. They're still going to take care of individual patients but they'll be thinking about it from a different perspective.
For Wittenstein, it is all about making health care better for the patient.
"I think we see health care in the future as being different than today, and hopefully this is the start that will really make a difference for central Pennsylvania," she said.
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