"Teaching up" health systems science in the clinical clerkships 

Health Systems Science (HSS) is an essential component of comprehensive medical education, but many faculty did not receive formal training in this area.  Utilizing a "teach up" method for students to help their preceptors recognize HSS topics in clinical encounters can address the hidden curriculum for residents and faculty who already apply HSS in their daily patient encounters but do not recognize it. SIU School of Medicine’s Department of Population Science and Policy (PSP) designed a curriculum titled PSP in Practice to engage students, residents and faculty as reciprocal teachers of HSS topics in clinical encounters. This was piloted first in Pediatrics, and then expanded to all eight core clerkships. SIU SOM PSP curriculum utilizes HSS domains defined by the American Medical Association.  All domains are addressed over the pre-clinical Y1 and Y2 curriculum, and electives are available in each domain in Y4. PSP in Practice aimed to directly identify clinical correlations between each core clerkship and one or more HSS domains.  These were jointly selected by the clerkship teams and PSP faculty. This project used voluntary, anonymous surveys to collect feedback, and explicit discussion of HSS topics by specialty occurred during fifteen minutes of clerkship orientation, and a one hour follow up meeting in the final week of clerkship.  Resident and Faculty members from various specialities participated in orientations, follow up meetings, and as clinical clerkship preceptors.  Two departments also requested and received a formal faculty development session on teaching HSS in clinical settings (Pediatrics and Obstetrics/Gynecology).  Objectives were to: 1. Discuss specialty-specific health systems science (HSS) topics - defining terms and identifying impact on clinical practice. 2. Provide examples to students and residents of impact of topics on healthcare practice and health outcomes for patients. 3. Use a common pathway for faculty to teach HSS topics to students and residents through a lens that touches on individual, community and policy level impacts. 4. Utilize a “teach up” method in which student questions about HSS topics result in increased awareness and understanding of impact for residents and attending faculty. Results demonstrated that after this curriculum, students reported improved confidence in identifying how health systems science topics relate to clinical encounters. Students rated residents and faculty as receptive to teaching clinical HSS examples, highlighting that despite low confidence about teaching among residents and faculty, students can “teach up” by knowing what to ask and how to find examples of PSP topics in practice in every specialty. PSP in Practice in Pediatrics was also formally expanded to residents, coinciding with PSP in Practice for students, and resulted in increased recognition noted by pre/post surveys, as well as improved percent program compliance reported on the annual ACGME survey for “taught about healthcare disparities.” Limitations were that survey collection was voluntary, with limited pre and post responses in some clerkships; confidence level is subjective, self-reported, and variable; some clerkships had challenges initially in integrating materials during their orientation due to time limitations. Feedback from students and clerkships demonstrated that the goal of increasing awareness through clinical discussions of HSS topics was achieved. Residents and faculty participated as both recipients of “teaching up” from students, and as mentors demonstrating how HSS integrates in clinical settings. Future work will examine further challenges among residents and faculty: assessing baseline knowledge, addressing gaps, improving confidence level recognizing HSS topics in clinical encounters, and teaching about HSS topics by specialty.