Reforming the Business of Health Care
This article was originally posted on @theU.
A typical week for Seth Biehn looks something like this:
- Monday: Psychiatry
- Tuesday: General Surgery
- Wednesday: Pediatrics
- Thursday: Obstetrics and Gynecology
- Friday: Family Medicine
Every medical student, including Biehn, must master seven core specialties before graduation: internal medicine, surgery, OBGYN, pediatrics, neurology, psychiatry and family medicine.
Traditionally, students learn these specialties in block rotations. They spend four to eight weeks immersed in one specialty before moving on to another, from internal medicine to surgery to pediatrics and so on. Each block brings a new clinic, a new doctor to learn from and new systems to learn.
Biehn, however, is parting from this standardized block rotation model by participating in what’s called a longitudinal integrated clerkship (LIC). He is enrolled in the newest LIC at the Spencer Fox Eccles School of Medicine at University of Utah (SFESOM): the Intermountain Population Health LIC.
Rather than compressing each specialty into a few weeks, LICs expose students to all seven specialties at once, progressing their learning throughout the year.
Biehn spends one day a week, for an entire year, learning from the same internal medicine doctor. In a block rotation, he would see that internal medicine doctor for a few weeks, then move on to another doctor and another specialty. LICs help Biehn and other medical students build strong and trusting relationships with their doctor teachers, known as preceptors.
In this way, Biehn is exposed to all seven specialties at once. The spaced repetition helps Biehn see how they intertwine and are each important to a patient’s health.
“Just yesterday, I took something I learned in neurology and used it with one of my other preceptors,” Biehn says. The ability to apply new knowledge in real-time across disciplines is just one advantage of the LIC model.
The medical school was drawn to LICs because of their collaborative and connected learning model. After a few pilot LICs, they are now a foundational piece of the new Mission-Driven MD curriculum at SFESOM. Starting with the class of 2027, all medical students will begin LICs in their second year.
“Traditional block rotations do not last long enough for students or preceptors to feel comfortable,” says Brian Good, MD, an LIC preceptor who works with both Intermountain and U of U Health to build strong LICs and other educational projects.
Condensed learning paired with new people and new places is a recipe for a high-stress, low-retention learning environment. Because LICs run all year, students and preceptors have time to get to know one another and build trust. With this trust, students do more becoming assets to their preceptors.
Additionally, LICs allow for more flexible scheduling. Rather than blocking out one month to a student, LIC preceptors only need to dedicate one day a week. This makes it much easier for physicians to opt into preceptorship.
According to Good, physicians who become LIC preceptors have higher job satisfaction. Seeing a student learn and grow over an entire academic year is a special and rewarding experience.
What makes Intermountain Population Health LIC unique?
At the U, students like Biehn have opportunities for a unique kind of LIC not found at other medical schools. The Intermountain Population Health LIC has been invaluable to Biehn’s education and future career. “I’m able to get comfortable with how Intermountain works as a system,” Biehn says.
He’s learning how to write accurate medical notes, do referrals, and become familiar with who people are. “It’s a really good way to get your foot in the door and start networking,” he says.
The Intermountain Population Health LIC is an extension to existing programs and collaborations between Intermountain Health and University of Utah Health. In 2021, they jointly announced the Intermountain Health Population Health Scholars Program, of which the LIC is a part.
The goal? Rebuild Utah’s primary care physician workforce.
Students in the program agree to pursue one of six population health specialties. They participate in a graduate certificate in population health and are paired with an Intermountain physician mentor. They receive 50% tuition and fees as a forgivable loan. After residency, they are offered employment with Intermountain Health and become eligible for loan forgiveness if they work for Intermountain.
As the scholars program entered its third year in 2023, SFESOM announced its shift from block rotations to LICs.
Karyn Springer, M.D., assistant dean for Intermountain Population Health wanted to build an LIC at Intermountain Health. In addition to her role at the U, Springer practices and serves as assistant vice president for Medical Education at Intermountain. She wanted a clerkship that would strengthen students’ experience and knowledge of population health and get them excited to work for Intermountain and know their system better.
Both Intermountain and U of U Health are committed to improving the health of Utahns. Intermountain wants to hire physicians who are educated in population health and value-driven care.
“Medicine is a team sport,” Springer says. “Together, we will do much more than we can separately.”
Seeing two competing health care systems collaborate is rare. Too often, health systems get caught up in the business of health. But together, U of U Health and Intermountain are reforming the business of health. Moving from a system that skews population and patient care to the periphery, they are putting Utah populations at the center of their vision.
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Why population health?
In population health, the doctor—or the system—tries to affect change in an entire population of people, not just one patient.
“Population health takes a 50,000-foot view of health care,” Good says.
Biehn, who studied public health as an undergrad, notes that population health reaches outside of clinics. It teaches people how to prepare fresh vegetables and where to pick up affordable prescriptions. It involves regular health check-ups and community walking groups. Population health investigates how to affect change in communities of people, rather than one person in one clinic.
“Expanding into a larger scale of public health is something I’ve always been really passionate about, and the population health pathway is opening the door for me to be able to do that,” Biehn says.
Good points out that part of population health involves thinking outside of the system. When med students do an LIC at Intermountain, they become aware of health system differences and realize what works and doesn’t.
“If you are on your island, you don’t see the best of both worlds,” Good says.
By training students in population health and immersing them in two health systems, Intermountain and U of U Health are training the next generation of compassionate, competent physicians who will also be change-makers and community builders.
LICs are good for patients, too. When a patient at Intermountain sees a student in training, that student can uniquely advocate for them. Because of the students’ constant exposure to other specialties and doctors within Intermountain, they can help see patients through their journey of care.
“A student can add a patient to their panel, follow them through the year, and adjust their schedule so they can see that patient for three-month, six-month and nine-month follow-up visits,” says Robert Brickley, M.D., director of the Intermountain Population Health LIC.
For example, Biehn was able to follow the health care journey of a new mom. “I helped with a C-section on labor and delivery,” he recalls. “And then I saw the baby two weeks later in pediatrics for their two-week check-up.”
“It’s an amazing opportunity to experience health care from the patient perspective,” Brickley says. “It helps students understand how health care systems affect patients, rather than being stuck in a silo of each specialty.”
Brickley points out that students who go through an LIC graduate with a more patient-centered approach to medicine. “[LIC students] score higher on assessments for patient-centeredness,” he says.
The LIC experience influences how a new physician will practice for the rest of their lives.
What’s next for SFESOM and Intermountain?
The Intermountain Population Health LIC launched this fall. Springer hopes to expand it to rural areas of the state.
“We know that we both need a strong pipeline of physicians to help support the health of our community,” Springer says. She looks forward to continued collaboration with U of U Health.
The key to successful LICs is strong preceptor relationships. As SFESOM expands LICs, they need more preceptors.
“We just need to know when willing physicians are free,” Good says. “The school provides faculty development and will help answer any questions about precepting.”
“It’s an exciting time for the medical school and medical community in Utah,” Brickley says. As the medical school curriculum changes in a major way, physicians, patients, and staff should expect to see students in more places than ever before.
Together, Intermountain and U of U Health are reforming the business of health care. They are building patient-centered pathways that sync students with patients and the real world. By learning in both systems, students can start realizing what’s best for patients and begin enacting change in their communities.
If you are interested in becoming a LIC preceptor or learning more, please contact Brian Good at brian.good@hsc.utah.edu.