Poster presented at: 14th Annual AMA Research Symposium in Orlando, Fl 
Objective: 
To investigate the effectiveness of Physican Leadership, an open access, student-led healthcare leadership program at Sidney Kimmel Medical College, in preparing to face five key emerging topics in medical practice: healthcare economics, health policy, care and quality and safety, law and medicine, and patient experience.
The Problem: Gaps in Medical Education
Healthcare in the US continues to evolve, and topics such as health policy, health finance, and patient experience are not central to the practice of medicine.
However, the sheer volume of material students are required to learn in the preclinical years makes it challenging to introduce new subjects into traditional medical school curricula.  As a result, these topics in healthcare leadership are often left out.  Indeed, only 40-50% of medical student report appropriate training in the  practice  of medicine, including subjects as medical economics, healthcare systems, and managed care.https://jdc.jefferson.edu/pel/1002/thumbnail.jp

Downing, Jessica W.

Gordon, Jonathan S.

Grunenwald, MS, Lauren E.

Modi, Ronuk M.

Shah, Anuh

Veloski, MS, J J

English

Poster presented at: 14th Annual AMA Research Symposium in Orlando, Fl 
Objective: 
To investigate the effectiveness of Physican Leadership, an open access, student-led healthcare leadership program at Sidney Kimmel Medical College, in preparing to face five key emerging topics in medical practice: healthcare economics, health policy, care and quality and safety, law and medicine, and patient experience.
The Problem: Gaps in Medical Education
Healthcare in the US continues to evolve, and topics such as health policy, health finance, and patient experience are not central to the practice of medicine.
However, the sheer volume of material students are required to learn in the preclinical years makes it challenging to introduce new subjects into traditional medical school curricula.  As a result, these topics in healthcare leadership are often left out.  Indeed, only 40-50% of medical student report appropriate training in the \u22practice\u22 of medicine, including subjects as medical economics, healthcare systems, and managed care.http://jdc.jefferson.edu/pel/1002/thumbnail.jp

Name not available

Physician Executive Leadership: Assessing a Student-Led Approach to Healthcare Leadership Education in Medical School

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsPhysician Executive Leadership Sidney Kimmel Medical College11-11-2016Physician Executive Leadership: Assessing aStudent-Led Approach to Healthcare LeadershipEducation in Medical SchoolJessica W. DowningSKMC, Thomas Jefferson University, jessica.downing@jefferson.eduAnuh ShahSKMC, Thomas Jefferson University, anuj.shah@jefferson.eduRonuk M. ModiSKMC, Thomas Jefferson University, ronuk.modi@jefferson.eduJonathan S. GordonSKMC, Thomas Jefferson University, jonathan.gordon@jefferson.eduLauren E. Grunenwald, MSSKMC, Thomas Jefferson University, lauren.grunenwald@jefferson.eduSee next page for additional authorsFollow this and additional works at: http://jdc.jefferson.edu/pelPart of the Medicine and Health Sciences CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inPhysician Executive Leadership by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationDowning, Jessica W.; Shah, Anuh; Modi, Ronuk M.; Gordon, Jonathan S.; Grunenwald, MS, Lauren E.; and Veloski, MS, J J.,"Physician Executive Leadership: Assessing a Student-Led Approach to Healthcare Leadership Education in Medical School" (2016).Physician Executive Leadership. 2.http://jdc.jefferson.edu/pel/2AuthorsJessica W. Downing; Anuh Shah; Ronuk M. Modi; Jonathan S. Gordon; Lauren E. Grunenwald, MS; and J J.Veloski, MSThis poster is available at Jefferson Digital Commons: http://jdc.jefferson.edu/pel/2Physician Executive Leadership:Assessing a Student-Led Approach to Healthcare Leadership Education in Medical SchoolJessica V Downing, Anuj Shah, Ronuk M Modi, Jonathan S. Gordon, Lauren E. Grunenwald MS, Jon Veloski MS  The Problem:   Gaps in Medical EducationHealthcare in the US continues to evolve, and topics such as health policy, health finance, and patient experience are now central to the practice of medicine. !!However, the sheer volume of material students are required to learn in the preclinical years makes it challenging to introduce new subjects into traditional medical school curricula. As a result, these topics in healthcare leadership are often left out.1 Indeed, only 40-50% of medical students report appropriate training in the “practice” of medicine, including subjects such as medical economics, healthcare systems, and managed care.2    A Proposed Solution: Physician Executive LeadershipIn response to this gap in medical education, students at Sidney Kimmel Medical College (SKMC) at Thomas Jefferson University founded Physician Executive Leadership (PEL) in 2013. PEL is an entirely student-led, student-centered, extracurricular program open to all SKMC students. The program’s mission is to provide medical students with a platform to build healthcare knowledge and cultivate leadership skills, in order to become well-informed and capable physician leaders and innovators.!!By connecting students to healthcare leaders and introducing them to key topics in healthcare leadership, PEL enables students to develop both depth and breadth of knowledge in a number of subject areas underrepresented in medical education.Health Policy How insurance works, why it exists, and how to affect change at the policy levelHealth Finance How doctors are paid, how value-based care works, and how to access venture capital for innovationPatient Experience How it's measured (HCAHPS, CAHPS), how it impacts reimbursement, and what doctors and hospitals can do to improve itLaw & Medicine How medical malpractice and employment contracts work and influence how care is providedCare Quality & Safety How to identify system and process errors, best practices for quality improvement, and how it all impacts the bottom linePEL Curriculum: Key TopicsOverview Next Steps  For the ProgramLecture SeriesSmall- Group SessionCurrent Events: Article of the Week SubmissionIndependent InquiryHealthy Policy X X X XHealth Finance XPatient Experience XCare Quality & Safety XLaw & Medicine XSample Requirements for Completion of the PEL Program,  2017-2018  For the ResearchBased on this research, we are developing a formal curriculum to be implemented in the 2016-17 school year, centered around small-group sessions with case-based discussions focused on each of the core PEL topics. Sessions will be facilitated by a physician leader, student, or expert, and require pre-reading and active participation. Each topic will be addressed in two sessions: the first focused on teaching the fundamentals of the topic, and the second on solving related problems facing healthcare today. In addition to the documented benefits of small-group and case-based learning, these sessions provide students the freedom to tailor their education to their learning styles and interests.6,7 To promote further exploration and applied learning, PEL will award select students summer grant funding to conduct self-designed projects with physician leaders and mentors.Because this new set of requirements is more extensive than those of previous years, and because students continue to encounter these topics throughout their medical education, PEL participation will become a multi-year engagement that tracks the length of the medical school experience, rather than resetting at the beginning of each academic year.!!We hope that by extending PEL participation through all four years of medical school, and creating a more structured set of completion requirements, we will be able to help students achieve both breadth of knowledge in all the subjects PEL teaches and depth of knowledge in the topics that interest them most.In an effort to more accurately capture the impact of the PEL program and address some of the limitations of this current study, we have implemented a number of changes in our research and assessment process, encompassing the questions themselves, the process of administering assessments, and the creation of a control group.Questions: We are working in collaboration with the experts who lead lectures and small group sessions on each of PELs key subject areas, as well as the Director of Medical Education Research at SKMC to write board-style questions externally validated to cover the material most pertinent to each topic. Assessment: Students will complete individual before-and-after assessments for each of the events they attend that focus on one of PEL’s five key subject areas. At the end of the year, all students participating in PEL will take an end-of-year assessment including all of the questions from each topic’s individual assessment.  Control: For each topic, students who attended a PEL event focused on a particular topic and completed the individual assessment will comprise the study group. Students who did not attend an event focused on that topic, and complete the questions relevant to it only at the end of the year, will comprise the control group. We are in the process of developing a method to recruit a focus group of students not involved in PEL.Citations!1. Gonzalo JD, Haidet P, Blatt B, Wolpaw DR. Exploring challenges in implementing a health systems science curriculum: A qualitative analysis of student perceptions. Med Educ. 2016;50(5):523-531. !2. Patel MS, Lypson ML, Davis MM. Medical student perceptions of education in health care systems. Acad Med. 2009;84(9):1301-1306. !3. 3. Webb AMB, Tsipis NE, McClellan TR, et al. A first step toward understanding best practices in leadership training in undergraduate medical education: A systematic review. Acad Med. 2014;89(11):1563-1570. !4.  Clyne B, Rapoza B, George P. Leadership in undergraduate medical education: Training future physician leaders. R I Med J. 2015;98(9):36-40. !5. Agarwal A, Anderson J, Sarfaty S, Rimer E, Hirsch AE. The value of an elective in business and leadership for medical students. J Med Pract Manage. 2015;30(4):276-280. !6. Koles PG, Stolfi A, Borges NJ, Nelson S, Parmelee DX. The impact of team-based learning on medical students' academic performance. Acad Med. 2010;85(11):1739-1745. !7. Srinivasan M, Wilkes M, Stevenson F, Nguyen T, Slavin S. Comparing problem-based learning with case-based learning: Effects of a major curricular shift at two institutions. Acad Med. 2007;82(1):74-82. For the 2017-2018 academic year, we plan to change the program requirements. For the past three academic years, students have been able to complete the PEL program each year by earning a set number of credits. Students could earn credits by attending PEL lectures, small-group events, or contributing to our online student journal, The Diagnostic.!!Moving forward, students will be required to: 1) earn one credit in each of PEL’s five key subject areas; and 2) earn multiple credits in a single subject area. To fulfill the latter, students will have to attend a lecture, participate in a small-group session, contribute a relevant news article to our weekly newsfeed and pursue an independent inquiry into their chosen subject area, via either a summer internship or a piece written for The Diagnostic. An example of how a student may complete these new requirements is outlined below. Limitations   ConclusionsSidney Kimmel Medical College, Thomas Jefferson UniversityLecture Series Small Groups & WorkshopsInternships & Special Events Research & Student JournalEmploying  Multiple Learning ModalitiesConnecting to  Healthcare LeadersAll medical students will face the complexities of healthcare throughout their careers as clinicians, researchers, educators, and entrepreneurs. Our research demonstrates that students view competence in these non-clinical aspects of medicine as vital to successfully navigating the current healthcare environment and to shaping its future. However, medical education at present does not prioritize these non-clinical teachings. By creating a program in parallel to the curriculum that does not require changing the curriculum itself, we provide a means through which these topics complement, rather than compete with, clinical medical education68.4%92.9%74.5%57.1%72.4%49%59.2%70.4%68.4%78.6%53.1%71.4%61.2%53.1%94.9%51%83.7%74.5%55.1%57.1%45.9%55.1%67.3%44.9%72.4%33.7%61.2%31.6%64.3%80.6%Start-of-YearEnd-of-YearWhat does Medicare Part D cover?Which of the following groups is NOT covered by Medicaid?Healthcare providers take the most financial risk when using what kind of payments? As an orthopedic surgeon, you ask a patient to get an x-ray of their ankle. What determines who bills for the scan and interpretation of the scan?Which of the following make up the Institute of Healthcare Improvement's Triple Aim?What are ACO’s?Which of the following innovations is already in place in one or more AAMC accredited medical institution across the US?What is HCAHPS?Healthcare is approximately what % of US Gross Domestic Product?Which is NOT a "never event" as described by the National Quality Forum?When will ICD-10 be put into effect in the US?For physicians employed by health systems, according to the Stark Law, factors that can be used to determine compensation include all of the following EXCEPT:You are a physician starting practice in 2018 in a hospital working under CMS's Value-Based Purchasing Initiative. You are likely to be paid by Medicare based on:Which of the following is typically most expensive?When states say they’ve “expanded Medicaid,” what do they mean?Research ResultsOn average, overall scores on the multiple-choice assessment improved by 9.7% (SD 18.9%) between the beginning and end of the year (CI=6.0-13.5, p<0.001). The graph to the right shows average percent correct answers for each question in the start-of-year (gray) and end-of-year (blue) assessments. To investigate the effectiveness of Physician Executive Leadership, an open access, student-led healthcare leadership program at Sidney Kimmel Medical College, in preparing students to face five key emerging topics in medical practice: healthcare economics, health policy, care quality and safety, law and medicine, and patient experience.ObjectiveObjective Assessment DesignWe assessed the impact of our program by surveying participants on their engagement and satisfaction with their participation in the PEL program, as well as their comprehension of representative content covered by PEL, at the beginning and end of 2015-2016 academic year. Both surveys collected demographic information and featured a 20-question multiple-choice assessment intended to provide an objective measure of what students learned through their participation in PEL. The second survey also included an assessment of students’ satisfaction with PEL and their perspectives on PEL’s importance in medical education using a 5-point Likert scale. The survey was administered to medical students at SKMC at Thomas Jefferson University in Philadelphia, PA. All students surveyed completed the PEL program during the 2015-2016 academic year by attending at least five events. !!174 students completed the start-of-year survey, and 112 completed the end-of-year survey. Our sample consisted of the 98 students who completed both surveys: 62 of whom were in their first year of medical school, 32 in their second, and four in their third. About one-third (31) of survey participants had completed the PEL program in a previous year.!Test scores were analyzed using a paired t-test in SPSS Statistics Version 22 (IBM, Armonk, New York). Five questions were excluded because they were later determined to have more than one acceptable answer, were changed between the two surveys, or were answered correctly by less than 20% of participants. Subjective questions were assessed by the percent of participants indicating that they were “satisfied” or “strongly satisfied” with the PEL program, (Likert scores of 4 and 5), and by the percent who “agreed” or “strongly agreed” with statements regarding the importance and value of the PEL program (Likert scores of 4 and 5).  Participants and Setting  Data AnalysisDemographics Objective Assessment Subjective Assessment• Medical school class year!• College graduation year!• College major!• Experiences between college and medical school!• Past participation in PEL20 multiple choice questions assessing student knowledge of:!• health policy!• health economics!• care quality improvement!• patient experience!• law and medicineBoth Surveys: Second Survey Only:Contents of the 2015-2016 PEL Assessment SurveysLikert scale responses (1-5) to the following statements:!• Exposure to PEL topics will help me as a physician!• PEL topics should be integrated into medical education!Overall satisfaction with PELSubjective Assessment4859500Strongly Disagree!(1)Disagree!(2)Neutral!(3)Agree!(4)Strongly Agree!(5)“Exposure to PEL topics will help me as a physician”n = 11248481600Strongly Disagree!(1)Disagree!(2)Neutral!(3)Agree!(4)Strongly Agree!(5)“PEL topics should be integrated into medical education for all students”n = 1123275500Very Unsatisfied!(1)Unsatisfied!(2)Neutral!(3)Satisfied!(4)Very Satisfied!(5)Overall Satisfaction with PELn = 112n = 98Because the survey was initially developed to internally validate the PEL program and better understand participant perceptions of the organization, we did not survey students who did not participate in PEL. A control group would have enabled us to differentiate the effects of PEL involvement from the effects of completing another year of medical school on assessment score.More questions would have allowed for stronger conclusions and a more powerful analysis.Given the absence of a standardized test for assessing student knowledge of healthcare social sciences, the exam was authored by PEL leadership, and thus, the survey’s validity and reliability are unknown. Students’ overwhelmingly positive responses to the subjective evaluations indicate that participants were highly satisfied with PEL and further validate its student-led, student-centered structure. Given the content of the 2015-2016 PEL program, the improvement in assessment scores was unexpected; although PEL programming addressed several of the topics included in the objective assessment, events were focused on the broader subject of healthcare leadership instead of these topics specifically.We expect results to further improve after introducing a formal curriculum in 2016-2017. Furthermore, we will administer a redesigned assessment in order to differentiate between the impact of PEL and that of completing another school year.

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Physician Executive Leadership: Assessing a Student-Led Approach to Healthcare Leadership Education in Medical School

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