ADEA CCI Liaison Ledger

Perspective on Person-centered Care: Medical Education

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Alison Whelan, M.D.The ADEA CCI Liaison Ledger talks with Alison Whelan, M.D., Chief Medical Education Officer, Association of American Medical Colleges (AAMC)

Liaison Ledger: What would need to change in medical education (such as curriculum, accreditation, licensure, admissions standards) to produce graduates that are person-centered care providers?
Alison Whelan: Some of it is teaching M.D. students and residents different skills and knowledge; some of it is providing different experiences.

Many schools are helping students early on understand who their patients are as people by getting students out of the clinic and into the spaces where their patients are living. That can be anything from home visits to broader community connections through volunteer work. Schools have always had students do community outreach, but now schools are including community members in the discussion of where students can make an impact. It sends a powerful message, and it’s shown to be a more effective way to do community interventions.

In terms of specific skills, the first is communication. As we teach our students how to take a history, we need to make sure that it’s a broad-based history, and that they understand the social context of the patient.

If you just look at health, and you look at health disparities, and you look at social determinants of health, then person-centered care has to become a part of the equation, so I think that recognition is driving the move toward person-centered care. Coming up with solutions is a work in progress, but I think we’re well on our way.

Liaison Ledger: Where does a health professions education association begin in trying to transform the faculty perspective from patient-centered to person-centered?
Alison Whelan: When something new comes up at AAMC, we help drive thought by convening our experts, and we help them to share best practices and give them a platform for leading-edge thinking. We have extraordinary members doing extraordinary things, and one of the best things we can do is help them to share those things, primarily through our meetings but also through showcasing their activities on our website and through AAMC News.

Liaison Ledger: What does the medical school of the future look like to you if the predominant model of practice is person-centered?
Alison Whelan: Medical students and residents will always need to spend a significant part of their educations in the hospitals in which complex care is delivered. As we move toward understanding how to impact population health and the social determinants of health, there will be a continued shift—which has already started—to more learning experiences in ambulatory health care settings and also in community settings, which may not be health care settings. 

There will also have to be more of a connection between M.D.s and other health professionals, particularly those involved in population health, such as social workers and public health professionals. 

Responses from our authors
Nadeem Karimbux: I still struggle a bit with who the health care provider is that brings all of that together in a holistic and meaningful way. It’s that challenge between being in these environments that are extremely complex with people that are focused on specific tasks, and how you take a step back and try to take into account the person at the center of that care. That’s where perhaps the role of technology will facilitate some of that understanding. The question becomes, will these health professions develop someone who will become the patient advocate to make sure that these pieces aren’t getting lost?

Andrew Spielman: It almost invites the creation of a highly educated, trained patient advocate that now becomes the champion. Could that be a digital person who has no agenda other than the patient’s best interest? I’m thinking of a robot that has artificial intelligence and can essentially collect all the data, monitor, advocate, use algorithms, interact with the various health care professionals, line up the appointments and make sure that the patient doesn’t get lost.

Muhammad Walji: We’ve tried these concepts through patient-centered medical homes in primary care. It isn’t an artificial intelligence system, but rather a human that is trying to coordinate the patient’s care. There have been challenges in that, and mainly again it’s because of the way our delivery system is set up with all the incentives going to tertiary care institutions where more and more expensive specialists do various things. That’s really the crux of the problem. There needs to be that transformation of health care delivery if we really are to try and make ourselves more person-centered.


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