AMA Health Systems Science Student, Resident and Fellow Impact Challenge

Medical students, residents and fellows making an impact Special COVID-19 Edition Submissions to the 2020 AMA Accelerating Change in Medical Education Health Systems Science Student, Resident and Fellow Impact Challenge Foreword In 2013, with the aim of creating the medical schools of the future, the American Medical Association launched the “Accelerating Change in Medical Education” initiative. Having closely monitored the progress of the initiative over the past seven years, it is clear it has made a significant impact on medical students who are now well on their way to becoming well-trained physicians. Today, a total of 37 schools (20% of all eligible U.S. allopathic and osteopathic medical schools) are now in the AMA Accelerating Change in Medical Education Consortium. These schools are educating nearly 24,000 students who will one day care for more than 41 million patients annually. Our efforts have also spread to residents. In 2019, we launched the AMA “Reimagining Residency” initiative, which includes 11 teams of educators working in graduate medical education. With the launch of the 2020 AMA Health Systems Science Student, Resident and Fellow Impact Challenge, our intent was to see if health systems science—which is one of the most important innovations to emerge from the consortium’s work—was aiding efforts to combat the COVID-19 pandemic, especially since: • Medical students were removed from most clinical settings • Medical education was disrupted for almost all learners • Health systems faced unprecedented systemic challenges The entries that the challenge generated were astounding. They demonstrate that training in health systems science—the third pillar of medical education, along with the basic and clinical sciences—empowered medical students, residents and fellows to find meaningful ways to contribute to the pandemic response. Covering a variety of topics, this book highlights a selection of submissions that show medical students, residents, and fellows moving rapidly in the face of a global crisis and devising innovative ways to trace the contacts of COVID-19 patients, provide childcare to the offspring of physicians and other health care professionals, serve as the conduit for information between patients’ families and physicians, and manage the constantly changing information about COVID-19, to name just a few. We are very proud that, not only did the AMA “Accelerating Change in Medical Education” and the “Reimagining Residency” initiatives make a difference in medical education, they made a difference in the lives of patients, communities, physicians and other health care professionals—as together we faced our greatest challenge. Susan E. Skochelak, MD, MPH Group vice president, Medical Education AMA AMA Medical Student Impact Challenge © 2021 American Medical Association. All rights reserved. Preface During the COVID-19 pandemic health systems and medical education have faced unprecedented systemic challenges. However, it was our belief that training in health systems science, the third pillar of medical education, would prove invaluable in empowering medical students, residents and fellows to find ways to contribute to the response. Under the most dire circumstances, how would medical students, residents and fellows across the country apply health systems science to impact patients, physicians and health systems? We launched the 2020 AMA Health Systems Science Student, Resident and Fellow Impact Challenge to find out. Eligible submissions from individuals or teams were required to show meaningful learner-led activities or projects in response to the COVID-19 pandemic and describe the components of health systems science that informed those activities. The competition was open to all U.S.-based medical students, residents and fellows. The submissions were outstanding. We are amazed at the impact medical students, residents and fellows have had on the lives of patients, fellow learners, physicians, other health professionals and the health system. We are in good hands! In this book you will find the abstracts for some of the most impactful submissions. We hope you will be as impressed as we are. Maya M. Hammoud, MD, MBA Senior adviser AMA “Accelerating Change in Medical Education” initiative AMA Medical Student Impact Challenge © 2021 American Medical Association. All rights reserved. Contents Change agency, management and advocacy �� 1 Clinical informatics and health technology ��16 Health care policy and economics . 44 Health care structure and process ��50 Health system improvement . 67 Leadership . 80 Population, public and social determinants of health . 93 Systems thinking �� 146 Teaming �� 170 Value in health care . 181 Index . 190 AMA Medical Student Impact Challenge © 2021 American Medical Association. All rights reserved. Change agency, management and advocacy AMA Medical Student Impact Challenge 1 © 2021 American Medical Association. All rights reserved. CHANGE AGENCY, MANAGEMENT AND ADVOCACY Electronic Workflow Improvement for COVID-19 Case Investigation and Monitoring at Health Department in Saint Louis, MO Project lead Christina Herbosa, Washington University School of Medicine Teammates Gaurang Guapte, Sharon Abada and Bruin Pollard Faculty mentor Dr. Steven Lawrence, Assistant Dean for Curriculum and Clinical Sciences, Washington University School of Medicine Abstract Leading up to the pandemic, contact tracing for Case investigation and contact tracing — the process of communicable diseases at the St. Louis DPH was notifying cases of COVID-19 positive status and identifying documented only on paper. The use of paper-based, exposed contacts — is a critical tool for outbreak control. rather than online, records was driven primarily by two From May to June 2020, a team of over 60 medical system-level factors: (1) the lack of a readily-available students from Washington University in St. Louis (WashU) HIPAA-compliant database for storing and sharing volunteered with the St. Louis County Department information and (2) a workforce lacking experience with of Public Health (DPH) to trace over 720 contacts and an online database. Although the department’s paper investigate over 2,400 cases of COVID-19 (accounting files were sufficient for routine communicable disease for 45% of total). Beyond this immediate impact, we also documentation, they were quickly saturated by the spike applied our training as medical students to improve of COVID-19 cases. Thousands of paper folders piled up, workflow efficiency by upgrading from paper folders to an often leading to duplication or misplacement of files. To electronic data management system, REDCap. Our project make matters worse, multiple people could not access highlighted the importance of community collaboration a given file at the same time. As the number of cases as well as the cross-system implementation of health continued to increase, it became more and more apparent technology. that this paper-based system was insufficient to keep up with the pandemic. Project addressed/problem discovered The COVID-19 pandemic has placed an unprecedented Approach burden upon regional health departments to serve On March 23, 2020, our team of medical student volunteers and support their local communities. Official Centers began volunteering as auxiliary contact tracers and for Disease Control and Prevention guidelines have case investigators at the DPH. In this role, we remotely encouraged health departments to “prioritize case interviewed laboratory-confirmed COVID-19 cases to investigation and contact tracing activities,” as well as gather information about exposures, travel and contacts. “build up their workforce, recruit from new applicant pools Next we called the close contacts to ask about symptoms, and train individuals from varied backgrounds” (Interim as well as provide recommendations for quarantine and/or Guidance on Developing a COVID-19 Case Investigation testing. & Contact Tracing Plan, 26 May 2020). For many health Once we became more familiar with the workflow, we departments, the sudden surge of infectious cases has recognized the inefficiencies of paper documentation been overwhelming. and approached the department leadership about the AMA Medical Student Impact Challenge 2 © 2021 American Medical Association. All rights reserved. CHANGE AGENCY, MANAGEMENT AND ADVOCACY possibility of transitioning to an online database. This for approximately 45% of the total health department idea was initially met with resistance, given apprehension productivity throughout this period. Patients in the about such a monumental shift in the middle of an already community benefited from faster and more consistent overwhelming situation. However, despite this inertia it follow-up, which we hope helped to increase trust in eventually became clear how unsustainable the current community health institutions. In addition, the health system was. We held multiple meetings

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