Dell Medical School at The University of Texas at Austin welcomed its first students in 2016 with the promise of taking an unorthodox approach to medical education.
That started with its curriculum. While all but doing away with traditional lectures, the school also turned students’ third year into a “growth year” in which they could pursue either an independent health care project or a dual degree.
This unusual structure is a key part of the school’s larger goal: remaking modern medicine, according to Dell Med’s inaugural dean, Clay Johnston, MD. Dell Med officials believe it will help develop graduates into more empathetic physicians and better leaders who can, in turn, transform the health care system.
“We’ll have to see what the students pick [for their projects],” Dr. Johnston told Texas Medicine in 2017. “But when they get [to the third year], we expect them to have impactful projects, either directly seeing patients, maybe setting up a system to care for the homeless, or in community health care or promotion. Time will tell.” (See “Dell’s Different Direction,” May 2017 Texas Medicine pages 28-33, www.texmed.org/Delldifferentdirection.)
With the 2018-19 school year, that time arrived – the 50 members of Dell Med’s inaugural class reached their growth year, during which they have three options:
- An independent project that focuses on health care innovation and design, population health, or clinical/translational research;
- A project proposed by Dell Med’s Design Institute for Health (see page 43), which uses a creative design approach to research and rethink local health care programs; or
- A master’s degree in business administration (MBA), public health, or education. (Next year the list will include a master of science in health care transformation and a master of arts in design.)
The school must approve each project, and students must secure funding, if necessary, says Sue Cox, MD, executive vice dean for academics and principal designer of Dell Med’s curriculum. Eleven students opted for independent projects, nine worked with the Design Institute, and 30 opted for other degrees.
“They are helping our community flourish,” Dr. Cox said in an email interview.
Here’s how three Dell Med students spent this past year.
Learning to be flexible
The connection may not be obvious, but third-year student Lindsey Teal plans to become a plastic surgeon, so her growth year project focused on mental health.
She explains, for instance, many people who need plastic and reconstructive surgery have tried to commit suicide, but instead they disfigure their bodies and compound existing problems.
“At first you would think [plastic and reconstructive surgery] could not be farther away from psych services, from mental health,” she said. “But there’s actually a lot of overlap, and I think it will make me a better surgeon by being able to address these things.”
She learned that helping people access mental health services is tougher than it looks.
Ms. Teal and a Dell Med classmate worked with social workers at Eastside Memorial Early College High School in Austin to improve the school’s delivery of mental health services to students. The social workers provide the services, but few students know about them, Ms. Teal says.
The school’s student body is 83% Hispanic and 90% economically disadvantaged, according to its website. It also has a high immigrant population, Ms. Teal says. Given that demographic makeup, counselors suspect many students deal with undiagnosed post-traumatic stress disorder.
The counselors asked Dell Med students if they could provide universal mental health screening for all students.
“We thought that would be easy enough, especially with the counselors on our side,” Ms. Teal said. “But come to find out, it is very difficult to get mental health screening [for public high school kids] in Texas.”
The biggest obstacle was parental consent. Parents have to opt in to give permission for any activity involving their child. Public schools often have low rates of consent even for fun activities like field trips. So getting approval for something like mental health screening was much more daunting – especially since so many of the children come from immigrant families, Ms. Teal says.
“With a lot of these parents being immigrants themselves, they are fearful of being in [any governmental records] system,” she said.
The Austin Independent School District (AISD) also had concerns about liability. For instance, what happens if a student is screened at Eastside and then moves to another AISD school and their mental health profile doesn’t follow them? So AISD created a kind of electronic medical record to share the information.
Ms. Teal hoped to begin screening in March 2019, but then another roadblock appeared.
School officials grew concerned the initiative might kick up raw emotions among students right before they took a series of standardized tests. So they put the screening on hold.
Eastside plans to roll out the program in September when the school year begins.
The whole experience taught Ms. Teal to be flexible about approaching big projects. “And to actually ask questions before you do something.”
Getting the word out
Many medical problems are communications problems. Dainon Miles and two other students worked with Dell Med’s Design Institute for Health to bridge one such gap.
The YMCA in Austin approached the institute to find out how it could get better buy-in from health care professionals given that many physicians don’t understand – except in vague terms – how the YMCA can help patients with chronic illnesses like diabetes or heart disease, Mr. Miles says.
“They know that, yeah, they have a gym and a swim program and youth programs. But they aren’t aware of some of the things like evidence-based programming around fall prevention and diabetes, nutrition classes, some of the active-older-adult classes, and some of their group-exercise classes,” he said.
Understanding exactly what programs are available – and understanding the range of chronic ailments those programs can help with – gives physicians more treatment options, Mr. Miles says. One of the project’s achievements is a tool that pairs medical conditions with YMCA exercise, fitness, and nutrition programs that can help manage those illnesses.
“A lot of the time, physicians get caught up in the clinic,” he said. “You know, we’re going to manage your diabetes with these medicines, and try to eat healthy, and exercise as much as you can.” But he says physicians often are short on specifics about how patients can go about changing their lifestyle.
Mr. Miles’ team also encouraged the YMCA to expand its target audience beyond physicians to nurses and social workers. And it recommended focusing initially on value-based medical clinics that “have more time and more resources to devote to the patient,” he said.
Mr. Miles’ team was invited to share their insights with YMCA officials in Washington, D.C., to help it shape the organization’s healthy living programming.
Mr. Miles plans to become an emergency physician, but his project dovetails with his long-term ambitions.
“I grew up in sports and fitness, and I think one of the things I want to pursue later on in my career is possibly [becoming] a sports medicine physician to help people get and stay healthy through fitness or through exercise,” he said. “That’s one of my passions. That’s one of the reasons I chose to work with the Y.”
Meanwhile, the Design Institute has shown him new ways to handle medical problems where there’s no clear-cut answer.
“A lot of problems in medicine are patient-specific or system-specific, so there’s not an easy solution,” he said. This experience “has helped me a lot with developing the tools and mindset necessary to approach these problems.”
Learning the business of medicine
Emily Niewiarowski knew she wanted to spend her growth year getting a second degree. Mentors and friends sold her on an MBA.
“They told me that there’s a lot of business in medicine,” she said. “And I knew that if I wanted to go into policy later on, it would be useful [for that as well]. I knew if I wanted to set up my own practice one day, it would be helpful …. It just seemed like a very useful degree to have.”
Students pursue their MBA through UT’s McCombs School of Business. She jumped right into classes in finance, accounting, and statistics. “It was kind of like learning a new language.”
An aspiring anesthesiologist, Ms. Niewiarowski’s favorite class was operations management.
“We looked at how to make a process efficient and work to the best of its ability,” she said. “That’s helpful in medicine, especially when designing processes like clinic or operating room flow.”
In addition to her second degree, she is finishing up some clinical rotations, as are other students. She’s also taking a course from UT’s Center for Health Interprofessional Practice and Education, focusing on projects designed to help the community.
One of the main goals of the class is to get students to pool their diverse third-year experiences to solve a problem, Ms. Niewiarowski says. This highlights another Dell Med goal – teaching physicians to become better team leaders.
“Seeing how everyone’s unique perspectives and experiences can be leveraged to create and complete a project has been great,” Ms. Niewiarowski said.
Tex Med. 2019;115(7):42-44
July 2019 Texas Medicine Contents
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