By incorporating population health into medical education, educators are aiming to bring together medicine and public health, which over the past hundred years or so have taken different approaches. The goal is to unite medicine’s focus on the individual doctor-patient relationship based in the healthcare system with public health’s interest in creating policies and programs for health prevention. Population health acknowledges that we spend the majority of life outside of the healthcare system — at work, at home, in our neighborhoods — and that our health is influenced by a host of factors in our lives, ranging from nutrition to early childhood education to discrimination. For these reasons, the healthcare system needs to incorporate public health approaches.
“What I discovered in mid-career, is that policy-makers welcome and need insights and advice from physicians. I wish I learned in medical school about how the health policy apparatus works.” ~Mark D. Schwartz, MD, FACP
In the past, most doctors learned little if anything about population health in medical school, but that is changing. This past fall, for example, NYU School of Medicine made population health a core part of the curriculum for all medical students, integrating it into all stages of their degree programs.
The introduction of the “Population Health pillar” at NYU responds to a growing consensus in the medical field that physicians should learn early not only about basic and clinical science, but also about health system science and social determinants of health, to prepare for the changing healthcare environment. NYU School of Medicine is one of 32 medical schools that has received a grant from the American Medical Association’s Accelerating Change in Medical Education Consortium to “create a system that trains physicians to meet the needs of today’s patients and to anticipate future changes.” The idea is for graduating physicians to understand the non-medical factors that contribute to their patients’ health, such as housing stability, access to food, and belonging to a community, and to understand health policy and the healthcare system.
“The AMA is collaborating with medical schools to accelerate change in medical education and create a system that trains physicians to meet the needs of today’s patients and to anticipate future changes.” ~American Medical Association
The core themes of the Population Health pillar include socioeconomic determinants of health, health behavior, public health, healthcare policy and economics, value-based care, clinical informatics and health system improvement. Students will have expanded opportunities to study these themes in coursework, online modules, patient interactions, clerkships, discussion panels, and multiple research opportunities throughout their education.
Here, we ask Mark D. Schwartz, MD, FACP, who leads the new pillar and is Professor and Vice-Chair for Education and Faculty Affairs in the Department of Population Health at NYU School of Medicine, why incorporating population health into a medical school curriculum is important and what it means for the practice of medicine.
Why is it important for medical students to learn about social determinants of health? What can a doctor be expected to do about non-medical health problems?
There is broad consensus that medical care accounts for no more than 20% of the variation in life expectancy, with most of it explained by genes, personal behavior, and the environment and social circumstances in which we live, play, and work. While we cannot yet change our patients’ genes, there is a growing role physicians can play in identifying and impacting modifiable determinants of health that go beyond the traditionally biomedical. Examples include connecting patients to community resources for healthy eating and exercise, helping patients navigate complex systems to address inequities in access, and expanding our reach into where patients live when they are not in our office! Physicians that ask about and act upon such social determinants of health will be more effective healers and advocates for their patients.
As someone who has designed health policy yourself, what do you wish you had learned as a medical student that could have helped you with this aspect of your career?
I was a clinician researcher for 20 years, happily seeking to answer medical research questions while leaving the policy implications to others with that expertise. What I discovered in mid-career, however, is that policy-makers welcome and need insights and advice from physicians. I wish I learned in medical school about how the health policy apparatus works (it is as fascinating and arcane as renal physiology) and how physicians can expand their impact by translating their work into messages that policy-makers can use to improve health at the broadest level.
What is the level of interest in population health subjects from your students?
Students are hungry to learn more about this content. Many have now completed our 4-week, intensive courses (selectives) in health systems and health policy, and in population health, and often say that all students should be learning about these themes. This growing interest led to the establishment of Population Health as a longitudinal pillar in the medical school curriculum at NYU School of Medicine.
Where does this kind of curriculum fit into the overall landscape of population health at medical schools? Are other schools making population health a key part of their curriculum?
Yes, many other medical schools are expanding their population health curriculum, but few are doing as deep a dive into these themes as NYU School of Medicine. The primary responsibility of medical schools is to train physicians to care for individual patients. However, it is also critical to prepare our graduates to improve the health of the entire population for which they will increasingly be held accountable.
What is an example of educational programming in this curriculum?
We offer interclerkship intensives (ICIs)—one-week blocks during the clerkship year that are structured like scientific medical conferences, with lectures, workshops, and panel discussions. At these clerkships, students will learn from a panel of physician leaders from NYU Langone Medical Center, NYC Health + Hospitals/Bellevue, and the VA NY Harbor Healthcare System about how the three healthcare systems compare in costs, safety, patient mix, and quality for complex medical illness such as sepsis.
In short, incorporating population health into medical education is supported at the highest levels, by a partnership between the Association of American Medical Colleges and U.S. Centers for Disease Control and Prevention, for example, and by the Institutes of Medicine. However, it is still something medical schools are catching onto. In addition to NYU School of Medicine, schools such as Georgetown University School of Medicine, Dell Medical School at the University of Texas at Austin, the Alpert Medical School at Brown University, and the University of Massachusetts Medical School have incorporated population health into the training of new physicians. In coming years, you can expect to see population health become a larger focus at many more schools. The goal is ultimately for the doctors of tomorrow to feel empowered to play a role in advocating for health system reform, social services, or public policies to improve the health of populations they serve.
Mark D. Schwartz, MD, FACP, is Professor and Vice-Chair for Education and Faculty Affairs in the Department of Population Health at NYU School of Medicine where he will also lead the new Population Health pillar. Dr. Schwartz also discussed health systems education recently on Medscape.