Hasan Reem, Caron Rachel, Kim Hannah, Phillipi Gina M, Taher Tajwar, Thind Kanwarabijit, Urbanowicz Erin
Departments of Internal Medicine and Pediatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 USA.
School of Medicine, Oregon Health & Science University, Portland, OR USA.
Med Sci Educ. 2020 Apr 25;30(2):833-841. doi: 10.1007/s40670-020-00957-6. eCollection 2020 Jun.
Early medical school education has historically focused on teaching basic medical sciences. More recently, medical schools are encouraged to incorporate health systems science (HSS) into early curricula. Addressing all of these components in an overcrowded curriculum remains challenging.
We report on the Student Navigator Project (SNaP), a pre-clinical experience where students engage longitudinally with medically and socially complex patients. SNaP is built on a foundation of trust, responsibility, and ownership in the student-patient relationship. Early learners take an active role in navigating, advocating, and coaching for their patients. In addition, students are integrated as medical assistants into a primary care clinic; complete a mentored, team-based quality improvement project; and engage in evidence-based medicine, teaching, and handoff activities.
As a result of these activities, students learn firsthand about HSS, contribute meaningfully to their patients' care, and are immersed in a systems-based practice approach early in their medical school education. Preliminary outcomes (2016-2019) show satisfaction with the program and knowledge of program focus areas.
The authors are engaged in improvement cycles to modify program structure and curriculum in order to promote dissemination in diverse clinical settings. Ultimately, we plan to measure longer-term outcomes, including clerkship and residency preparation, career choice, and practice setting.
早期医学院教育历来侧重于基础医学科学教学。最近，医学院被鼓励将卫生系统科学（HSS）纳入早期课程。在拥挤的课程中涵盖所有这些内容仍然具有挑战性。
我们报告了学生导航项目（SNaP），这是一种临床前体验，学生在此过程中与医疗和社会复杂性患者进行纵向接触。SNaP建立在学生与患者关系中的信任、责任和自主性基础之上。早期学习者在为患者导航、倡导和指导方面发挥积极作用。此外，学生作为医疗助理融入初级保健诊所；完成一个有导师指导的、基于团队的质量改进项目；并参与循证医学、教学和交接活动。
通过这些活动，学生直接了解卫生系统科学，为患者护理做出有意义的贡献，并在医学院教育早期就沉浸于基于系统的实践方法中。初步结果（2016 - 2019年）显示了对该项目的满意度以及对项目重点领域的了解。
作者正在进行改进循环以修改项目结构和课程，以便在不同临床环境中推广。最终，我们计划衡量长期结果，包括临床实习和住院医师培训准备情况、职业选择和执业环境。
