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Abstract Health care delivery is undergoing an accelerated period of digital transformation, spurred in part by the COVID-19 pandemic and the use of “virtual-first” care delivery models such as telemedicine. Medical education has responded to this shift with calls for improved digital health training, but there is as yet no universal understanding of the needed competencies, domains, and best practices for teaching these skills. In this paper, we argue that a “digital determinants of health” (DDoH) framework for understanding the intersections of health outcomes, technology, and training is critical to the development of comprehensive digital health competencies in medical education. Much like current social determinants of health models, the DDoH framework can be integrated into undergraduate, graduate, and professional education to guide training interventions as well as competency development and evaluation. We provide possible approaches to integrating this framework into training programs and explore priorities for future research in digitally-competent medical education.
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Lean Health Care Internships: A Novel Systems-Based Practice Education Program for Undergraduate Medical Students
Problem: Given the United States’ urgency for systemic-level improvements to care, advancing systems-based practice (SBP) competency among future physicians is crucial. However, SBP education is inadequate, lacks a unifying framework and faculty confidence in its teaching, and is taught late in the medical education journey. Approach: The Oklahoma State University Center for Health Systems Innovation (CHSI) created an SBP program relying on Lean Health Care for a framework and targeted medical students before their second year began. Lean curricula were developed (lecture and simulation) and a partnership with a hospital was secured for work-based practice. The CHSI developed a skills assessment tool for preliminary evaluation of the program. In June 2022, 9 undergraduate medical students responded to a Lean Health Care Internship (LHCI) presentation. Outcomes: Student SBP skills increased after training and again after work-based practice. All 9 students reported that their conceptualization of problems in health care changed “extraordinarily,” and they were “extraordinarily” confident in their ability to approach another health care problem by applying the Lean method. The LHCI fostered an awareness of physicians as interdependent systems citizens, a key goal of SBP competency. After the internship concluded, the Lean team recommendations generated a resident-led quality assurance performance improvement initiative for bed throughput. Next Steps: The LHCI was effective in engaging students and building SBP skills among undergraduate medical education students. The levels of student enthusiasm and skill acquisition exceeded the Lean trainers’ expectations. The researchers will continue to measure LHCI’s effect on students’ rotation experiences to better evaluate the long-term benefit of introducing SBP concepts earlier in medical education. The program’s success has spurred enthusiasm for continued collaboration with hospital and residency programs. Program administrators are exploring how to broaden access.
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- Award ID(s):
- 2026584
- PAR ID:
- 10464154
- Date Published:
- Journal Name:
- Academic Medicine
- ISSN:
- 1040-2446
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1097/ACM.0000000000005312
