At Columbia-Bassett, we are creating new curriculum intended to prepare students to be future leaders. While some of our curriculum embraces proven learning approaches of the past, other components look to the future. Curriculum must be a response to the issues most pressing on current health care.
Currently, the biggest challenges in health care are “quality” and “cost”. Columbia-Bassett is responding to this through a non-clinical element of curriculum, comprising about five percent of a students experience.
This component is called SLIM, which stands for Systems/Leadership/Integration/Management. We have created a unique collaboration between Bassett faculty and the faculty of the Columbia Schools of Business and Public Health to achieve substantial training in these areas. Our mission is to empower our students to become doctors who apply the science of performance improvement to healthcare delivery problems at any level, from a malfunctioning system in a clinic to a malfunctioning component of Medicare.
Students are immersed in the following:
Literature on overtreatment
The Dartmouth Atlas of Health Care
High level administrative teams
Systems and Skills Journal Club
Health care struggles – guest speakers
SLIM writing project
Components of the SLIM curriculum include:
During the Columbia-Bassett orientation week (which occurs immediately before orientation week at the main campus), students are exposed to their first round of SLIM training. Working with faculty from the Columbia Business School and Columbia Mailman School of Public Health, students learn about the healthcare and insurance systems and about the cultural and organizational factors that influence them
During the 1.5-year pre-clinical training in NYC, students meet periodically to discuss SLIM concepts with major leaders in health care – from hospital CEOs and COOs to insurance company executives to other major players.
Interested students are able and welcome to pursue research opportunities at any time, including during the summer before matriculation or the summer after their first year, either in Cooperstown or elsewhere. Students can find support from Bassett's Research Institute at Bassett, under the direction of Dr. John May, and conduct research in any of a variety of areas, including with the New York Center for Agricultural Medicine and Health (NYCAMH), the New York Health Census, or a project of the student's choosing in conjunction with a clinical mentor. These projects can be initiated at any time and may extend throughout the student's medical school career.
Major Clinical Year
Themes week - This occurs after the first 10 weeks of training in the Rapid Inpatient Blocks in Cooperstown.
Subsumed under the SLIM curriculum are concepts of Ethics, evidence-based Medicine, Systems, Leadership, Integration and Management. During this one-week period, these themes are discussed and exemplified, in the context of our existing health system and in contrast to others. Students will meet with organization leaders, from trustees, to CEO/COO/CFO, to physician and administration vice presidents. Each person the students meet has to answer three questions:
What is my job?
What are my goals?
How will I execute and sustain those goals
Participation as a member of a Bassett Institutional Committee: This experience places a student in the core of management and leadership, as a health system tries to balance priorities, improve care, and stay solvent in a very adverse environment. The students will be on teams addressing non-clinical challenges – everything from how to effectuate better hand hygiene, to how to organize a revenue cycle, to how to integrate an information system to promote safety and parsimony, to how to systematize risk/quality/safety. Students will see the reality of these difficulties, but also see the invaluable orienting force of "a physician at the table."
Participation as a member of a Bassett Institutional Committee Team Project Team: In this extension of the bullet above, students go through all stages of a project, from idea to design in committee to deployment. The students then follow up by observing front line consequences, see the inevitable need for rapid cycle improvement, and gain insight into creating functional systems. Examples of projects include an initiative to improve performance and efficiency in the operating room; analysis of the potential benefits and drawbacks of implementing geographic care in the hospital; identification of and reduction of barriers to effective doctor-patient communication; and standardization and dissemination of protocols for the management and tracking of diabetic patients. Students present their projects and experiences to a mixture of other students, mentors and administrative leaders.
Journal Club: Running through the entire two and a half years at Bassett, this monthly experience is intended to delineate the spectrum of American health care, other systems around the world, the magnitude of the expense here, the impact of costs on people, companies, taxes, and government, and the impact on outcomes.
"SLIM Lunches": Introduces the students to the plights of stakeholders: A person with insurance but insufficient coverage to make ends meet during a critical illness, who has to decide whether to buy groceries or medications; a person with a history of rectal cancer, but college age children, who has opted to give up coverage (and therefore crucial follow-up screening) in order to pay tuition; a local business owner who struggles to provide insurance to employees, but with major implications to profitability; a payer who defends price by blaming doctor habits; a politician who talks about change (but has he done anything? Why not?); a lobbyist; a leader from NYS Department of Health; and so on. At the end of every lunch, students are asked to discuss their responsibilities as physicians to assure a reasonable experience for patients, and how they can do so.
Research Curriculum: Students will have a series of lectures on research and data analysis methods by the members of Bassett’s Research Institute. As mentioned above, students interested in research may initiate projects of their own at any time, and the full resources of the New York City and Cooperstown campuses and mentors are open to them. Advisors in the Bassett Research Institute are available to aid in all steps of research design, approval, data collection, and analysis.
Differentiation & Integration
Research & Scholarly Project: As part of earning a Columbia diploma, students must complete a scholarly project under the rubric of a "major" as one would elect in college. Columbia-Bassett students may elect any of the majors available in New York City (e.g., basic sciences or world health) or may perform a scholarly project within the SLIM construct (as we anticipate most will do). These projects culminate in a thesis during the final year of medical school. Projects may be on any relevant topic in the health services research arena, and faculty members from the Bassett Research Institute are available to provide guidance and support. Examples of final projects to which Columbia-Bassett students will be especially well suited include an in-depth study of an optimal practice within the salaried model, such as end-of-life care; or identification of health improvement opportunities in the population Bassett serves and development of a possible new program adjustments.
This broad view of health care is complimented by lived experience in the low utilization, comparatively good outcomes setting of Bassett – caring for 650,000 outpatient practitioner encounters, 15,000 inpatient encounters, and substantially caring for a population in an area the size of Connecticut.
Thus, you hear theory globally, theory locally, and participate in the clumsy process of applying theory to reality. Here, the essential process of Continuous Quality Improvement (defining a problem, theorizing a solution, and implementing a solution with rapid cycle measuring and improvement) becomes manifestly evident to students as an indispensable skill. And students will realize that the SLIM curriculum is one large CQI project enacted upon them: The summer population research to learn how to define a population problem, small group to learn the vision of solving population problems, and live experiences to learn the awkward realities of implementing solutions, all the while with measurement of your internalization of attitudes and skills.