MEDU-4104 - Introduction to US Health Policy and Financing

MEDU-4104 - Introduction to US Health Policy and Financing

Elective Title: Introduction to US Health Policy and Financing
Course Number: MEDU-4104
Elective Type: career Duration/Weeks: 4 Max Enrollment: 8
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Peter Cram, MD Periods Offered: 9 excluding holiday period 8 
Coordinator: Victoria Garcia & Kiki Baldwin Other Faculty:
Location to Report on First Day:
John Sealy Annex, Suite 4.124

Introduce medical students to the general organization and financing of the US healthcare system. Teach students about how various constituent groups (government, healthcare professionals, employers, private insurance) influence US healthcare and the health of the public.

1. Students will learn about the origins of health insurance during the 20th century.
2. We will discuss the origins of the patient safety and quality movement
3. Students will compare/contrast health insurance in the US with other high-income countries.
4. Students will compare/contrast costs of medical care in the US with other high-income countries.
5. Students will learn about new and emerging models of healthcare financing (alternate payment models).
6. Students will explore the US Medicare program.
7. Students will learn about the US Medical program.

Description of course activities
Over a 3-week period, enrolled students will attend twice weekly seminar sessions to be led by Dr. Cram with potential guest lectures. Each session will cover a different topic or issue facing the US healthcare system. Students will be given 2 articles to read prior to each session. During each session students will lead a discussion and debate on each topic. In addition to the 2 seminars convened each week (Tuesday and Friday, 1-4pm), there will be about 24 hours per week devoted to self-directed study.

Type of students who would benefit from the course
Any medical student interested in understanding the US healthcare system.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM

 Average number of patients seen per week:
 Call Schedule:

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Students will participate in discussions with their peers, facilitated by Dr. Cram on topic issues described previously. Discussions will focus on articles and assigned readings.
  B. Frequency / Duration of Presentation(s)?
    Seminars and discussions will occur 2 times per the week (Tuesday and Friday)
  C. Format - What guidelines are set for the student's presentation?
    Sessions will informal discussions. For some sessions, we will use a pro/con format with students split into groups and asked to advocate for or against a given policy proposal. For other sessions, students will be asked to give a more formal presentation about a particular issue or policy. Students will have a final capstone project. For this project, they will be asked to investigate a contemporary healthcare policy issue that will be chosen by the student with input from the instructor. Students will be required to submit a written paper and/or presentation describing the issue & potential interventions/solutions that could be considered. Examples of topic to include is access to healthcare for undocumented immigrants; health insurance for the uninsured; controlling healthcare spending & reimbursement for telemedicine.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
  B. Format - What guidelines are set for the student's written work?
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    student selected with the help of the instructor
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    1. Attendance 2. Participation in discussions 3. Evidence of completion of assigned readings.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.