Novel academic program uses medical students as patient navigators
Penn State College of Medicine is nearing the end of the inaugural year of its Systems Navigation Curriculum (SyNC) that embeds first-year medical students into the healthcare system as patient navigators.
The first-of-a-kind innovative and novel academic program was made possible by a $1 million grant from the American Medical Association, awarded to the college last year for its ideas for reshaping medical education.
The experience offers future physicians a look at what patients often face when trying to maneuver through a complex and often confusing healthcare delivery system. It helps students understand the healthcare system as a whole and not just their individual roles.
“In the long run, it will help them become better physicians because they will have a better understanding of what the patient goes through at home, outside the healthcare system,” said Deanna Graaf, patient navigation coordinator. “The curriculum gives the students a holistic view of the patient. It allows them to see other factors that affect patient care, not just the medical diagnosis.”
Patient navigators guide patients over hurdles that may make their experience difficult, including insurance issues, medication concerns and follow up appointments.
“The navigator links, they integrate, they build relationships–they know resources and they bridge the gaps between one healthcare delivery component and another,” said Dr. Jed Gonzalo, assistant dean for health systems education, who directs the SyNC program. “It’s an evolving healthcare role.”
Adam Nasreddine, a first-year medical student serving as a navigator at Lancaster General Hospital, says he has housing, transportation, food stamp and social issues to help his patients with in addition to medical concerns.
“We see the patient in the community, assess their understanding of their health care and help them overcome the different obstacles to getting the help they need,” he said.
Nasreddine believes it is an invaluable experience for medical students.
“It’s like trying to understand the whole healthcare system from a patient point of view rather than a clinician point of view, which I think is very eye opening,” he said.
There are currently 85 students placed with the 16 participating sites. The goal is to increase to 150 students next school year.
While the grant provides funding through the 2018-‘19 school year, the College of Medicine hopes to continue the program and serve as a model for other schools.
Gonzalo already receives calls from medical educators across the country asking how Penn State has implemented its program, in which students are playing an authentic value-added role to the healthcare system.
“This idea is very new and novel,” Gonzalo said. “This is the first time that a medical school in the United States has tried to educate and embed students as patient navigators in the healthcare system.”
The students are working at sites throughout the region including PinnacleHealth, Holy Spirit Health System and Lancaster General Hospital, sites where care coordinators identify the patients who have stumbling blocks.
“If a patient is coming across a barrier—such as problems with medication reconciliation or they’re not making their appointments–the students navigate the person through the health system so that they make it through those transitions of care,” Graaf said.
The first visit involves both a patient navigator and a social worker in a patient’s home. Patients are likely more comfortable and will speak freely at home. Team members can take their time with the patient and are not as limited as primary care providers can be. The initial interview is very detailed and encompasses a patient’s medical issues, psychological issues, support system, family history, and daily stressors.
The navigator does a medication check to see if the patient is missing any medication and that proper use is understood. For example, one visit found the patient had many outdated prescriptions that were being held onto, “just in case.”
Navigators visit weekly to start and remain with the patients as long as needed, depending on his or her circumstances.
“The fact that a patient navigator may be required to improve someone’s healthcare is a reflection of our delivery system not being truly streamlined or designed in a way that is truly patient-centered,” Gonzalo said.
SyNC is designed to address the much needed change. The navigator program is just one component.
According to Barbara Blatt, health systems curriculum program manager, every medical student takes the two-year science of health systems class.
The first module is a primer on how to communicate with patients and identify the barriers the patients might be experiencing.
“The course itself and the patient navigator experience work hand in hand,” she said. “We hope as they’re learning about insurance, transitions of care, communication as a patient is discharged and medication reconciliation. Ideally they will be implementing the same in their patient navigator role.”
Small groups of students from the various sites meet periodically to share different experiences.
“That was by design. We want them to be contributing and collaborating with each other from their different experiences so the students are seeing the nuances of various clinical settings within different healthcare systems,” she said.
Once the program is successful and the patients are receiving more proactive than reactive medical care, ideally, they will have better outcomes.
Right now, SyNC is part of the first two years of a medical student’s education. Ultimately, it will be integrated into years three and four, making future physicians even more prepared to address the challenges their future patients face.
“Initially, you think, going to medical school and becoming a physician, your goal is to help the patients and getting the medication that they need and it stops there, but that’s far from the truth as we’re all coming to realize,” Nasreddine saiid.
- Jade Kelly Solovey