Bringing Fresh Perspectives to Health Care Redesign

Dell Med’s Distinction Track in Care Transformation gives medical residents time and resources to improve health in their communities.

Participants pursue solutions to the problems they see each and every day, on the front lines of care.

Residency is a tumultuous time in a new doctor’s life. Having just earned their MD, but not yet fully licensed to practice medicine, residents spend years training under the supervision of faculty physicians, working long hours to learn the fundamentals of clinical care.

For doctors who envision a better health care delivery system, a traditional residency can present a frustrating challenge: there is rarely an opportunity for eager residents to develop the skills and experience to help build the type of health care system they want to see.

Medical educators at Dell Medical School at The University of Texas at Austin are looking to fix that.

The Distinction Track in Care Transformation, launched with its first cohort in 2017, is a two-year program within Dell Med’s graduate medical education (GME) curriculum that provides residents with mentorship opportunities and resources to explore and implement innovative solutions for improving health care in Austin.

“At Dell Med, we have an unparalleled opportunity to start from scratch in many areas of medical education,” says Sue Cox, MD, executive vice dean for academic affairs at Dell Med. “That includes building features into our residency program that help our residents fulfill the school’s mission to revolutionize how people get and stay healthy in our community and beyond.”

The first year of the GME Distinction program — the end of their intern year — includes a foundational curriculum that prepares residents to undertake an independent project during their second and third years. Independent projects are intended to help residents identify some of the improvements they’d like to see in health care based on their own areas of interest — and to get to work applying those innovations in their own backyard.

“The type of doctor that is drawn to a residency like the GME Distinction program is, by definition, also drawn to Dell Med’s mission as a whole,” says Emily Vinas, EdD, director of Educational Strategy and Program Development at Dell Med. “They are proactive, self-starting and are motivated to juggle their regular residency work while also looking for ways to be innovative in their communities.”

Crucially, the GME Distinction program, which will also include residents focused on internal medicine, pediatrics, women’s health or surgery, is structured so that it does not extend medical training for any given specialty.

Protecting Residents’ Time — and Giving Them Resources to Succeed

The GME Distinction residents’ intern year is similar to a traditional residency, in that residents must begin to learn the ropes of full-time clinical care within their specialties. But residents in the GME Distinction program also spend a month at the end of their intern year taking part in a foundational curriculum that includes lessons on concepts like design thinking (problem-solving through systemic change) and value-based care (providing better care at lower cost). This first year gives residents protected time to learn how to be a good doctor, and to network with the world-class mentors at Dell Med.

“Having an intern year dedicated just to learning clinical medicine has been such a blessing,” says Anupama Kapadia, MD, first-year internal medicine resident. “The patient population in Austin is diverse and challenging, so getting the time just to learn how to be a good doctor in this community has been a crucial step in defining the type of work I want to do over the next two years and beyond.”

This work is meant to be real and impactful. Value-based care is a defining aspect of Dell Med’s mission, and it should extend to the work our residents are doing as well.
Chris Moriates, MD
Assistant Dean for Healthcare Value, Dell Medical School

Residents in the GME Distinction program will also get ample time to network with each other and their other colleagues as interns. Current residents in the program have found that having a formal outlet to forge pathways to better health quickly builds camaraderie while also preventing burnout.

“This program is an amazing canvas that gives us the tools we need to create the artwork we envision for the health care system,” says Nicholaus Christian, MD, first-year internal medicine resident. “Meeting others who are equally as motivated as I am to make changes in health care continues to inspire me to be at the forefront of figuring out how we can provide better care to patients, particularly those who have been traditionally underserved.”

Redefining What Residency Looks Like

During the second and third year of the GME Distinction program, residents begin to pursue independent projects based on their personal interests. There isn’t a prescribed method for how residents should carry out their chosen work — working with an approved faculty mentor, residents can design projects dedicated to Dell Med initiatives, or reach out across campus to work on initiatives elsewhere. They can even work with undergraduate medical students. The only real mandate is that a project serves to further value-based health care and the health of Central Texas communities.

“It’s not an academic exercise,” says Chris Moriates, MD, assistant dean for health care value at Dell Med. “This work is meant to be real and impactful. Value-based care is a defining aspect of Dell Med’s mission, and it should extend to the work our residents are doing as well.”

Project topics will vary as much as the residents themselves. One project might entail building a maintainable list of local physicians who identify themselves as prepared to serve the LGBTQ+ community with sensitivity to patients’ lifestyles and particular needs — needs that medical providers have not historically met.

Another might include helping patients who are both addicted to opioids and experiencing homelessness get access to buprenorphine (a medication that helps treat opioid addiction), while connecting them with CommUnityCare Health Centers, a Federally Qualified Health Center system that serves much of the uninsured population in Austin, for appropriate follow-up care.

“A program like this is meant to produce system-ready physicians, and ones that are prepared to lead interdisciplinary groups across the health ecosystem,” says Jonathan MacClements, MD, associate dean of graduate medical education at Dell Med. “I anticipate that we will soon see something like a renaissance of physician leaders — that is, physicians willing to lead health care changes which enhance meaningful value in their patients’ lives.”