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Innovation Reports

The American Medical Association Medical Education Innovation Challenge: Incorporating the Student Voice Into Medical Education Transformation

Elliott, Victoria Stagg MA; Dekhtyar, Michael; Pouwels, Mellie Villahermosa MA; Skochelak, Susan E. MD, MPH

Author Information
doi: 10.1097/ACM.0000000000002734
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Abstract

Problem

Our health care system is undergoing significant transformation in how care is delivered and in how patients opt to receive care. Consensus exists that medical education has not kept up with this transformation and must evolve to produce physicians who are able to meet the medical needs and wants of diverse patient populations.1

The American Medical Association (AMA) Accelerating Change in Medical Education Consortium, the Josiah Macy Jr. Foundation, and the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education all are working toward medical education transformation. Medical students have sometimes been a part of these efforts, and their contributions have been extremely valuable.2

To further accelerate change in medical education, beyond the AMA Consortium’s 32 member schools, and identify the most innovative ideas at member and nonmember schools, the AMA leadership and staff organized the Medical Education Innovation Challenge to capture medical students’ perspectives on the direction of medical education transformation, encourage students to be creative about the possibilities of transformation, and elicit the most innovative ideas for transforming medical education.

Approach

Challenge development

We developed the Medical Education Innovation Challenge with the goal of involving medical students in medical education transformation. We specifically included students at non–AMA Consortium schools, providing an opportunity for these schools to participate in the national discussion on transforming medical education. We chose the challenge format because organizations are increasingly turning to crowdsourcing to solve the most intractable problems, including those in health care.3

Challenge overview

We asked teams of students to write a five-page proposal and create a 90-second video describing an innovation that could “turn medical education on its head” and be incorporated into a new medical school. This school was meant to be different from any other school that already existed. The proposed innovation could address the school’s infrastructure, curricular content, learning environment, technology, students, or faculty. The most important aspect of the proposal was the team’s description of how their innovation prepared graduates of this school to meet the health care needs of the future.

We challenged teams to assume the role of a faculty member and consider what novel teaching and assessment methods they would use to teach and evaluate their proposed innovation. Other questions we asked included the following: Who are the students in the inaugural class? What happens to these students between matriculation and graduation? Who do they become when they graduate? How would you ensure they are prepared to practice medicine?

We enlisted Health 2.0, a consulting firm that has developed innovation challenges for other health care organizations, to assist with the submission process and vet the eligibility of team members. We chose monetary prizes for the challenge: The third-place team would receive $1,000, the second-place team $3,000, and the first-place team $5,000. The first-place team would also be asked to present their project at an AMA Consortium meeting. These meetings are attended by representatives from the 32 medical schools that are implementing innovations funded by the AMA Accelerating Change in Medical Education initiative.

We required that teams include two to four students, with the team lead being a medical student pursuing a degree at an institution accredited by the Liaison Committee on Medical Education (LCME) or the Commission on Osteopathic College Accreditation (COCA). In the interest of identifying the most innovative solutions, we decided to allow other team members to be students of any discipline, not just medicine.

Challenge process

The challenge launched on October 2, 2015. The deadline to submit a proposal was December 11, 2015. We announced the challenge through the AMA and Health 2.0 social media channels and websites, handouts at the AMA’s and other organizations’ events, press releases to the health care trade media, and emails to medical students and medical educators in the AMA’s database.

The AMA and Health 2.0 selected 66 judges from a national pool of medical education scholars, researchers, and administrative leaders at the undergraduate, graduate, and continuing medical education levels. Judges were chosen according to their past experience judging other challenges, their role in the AMA Consortium, and their role at national health care organizations. They scored the proposals on innovativeness and creativity as well as on comprehensiveness of answers and potential to improve the practice of medicine and patient outcomes.

Because of variance in the number of submissions scored by each judge, Health 2.0 provided the AMA with adjusted and unadjusted rankings using a multiplicative index. We used both rankings to determine which submissions to review further. Two AMA staff members (including M.D.) reviewed these rankings to determine the top 30 submissions. Seven additional AMA leadership and staff members reviewed these top 30 submissions (henceforth referred to as the top 20%) and identified the top 15. Nine AMA education leaders and staff members reviewed and ranked the final 15 submissions. The AMA team, including V.S.E., M.D., M.V.P., and S.E.S., made final decisions on January 28, 2016.

We emailed all participants in February 2016 to inform them whether they placed, received an honorable mention, or did neither. We publicly announced the winners on March 7, 2016, and we required that they write an abstract for their proposal to be included in an abstract book that would be published on the AMA website.4 To publish the abstract book in a timely manner, all other participants had the option of writing an abstract for their proposal, but they were not required to do so. Abstracts receiving an honorable mention were noted as such in the abstract book.

In December 2016 and November 2017, we contacted the winning teams and the teams that both received an honorable mention and submitted an abstract to determine the impact of their participation in the challenge. We asked: (1) What was the impact of winning an honorable mention (or placing) in the AMA Medical Education Innovation Challenge? (2) What was the impact on you? (3) What was the impact on your project? (4) What was the impact on your school? (5) Has your project moved forward? and (6) Where does your project stand now? We contacted the winning and honorable mention teams because we wanted to know how the challenge had affected the most promising innovations.

The Office of the Vice Chancellor for Research at the University of Illinois at Chicago deemed this study exempt from ethical review.

Outcomes

Challenge participation

We received 154 proposals from 90 medical schools. Four were duplicates, 3 did not include a video, and 1 was from an individual who did not meet the eligibility requirements. That left for consideration 146 submissions submitted by 414 medical students and 42 students from other disciplines. A total of 24 teams were interdisciplinary.

Submissions covered a wide array of subjects and innovations including online platforms for sharing common curricular materials, dedicated spaces for medical students to pursue innovative solutions to health care quandaries, and peer-driven education around wellness. Other submissions suggested implementing four-year curricula on physician advocacy and creating patient scenarios that students could experience through augmented virtual reality.

We awarded first place to a team from Vanderbilt University School of Medicine. They were invited to present their proposal at the spring meeting of the Accelerating Change in Medical Education Consortium in Hershey, Pennsylvania, March 6–8, 2016. The two-person team proposed Muse, an online national exchange for teaching materials that would act as an information repository, a social network, and a learning management system allowing medical schools to publish their full curricular materials as free, open-access content for use by educators, curriculum developers, and learners. We awarded second place to a team from Sidney Kimmel Medical College at Thomas Jefferson University. This four-person team proposed the creation of a makerspace that would give medical students the opportunity to tinker during collaborative workshops to prototype solutions to health care problems. The curriculum would incorporate skills centered around (1) computer science and small electronics, (2) textiles and medical materials, and (3) rapid prototyping technologies.

Two teams tied for third place. One of the teams was from the University of Louisville School of Medicine. This four-person team proposed a wellness curriculum to develop student self-awareness, self-care, and coping skills. The other team was from Midwestern University/Chicago College of Osteopathic Medicine. This two-person team proposed an intentional, four-year, community-based service–learning experience beginning at matriculation to medical school to provide medical students with a deeper understanding of the social determinants of health.

We awarded honorable mentions to all other submissions that ranked in the top 20% (top 30 submissions). We invited all participants to submit an abstract; 113 teams did so.

Challenge evaluation

Our goals for the Medical Education Innovation Challenge included providing a platform for students from all LCME- and COCA-accredited medical schools to share their ideas, expanding innovative work beyond the AMA Consortium medical schools, and providing an opportunity for non–AMA Consortium schools to participate in the national discussion on transforming medical education. Unlike some other medical education innovation programs for medical students, we did not ask students to implement their innovations, and innovations were not judged on feasibility.5 We realized, however, that achieving our goals required more than operating a successful award program; the top-ranked proposals should live beyond the challenge.

To that end, we surveyed the 4 winning teams and the 24 honorable mention teams represented in the abstract book. All 4 of the winning teams and 11 of the honorable mention teams (54%) responded to at least one of our requests for follow-up information.

One team had implemented their proposed project at their institution. Sidney Kimmel Medical College at Thomas Jefferson University (second-place winner) opened a makerspace on its campus in November 2016.

Three teams had implemented proposal-related projects. For example, the team from the University of Louisville School of Medicine (third-place winner) took their idea for a wellness curriculum and, in 2017, held an international conference on campus focused on creating compassionate, sustainable change. Development of a wellness curriculum at the school is ongoing. The team from Midwestern University/Chicago College of Osteopathic Medicine (third-place winner) developed a program in which medical students train their peers to mentor minority and low-income high schoolers to diversify the health care workforce pipeline and improve their own understanding of health disparities. This team is continuing discussions with their school’s administration about integrating aspects of their proposal into the curriculum. An honorable mention team from the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University proposed a four-year curriculum that created deeper integration between physicians and private-sector research and development firms. Their proposal led to a new one-day leadership and organizational development course that was held at the school in February 2017.

Of the remaining teams that responded to our survey, four were in discussions with their medical school leadership about implementing their projects. One team had moved forward with their project, but the project had not yet been implemented. Another team had published their proposal in a peer-reviewed journal.6 Five teams had not moved forward with their projects.

Also of note, the abstract book we published was downloaded from the AMA website nearly 1,000 times in March 2016 when it was first posted. As of March 2019, it has been downloaded more than 2,000 times.

Next Steps

Innovation challenges like our Medical Education Innovation Challenge are a way to elicit novel ideas from medical students and spur innovation at medical schools. In fact, several of the teams that either placed or were awarded an honorable mention in our challenge implemented at least some aspect of their project at their institution.

Despite these successes, we did not survey the teams that did not place or receive an honorable mention or the teams that received an honorable mention but did not submit an abstract, so we cannot say how the challenge affected those teams or if they implemented their work. Our ability to evaluate the long-term effects of our challenge is also limited by participating students matriculating into residency, where they are no longer able to support their projects. Anecdotally, we have heard that a few of the proposals have evolved through engagement with the broader medical education community, such as with presentations at national conferences.

The AMA continues to facilitate innovation challenges among diverse stakeholders as a way to spread change throughout the health care system, because innovation happens when people with contrasting perspectives and complementary areas of expertise come together.7 After the conclusion of our Medical Education Innovation Challenge, we launched the Healthier Nation Innovation Challenge in April 2016.8 We then launched the Health Care Interoperability & Innovation Challenge in April 2018 and the Health Systems Science Student Impact Competition in October 2018.9,10 Each incorporated lessons from previous challenges, such as how to improve communication and better assess impact. We chose to focus this report on the Medical Education Innovation Challenge to show how the involvement of medical students in innovation activities provides them with opportunities for professional development and spurs innovation locally and nationally. Medical schools, health systems, and national organizations can use this type of incentive-driven format to generate ideas from students and effect local change.

References

1. Skochelak SE. A decade of reports calling for change in medical education: What do they say? Acad Med. 2010;85(9 suppl):S26–S33.
2. How students are affecting med ed transformation. AMA Wire. February 6, 2015. https://www.ama-assn.org/education/accelerating-change-medical-education/how-students-are-affecting-med-ed-transformation. Accessed March 28, 2019.
3. Lee YJ, Arida JA, Donovan HS. The application of crowdsourcing approaches to cancer research: A systematic review. Cancer Med. 2017;6:2595–2605.
4. American Medical Association. Medical education innovation challenge: 2016 team proposals. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/ace/ace-innovation-booklet.pdf. Published March 2016. Accessed March 28, 2019.
5. Cofrancesco J Jr, Wright SM, Vohr E, Ziegelstein RC. Creating an “education shark tank” to encourage and support educational scholarship and innovation. Acad Med. 2017;92:1578–1582.
6. Faber E, Wells D. Incorporating high value care into undergraduate medical education. Univers J Educ Res. 2017;5:1145–1148.
7. Degraff J. The Innovation Code. 2017.Oakland, CA: Berrett-Koehler Publishers, Inc..
8. AMA Healthier Nation Innovation Challenge. https://www.innovatewithama.com. Accessed March 20, 2019.
9. American Medical Association. AMA, Google launch health care interoperability & innovation challenge [press release]. April 9, 2018. https://www.ama-assn.org/ama-google-launch-health-care-interoperability-innovation-challenge. Accessed March 20, 2019.
10. Murphy B. Medical students as change agents? How these six are doing it. American Medical Association website. https://www.ama-assn.org/education/accelerating-change-medical-education/medical-students-change-agents-how-these-six-are. Published March 6, 2019. Accessed March 28, 2019.
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