Incorporating health policy and advocacy in emergency medicine residency

Medical education is nuanced. While focusing on clinical science and care is of the utmost importance, understanding health policy and advocacy is also essential.

At Baylor College of Medicine, residents receive foundational training through EP3 (Ethics, Professionalism and Policy Program), an innovative curriculum developed by the Center for Medical Ethics and Health Policy. Using a blended, flipped-classroom model, EP3 combines online learning with interactive sessions that help learners apply ethical, professional and policy concepts to real-world clinical practice.

Emergency medicine residents utilize several EP3 modules, including Social and Structural Determinants of Health, Healthcare Economics and Medical Errors. Building on this foundational content, Baylor College of Medicine faculty developed a Health Policy and Advocacy curriculum specifically for emergency medicine trainees understand the healthcare system. A description of this curriculum was published in AEM Education and Training.

“There is not a lot written about this in the broad medical school literature, especially not in emergency education. People have been teaching it for a long time, but it hasn’t been written. The goal is for people to find this if they want to teach it,” said Dr. Cedric Dark, associate professor in the Henry J.N. Taub Department of Emergency Medicine at Baylor and first author of the paper.

The curriculum helps emergency medicine residents understand various parts of the healthcare system and covers six domains:

• Adverse events, medical errors and malpractice.
• Healthcare safety net.
• Quality indicators, measures and outcomes.
• Physician reimbursement.
• S. healthcare system, financing and delivery.
• The business of emergency medicine.

Emergency medicine physicians face patients with different insurances, such as Medicare, Medicaid or private insurance, as well as uninsured patients.

“When we see a patient, it’s important for us to know if they’re going to follow up or not: How are they going to move through the healthcare system? Without understanding how that system works, especially how the finances work, it makes it impossible for us to advocate for our patients on a professional level,” Dark said.

Physicians must understand how patients will navigate the healthcare system. If a patient goes to the hospital with a severe need and without insurance, physicians must know where to send them. Some patients might be admitted to the hospital, while other patients with insurance might be referred to specialists that can see them the following day.

According to Dark, it is incumbent upon people to focus on documentation: How to write something in the chart that not only explains what the physician did medically but also gives credit for their work to be appropriately paid when submitting a bill to insurance. Lawsuits are not foreign in the field of emergency medicine, so the curriculum offers a four-hour mock trial for residents, working with law students to argue a case.

“It’s a pretty eye-opening experience for them, and sometimes it changes the way they think, how they approach patients and how they chart,” Dark said.

Residents can learn about quality metrics under the curriculum, such as CT utilization, to understand the measures, why they exist and whether they are accurate or useful. The course also dives deeper into important parts of health policy and advocacy curriculum since board exams only broadly touch on these topics.

“Understanding the nuances of our healthcare system is huge, and it’s not something that is typically taught in medical school or residency. People figure it out along the way, and it’s unfortunate people have to figure it out without understanding that picture,” Dark said.

The curriculum provides a syllabus that academic institutions can access through their institutional libraries should they choose to incorporate it. The authors hope to provide a better way to integrate this into formalized emergency medicine curriculum.

“My hope is that if there are people out there trying to teach this, we give them some ideas into how they can work with their departments to incorporate it,” Dark said. “It’s very niche. Unless you have someone available to teach it, you might ignore it. Now institutions can include it in the curriculum and become experts in teaching it.”

Other contributors to this work include Dr. Sara Andrabi and Dr. Vidya Eswaran.

By Homa Warren