SLIM Curriculum Now Offered to All P&S Students

The SLIM curriculum first introduced to students in the Columbia-Bassett program has been expanded to all of P&S.

SLIM, which stands for Systems, Leadership, Integration, and Management, teaches medical students fundamental business concepts—such as how to reengineer processes to render them safer and more effective—as part of an effort to improve the quality and efficiency of the health care system. SLIM incorporates business and public health coursework to equip students with scientific tools of performance improvement and to help students understand the U.S. health care system through study of care delivery, cost, and payment issues.

“With SLIM, P&S is responding to a profound societal need,” says Henry Weil, MD, assistant dean for medical education at the Bassett campus. “The Institute of Medicine identifies at least $750 billion in waste in health care each year, which profoundly affects the U.S. economy; the Dartmouth Institute estimates as many as 187,000 avoidable deaths are due to medical error in inpatients alone.”

Supported by a generous grant from IBM, SLIM forges an understanding about how health care is delivered at both the macro and micro levels, how policies are created, and how physicians, working collaboratively across disciplines, can lead the transformation of the U.S. health care industry.

Dr. Weil was the driving force in developing the SLIM prototype in the Columbia-Bassett program, and he negotiated the grant with IBM to adapt the program of best health care business practices into the P&S curriculum for all P&S students and to study the curriculum’s efficacy. Many of the first Columbia-Bassett graduates credited SLIM with helping them understand medical practice beyond the clinical and scientific knowledge that medical schools teach. “Through carrying out my own projects, I saw just how difficult and important it is to continue to refine how we deliver health care to patients,” said Monika Laszkowska’14. “I learned the importance of asking the right questions, and I was able to build a tool set that enables me to use data-driven, collaborative approaches to find the right answers.”

P&S is the first medical school in the nation to offer a comprehensive, four-year curriculum of business lessons for medical students.

The curriculum spans all four years of medical school, slowly building on concepts instead of compressing them into one course. In the first two years, as program director Robert Sideli, MD, associate professor of biomedical informatics and CUMC chief information officer, explains, “Students learn the what, why, and how of business. In the third year, they’re put in the real world to be horrified by all the broken things, and in the fourth year they return with these stories from the front. Then they try to put it all together and ask, ‘How do you fix these problems?’

“We have so much to learn from the business world,” says Dr. Sideli. He cited Toyota’s success in applying lessons learned not only from Detroit, but also from American supermarkets, an approach that has improved productivity and improved prices. After U.S. automakers lost significant market share, they adopted the Toyota model for themselves. “Every industry does this,” says Dr. Sideli. “Now it’s coming to medical school.”

A fundamental part of the curriculum’s implementation is the SLIM student committee. Zoe Sansted, a medical student who co-founded the committee, says the group has three goals: improve the curriculum by offering helpful feedback, put students in touch with hospitals where they will have an opportunity to participate in quality improvement projects and business management, and organize events to get other students interested.

“Physicians are agents for change,” she says. “Specifically, quality improvement and safety initiatives should be led by doctors.”

Before the introduction of SLIM, the only access P&S students had to instruction on the business aspect of medicine was an elective taught each fall by Dr. Sideli, called “Process Redesign in a Complex Organization.” But consensus seems to be growing that all medical students should be taught how to improve quality and reduce costs as well as how to see their work in the larger context of the health care industry.

“The goal is to teach students to take ownership of the health care system,” says Dr. Sideli. “Otherwise, they’re passive, which is something that has been going on for years. Everyone blames everyone else. Ultimately, it’s the physicians who are responsible.”

SLIM, originally slated to debut with only the first-year class, will be offered to all students even if that means students in their final years receive only a cursory introduction to the material.

As the first medical school to offer the program, P&S has a responsibility to thoroughly evaluate SLIM’s progress and publish the findings. The goal is to see the idea spread nationally. “One of the best ways to address the health care industry’s manifold inefficiencies is to teach physicians directly what they can do to effect change,” says Dr. Sideli.

“How can we have safer procedures? How can we have higher quality?” says Ms. Sansted. “There is an awareness among my classmates that we are the key to answering these questions.”