As the landscape of primary care evolves, pressures on practitioners rise, and artificial intelligence promises to empower physicians with greater knowledge and efficiency, Harvard Medical School is acting to align its educational goals and reinforce its support for and leadership in primary care.
Effective June 30, the educational offerings of the HMS Center for Primary Care — directed by Russell Phillips, the William Applebaum Professor of Medicine — will move to the Program in Medical Education, overseen by Dean for Medical Education Bernard Chang. This integration will allow for greater coordination between the primary care core clerkship required of all medical students, the new pilot curriculum track for medical students dedicated to primary care leadership and transformation, and other primary care-focused educational initiatives.
The Office for Community-Centered Medical Education, which oversees a growing catalog of opportunities for students to engage in community health, will also become part of the PME.
Opportunities for primary care research will be supported through the HMS Office of Scholarly Engagement, and the Primary Care Student Leadership Committee will continue as an important forum for innovation and engagement within the HMS community.
Beyond the PME, the highly successful HMS HealthTech Fellowship Program will move to the HMS Therapeutics Initiative, and the recently launched Lancet Global Health Commission on People-Centered Care for Universal Health Coverage will now be supported by the Office for Research Initiatives and Global Programs.
These changes follow years of effort to build and sustain the Center for Primary Care as an independent entity. However, the current financial realities have necessitated a strategic restructuring, said Dean George Q. Daley in an email to the community on June 20.
“Dr. Phillips and I have tried in earnest to raise additional philanthropic and endowment funds to sustain the center as an entity with its own administrative and research infrastructure. This has proven difficult,” he wrote.
As such, HMS will reorganize its primary care curricular offerings to preserve and sustain the center’s most successful programs. The overall aim is to embed primary care innovation and leadership within the medical student experience, allowing students and faculty to more effectively engage in the learning process and collaborate to imagine and design new models of primary care.
The Center for Primary Care — established in 2010 thanks to a generous $30 million current-use gift from an anonymous donor, together with input from members of the HMS community, including many students — has contributed significantly to the HMS community and to progress in health care. The decision to integrate key components of the center’s robust offerings within the PME comes at a critical moment.
“Our society has a primary care crisis right now. There’s no more important time to be teaching our medical students at Harvard about the problems we face in primary care and about potential solutions,” Chang said. “We have many tools within our Program in Medical Education to help identify the best learning opportunities for students. [This realignment] will allow primary care education and community-centered education to be coordinated more easily with those tools.”
One such tool is a pilot curriculum track that enables students to express an early interest in primary care leadership and transformation and have that interest affect the trajectory of their time at HMS.
“Most Harvard Medical School students get exposure to primary care in their first-year clinical skills course,” Chang said. “All of them get exposure to primary care in the required primary care clerkship, and many of them take advanced electives that also involve primary care.”
But according to Chang, the disjointedness of that three-pronged approach means students might have multiple primary care preceptors over the course of their HMS medical education.
The new longitudinal curriculum track, on the other hand, connects first-year students who are dedicated to primary care leadership and transformation to a primary care preceptor who they will stay with throughout their education, including the core clerkships and beyond.
“With the integration of the Center for Primary Care under the auspices of the PME, I’d like to not just continue that program but hopefully expand it to more and more students,” Chang said.
He is also hopeful that bringing the Office for Community-Centered Medical Education under the PME umbrella will allow community-based efforts to be organized more intentionally. These efforts — which are intimately tied with primary care — include a special on-the-ground session during the first-week Introduction to the Profession in which students visit community-based organizations and community health centers in the neighboring communities of Roxbury, Mission Hill, and Jamaica Plain.
Powering innovative programs
Outside of the PME, other adjustments will allow existing programs to be contained within infrastructures that can help facilitate their success. David Duong, HMS instructor of medicine at Brigham and Women’s Hospital, will continue in his role as director of global primary health care. Duong leads a team of researchers and trainees in the creation of high-quality and sustainable primary health care systems for people and communities worldwide — work that will now be supported by the Office for Research Initiatives and Global Programs.
Programs that fall under Duong’s purview include the federally funded Technology Enabled Education for Community Health (TEECH) project and the recently launched Lancet Global Health Commission on People-Centered Care for Universal Health Coverage.
Duong emphasized the importance of the people-centered approach in primary care.
“Students are learning that patients and communities are also their teachers,” he said. “These are critical voices that students can learn from.”
Finally, the HMS HealthTech Fellowship Program will move to the Therapeutics Initiative, under the leadership of Executive Director Mark Namchuk. The 10-month HealthTech Fellowship Program, directed by Paola Abello, teaches the biodesign innovation framework and prepares the next generation of health care innovators to set new standards in care through technology, engineering, business, and science.
“The purpose of the Therapeutics Initiative and the HealthTech Fellowship is to scale innovations that will improve human health,” Namchuk said, noting that the migration of the fellowship to the Therapeutics Initiative will amplify the latter’s remit beyond the translational sphere and into entrepreneurship and business creation.
Namchuk himself has served as a mentor in the HealthTech Fellowship Program. “Working with young scientists and engineers to help them build something — it’s a joy, and it’s a big chunk of why I came to HMS,” he said. “I love it.”
A legacy of progress
For 15 years, the Center for Primary Care has helped to improve patient outcomes, produce high-impact studies, and graduate innovative leaders in primary care research, education, and policy. In addition, under Phillips’ leadership, the center has raised the stature of primary care nationally, resulting in HMS being ranked as one of the top 10 medical schools in primary care nationwide.
Phillips will dedicate a portion of his time to HMS as he concludes his current grant-funded work and continues to see patients as a primary care general internist at Beth Israel Deaconess Medical Center. He considers the center’s greatest achievements to include the training of students who have since become successful clinicians, policymakers, educators, and leaders. He’s equally proud of the faculty collaborations the center has fostered to enhance student support, as well as the innovative approaches developed to strengthen primary care.
“But I am most proud that Dean Daley views the work of the center as being of sufficient importance to embed our programs throughout HMS in ways that will increase synergies and create efficiencies and will continue to build and sustain the work that we have had underway at the center for the last 15 years,” Phillips said.
Duong acknowledged that although change is never easy, “It’s a chance for us to evolve and to reframe primary care not as an entity that’s separate from the health care system but a major part of it.”
Daley recognized the hard work of all faculty, staff, and students associated with the Center for Primary Care in his community email.
“I want to acknowledge the dedication of all those associated with the center and its progress,” he wrote. “I am confident that this transition will reinforce and sustain HMS’ commitment to primary care well into the future.”
