Latest / Becker’s Healthcare Podcast / Carmela Rocchetti, MD, Assistant Dean of Community Engaged Medical Education and Associate Professor Professor of Internal Medicine at the Hackensack Meridian School of Medicine

Transcript

Carmela Rocchetti, MD, Assistant Dean of Community Engaged Medical Education and Associate Professor Professor of Internal Medicine at the Hackensack Meridian School of Medicine · Becker’s Healthcare Podcast

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  - This is Laura Dirdo with the Becker's Healthcare
• 1:01
  - podcast. I'm thrilled today to be joined by
• 1:03
  - doctor Carmela Rocchetti, who is the assistant dean
• 1:06
  - of community engaged medical education and associate professor
• 1:09
  - of internal medicine as well as director of
• 1:11
  - the human dimension program at Hackensack Meridian School
• 1:14
  - of Medicine.
• 1:15
  - Doctor Rokheti, it's a pleasure to have you
• 1:16
  - on the podcast today.
• 1:18
  - Thank you so much, Laura. I'm really excited
• 1:20
  - to be here and look forward to our
• 1:21
  - conversation.
• 1:23
  - Absolutely. I am too. I know we're gonna
• 1:24
  - be talking a lot about the human dimension
• 1:27
  - program. But before we dive in, can you
• 1:28
  - tell us a little bit more about yourself
• 1:30
  - and the organization?
• 1:32
  - Absolutely.
• 1:33
  - So I'm a general internist by training.
• 1:35
  - And as you mentioned, I'm the director of
• 1:37
  - the human dimension program at Hackensack Meridian School
• 1:40
  - of Medicine.
• 1:41
  - The school of medicine sits within the Hackensack
• 1:43
  - Meridian Health System, which is the largest and
• 1:46
  - most comprehensive
• 1:47
  - health care network in New Jersey.
• 1:50
  - The hospital network has 18 hospitals,
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  - over 500
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  - outpatient locations,
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  - and is is really a huge enterprise
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  - across New Jersey.
• 2:01
  - About nine years ago, we opened up the
• 2:04
  - school of medicine.
• 2:05
  - In 2017,
• 2:07
  - we,
• 2:09
  - recruited our first class,
• 2:11
  - and
• 2:12
  - we had this amazing opportunity
• 2:15
  - to
• 2:16
  - build a school of medicine in a mission
• 2:18
  - driven way and really think
• 2:21
  - intentionally about how we wanna train our future
• 2:23
  - physicians.
• 2:25
  - I love that. That's incredible to have that
• 2:27
  - opportunity and then to really see what you
• 2:29
  - are building there. I'm excited to learn more.
• 2:31
  - So can you tell us about the human
• 2:33
  - dimension program and what makes it different from
• 2:35
  - a traditional medical education?
• 2:37
  - Absolutely. So the human dimension is one component
• 2:41
  - of the Hackensack Meridian School of Medicine.
• 2:44
  - The the entire school's vision and mission is
• 2:47
  - really focused on humanism
• 2:49
  - and equity.
• 2:50
  - The vision and mission of the school is
• 2:52
  - to create a new generation of physicians, physician
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  - leaders,
• 2:56
  - who really center humanism
• 2:57
  - and innovation
• 2:59
  - to ensure that people from all different communities
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  - and contexts,
• 3:04
  - are able to enjoy the highest level of
• 3:06
  - well-being.
• 3:07
  - So everything we do at the school of
• 3:09
  - medicine is centered on this vision and mission.
• 3:12
  - At the heart of our school is the
• 3:15
  - human dimension, which is a program that all
• 3:18
  - students are required to take while they're at
• 3:20
  - the school. The program runs
• 3:22
  - three or four
• 3:24
  - years,
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  - and really
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  - helps bring the determinants of life,
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  - to,
• 3:31
  - the determinants of health, excuse me, the determinants
• 3:33
  - of health to life for our students. So
• 3:36
  - we talk about the determinants of health a
• 3:38
  - lot, and those are the things,
• 3:41
  - good or bad, that shape an individual's
• 3:44
  - health outcomes. So that those could be
• 3:46
  - biologic,
• 3:47
  - environmental,
• 3:49
  - social,
• 3:50
  - access to care.
• 3:52
  - So all of our programming is really focused
• 3:54
  - on helping our students
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  - connect with an individual in a very humanistic
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  - way, understand
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  - that individual's
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  - context, understanding their culture, understanding what's important to
• 4:06
  - them, understanding
• 4:08
  - how they make health decisions, how they prioritize,
• 4:12
  - their health and their behaviors,
• 4:14
  - and and really helping our physicians have those
• 4:16
  - skills so that they can
• 4:18
  - deliver care in that comprehensive
• 4:21
  - way. I can tell you more about the
• 4:23
  - the details of the program.
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  - Absolutely. I think that would be great because
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  - this seems like such an important,
• 4:30
  - space to be digging into. I know so
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  - many hospitals and systems as well as academic
• 4:34
  - medical centers and schools of medicine are trying
• 4:37
  - to look out into their communities and finding
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  - those pockets of
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  - inequalities and and challenges and and those who,
• 4:44
  - don't have the same access to care and
• 4:46
  - being able to close those gaps is a
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  - mission critical,
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  - for many organizations. And so I'd love to
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  - hear more about the ways that you're doing
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  - that and, what that really looks like for
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  - you as you're building out this program.
• 4:57
  - Yeah. So as we built the school, we
• 5:00
  - realized that we really needed to change
• 5:02
  - the different areas that medical education
• 5:05
  - was being delivered. So classically, medical education
• 5:08
  - happened in a lecture room, right, in a
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  - classroom or anatomy lab
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  - and in the hospital.
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  - And then it evolved and some medical education
• 5:17
  - was being delivered in outpatient settings. But really
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  - what what we've done is expanded
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  - the areas where medical education is happening to
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  - include the community. So now our students are
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  - learning in the classroom, they're learning in the
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  - clinical setting, and they're learning in the community,
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  - and they're learning directly from community members.
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  - We frequently say,
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  - patients are our teachers and the community is
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  - our class
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  - classroom. So to make that happen,
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  - students come in,
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  - really week one of medical school, and they
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  - get matched to a community
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  - and to a family.
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  - And they spend time in that community
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  - meeting with different stakeholders,
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  - really
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  - understanding,
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  - the assets and challenges in that community.
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  - And they similarly
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  - spend oh, excuse me. Sorry about that. But
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  - similarly, they spend time with families,
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  - understanding
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  - what impacts those families' health.
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  - They go into the family's homes and do
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  - home visits regularly over three years,
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  - and as a result of all of those
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  - experiences,
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  - students start to understand
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  - the true drivers of health outcomes.
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  - I love that. That's so helpful to understand
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  - it and really cool that you're able to
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  - connect with,
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  - students and families and those who can really
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  - make a big difference because,
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  - being able to grow the health and wellness
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  - of the community starts in a variety of
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  - fronts.
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  - What does that first community experience actually look
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  - like for incoming students, and how do you
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  - help them navigate,
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  - getting into that position?
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  - Because this is so core and central to
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  - our program,
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  - we have our students come in very first
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  - day of school. They're hearing from
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  - community members. They're welcomed by a variety of
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  - different community members,
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  - during their onboarding week, their orientation week, which
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  - we call,
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  - becoming a physician. It's it's more than orientation.
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  - It's really a transition into medical school.
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  - Day one,
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  - they are working with
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  - a community organization
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  - on a service project.
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  - For the past few years, we've had our
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  - students building bicycles with, the boys and girls
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  - club from Clifton
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  - where we have a group of,
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  - young students come, they work with our students,
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  - build these bicycles together,
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  - have some
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  - discussion around
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  - bike safety.
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  - Our students help the kids learn how to
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  - use the bikes, talk about bike helmets, and
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  - then we're able to give the bikes to
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  - the students.
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  - So that's literally the first day of medical
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  - school, which is very unusual,
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  - for medical school.
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  - But it doesn't stop there. Throughout the next
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  - two weeks, students are meeting with stake community
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  - stakeholders
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  - and those range from
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  - leaders of community based organizations,
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  - church leaders, store owners,
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  - health commissioners,
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  - school leaders.
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  - They spend time in communities
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  - doing service work.
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  - They spend time,
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  - studying communities,
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  - looking at data related to the communities to
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  - really understand that the health.
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  - And then, of course, we have the families
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  - that our students work with,
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  - also welcome the students when they they arrive.
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  - That's really cool to hear and sounds like
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  - a great opportunity to start immersing students into
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  - the the work that they'll need to be
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  - doing and the right people to network with
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  - and and and find the solutions,
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  - as they're looking into some of those tough
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  - challenges that are ahead.
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  - Yeah. It's really it's a really neat,
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  - opportunity to get our students out on the
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  - ground day one.
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  - Many medical schools,
• 9:05
  - don't have enough
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  - like, they don't have enough,
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  - activities where students really feel that they're contributing
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  - in a meaningful way.
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  - So from a very early
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  - stage in our training, our students are actually
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  - doing meaningful work. Medical students are a very,
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  - significant
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  - workforce that is frequently underutilized
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  - and what we've realized is
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  - when they are
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  - asked to do meaningful work early on, it
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  - not only provides a great service to our
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  - communities but it also helps our students
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  - feel more connected to their purpose and it
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  - helps build their own health and wellness and
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  - resiliency because,
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  - they they feel like they're not just studying,
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  - they're actually doing what they came to medical
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  - school to do from day one.
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  - I love that. What a great example
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  - of the ways that they can make a
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  - big impact right away. Now I'm also curious,
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  - how do you build and sustain trust with,
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  - some of these underserved communities who are at
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  - the center of the program? I know that
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  - can be a really big challenge,
• 10:09
  - for health care organizations as they're trying to
• 10:13
  - do work out in the community. So what
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  - does that look like, and, how do you
• 10:16
  - make sure that you continue to,
• 10:19
  - build that trust as a two way street
• 10:21
  - between the two?
• 10:23
  - Yeah. I think that that's a critically important
• 10:25
  - question, building trust. And, also,
• 10:28
  - you mentioned two way street. So making sure
• 10:31
  - that as you build relationships with communities that,
• 10:35
  - the benefit is is mutual. Right? So that,
• 10:38
  - obviously, the medical
• 10:39
  - school and the students are learning from the
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  - community, but we wanna make sure that we're
• 10:44
  - at giving a meaningful service back.
• 10:47
  - And I think by
• 10:49
  - really focusing on that mutual benefit, that is
• 10:52
  - one way to build trust.
• 10:54
  - But, really, it comes down to making sure
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  - the right people are at the table from
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  - the very beginning.
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  - We have depended on our communities to really
• 11:04
  - guide us and give us a lot of
• 11:05
  - input every step of the way,
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  - and that has been significant because,
• 11:12
  - our programming is really built around the needs
• 11:15
  - of our communities.
• 11:17
  - And as such, our curriculum has to change
• 11:19
  - or evolve year after year. We have core
• 11:22
  - kind of principles and and objectives that our
• 11:25
  - students need to meet.
• 11:27
  - But as communities
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  - face different challenges, our curriculum has to change,
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  - and we need our community partners to help
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  - inform how we need to evolve.
• 11:36
  - I think what is really important for others
• 11:39
  - that are thinking about
• 11:41
  - having,
• 11:43
  - programming that really allows students to learn
• 11:47
  - in communities
• 11:48
  - is to ensure that the medical school has
• 11:52
  - some dedicated
• 11:54
  - staff that
• 11:56
  - manages the community relations.
• 11:58
  - We are very fortunate. We have we have
• 12:01
  - dedicated community engagement
• 12:02
  - specialists and community liaisons,
• 12:05
  - and it doesn't need you know, you don't
• 12:08
  - need to have a very large staff to
• 12:10
  - do this, but you you do need to
• 12:11
  - have
• 12:13
  - dedicated resources
• 12:15
  - to, build the relationships and maintain the relationships.
• 12:19
  - Students, as amazing as they are and as
• 12:22
  - committed and proactive as they are, they are
• 12:25
  - pulled in a lot of different directions and
• 12:26
  - have to prioritize their exams and their studying
• 12:29
  - and and,
• 12:30
  - you know, they cycle in and out. So
• 12:32
  - having consistent,
• 12:35
  - administrators, staff, faculty that are committed to the
• 12:39
  - communities,
• 12:40
  - I think are is an important
• 12:42
  - component of success when you're working with communities,
• 12:46
  - and it also ensures
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  - that
• 12:50
  - the,
• 12:52
  - the institution is consistent
• 12:54
  - with the community, which I think
• 12:56
  - is often a problem.
• 12:59
  - Well, it's really interesting to hear. And, you
• 13:01
  - know, I
• 13:02
  - I love that idea of being able to,
• 13:05
  - really strongly
• 13:06
  - have that consistency in place, within the larger
• 13:09
  - staff of the organization and,
• 13:12
  - building those inroads, and then having the student
• 13:15
  - exposure as well.
• 13:16
  - Is there anything that you've I guess, anything
• 13:19
  - else you've learned throughout the years that would
• 13:20
  - be helpful,
• 13:21
  - for other organizations and health systems that are
• 13:24
  - looking to do something similar and build similar
• 13:26
  - programs?
• 13:27
  - What should they do first and and what
• 13:29
  - should they know in order to be successful?
• 13:32
  - Well, I think that having students learn in
• 13:36
  - the community is the future of medical education.
• 13:39
  - As
• 13:40
  - technology has evolved, humanism and understanding
• 13:44
  - true
• 13:45
  - precision medicine,
• 13:47
  - understanding
• 13:49
  - what someone's context is and what their community
• 13:51
  - is and really understanding the determinants of health
• 13:54
  - is gonna be even more important,
• 13:58
  - to our future doctors. So
• 14:00
  - this type of learning,
• 14:03
  - in
• 14:05
  - in an integrated way with the traditional way
• 14:07
  - of learning
• 14:08
  - is critical,
• 14:09
  - to the future of health care.
• 14:12
  - But in order to do it,
• 14:14
  - health systems have to think a little bit
• 14:16
  - differently
• 14:17
  - about what the delivery of a medical education
• 14:21
  - program looks like, and they need to recruit
• 14:24
  - partners that perhaps
• 14:26
  - were not traditionally
• 14:28
  - partners and those are community leaders,
• 14:31
  - community organizations.
• 14:34
  - And really this requires a culture shift. It
• 14:37
  - requires support from the highest level of leadership.
• 14:40
  - At many institutions, there are faculty and leaders
• 14:44
  - that are interested in doing this and trying
• 14:46
  - to do this,
• 14:47
  - but
• 14:48
  - in order to really
• 14:50
  - build a comprehensive
• 14:51
  - program for all of your students,
• 14:54
  - you need
• 14:55
  - leadership support from the highest level and you
• 14:57
  - need a dedicated staff.
• 15:01
  - I also think, you know, just some lessons
• 15:03
  - learned,
• 15:04
  - from our
• 15:05
  - program,
• 15:06
  - we have realized that having a program that's
• 15:09
  - required for all students and is longitudinal
• 15:12
  - is really important.
• 15:14
  - So we think that
• 15:16
  - understanding context and community, understanding the determinants of
• 15:19
  - health is just as important as understanding pharmacology.
• 15:22
  - And it needs to be integrated throughout all
• 15:25
  - of all of the curriculum. It's not just,
• 15:28
  - oh, I think about community and context on
• 15:30
  - a Tuesday afternoon. No. It's I'm thinking about
• 15:32
  - it all the time as I'm taking care
• 15:34
  - of patients.
• 15:35
  - And in order to
• 15:37
  - integrate
• 15:38
  - that deeply,
• 15:40
  - you need to you need,
• 15:42
  - it needs to be required. It needs to
• 15:44
  - be something that students engage in the entire
• 15:46
  - time they're at your school.
• 15:49
  - The other thing that,
• 15:51
  - we we've recently published a few,
• 15:54
  - journals that
• 15:56
  - will highlight some of the lessons learned,
• 15:59
  - about developing a program.
• 16:01
  - And right now, we've just started a comprehensive
• 16:04
  - program evaluation to
• 16:06
  - really identify the impacts
• 16:09
  - of this type of learning on our students
• 16:13
  - and their future practice.
• 16:16
  - I love that. It's so helpful to have
• 16:18
  - those types of resources,
• 16:19
  - to learn and grow. Thank you so much,
• 16:22
  - doctor Ropetti, for joining us on the podcast
• 16:24
  - today. This has been a fun and inspiring
• 16:26
  - conversation.
• 16:27
  - I look forward to connect with you again
• 16:29
  - soon and and continuing,
• 16:31
  - to talk about some of these important topics
• 16:33
  - and and really,
• 16:34
  - work together to solve some of these big
• 16:36
  - issues within the health care space.
• 16:38
  - Well, Laura, I thank you for inviting me.
• 16:40
  - We,
• 16:41
  - are really passionate about this type of medical
• 16:44
  - education.
• 16:45
  - Myself, our vice dean, Miriam Hoffman,
• 16:48
  - and really all of the folks at the
• 16:50
  - Hackensack Meridian School of Medicine are eager to
• 16:53
  - connect with other schools across the country that
• 16:57
  - are doing similar work and, partner and share
• 16:59
  - ideas. So,
• 17:01
  - to all the listeners out there, I would
• 17:03
  - love to connect and and reach out and
• 17:05
  - share
• 17:06
  - some lessons and learn from each other so
• 17:08
  - that we can advance,
• 17:10
  - this work together.