Currently, the biggest challenges in health care are “quality” and “cost”.  Columbia-Bassett is responding to this through a non-clinical element of curriculum, comprising about five percent of a students experience.

This component is called SLIM, which stands for Systems/Leadership/Integration/Management. We have created a unique collaboration between Bassett faculty and the faculty of the Columbia Schools of Business and Public Health to achieve substantial training in these areas.

Students are immersed in the following:

• Population-based research
• Literature on overtreatment
• The Dartmouth Atlas of Health Care
• Non-traditional skills
• High level administrative teams
• SLIM presentations
• Systems and Skills Journal Club
• Health care struggles – guest speakers
• SLIM writing project

SLIM SCHEMATIC

The SLIM curriculum includes:

• Research:  As part of earning a Columbia diploma, students must complete a scholarly project under the rubric of a "major" as one would elect in college. Columbia-Bassett students may elect any of the majors available in New York City (e.g., basic sciences or world health) or may perform a scholarly project within the SLIM construct (as we anticipate most will do). These projects culminate in a thesis. Projects may be on any relevant topic in the health services research arena. Examples thereof playing to existing strengths include in depth study of an optimal practice within the salaried model, such as end-of-life care; or identification of health improvement opportunities in the population Bassett serves and development of a possible new program attendant thereto using data from Bassett's population data bank.
• Themes Week: Subsumed under the SLIM curriculum are concepts of Ethics, evidence-based Medicine, Systems, Leadership, Integration and Management. During this one-week period, these themes are discussed and exemplified, in the context of our existing health system and in contrast to others.  Students will meet with organization leaders, from trustees, to CEO/COO/CFO, to physician and administration vice presidents.  Each person the students meet has to answer three questions:

• What is my job?
• What are my goals?
• How will I execute and sustain those goals?

• Journal Club: Running through the entire two and a half years at Bassett,  this monthly experience is intended to delineate the spectrum of American health care, other systems around the world, the magnitude of the expense here, the impact of costs on people, companies, taxes, and government, and the impact on outcomes.
• "SLIM Lunches": Introduces the students to the plights of stakeholders:  A person with insurance but insufficient coverage to make ends meet during a critical illness, who has to decide whether to buy groceries or medications; a person with a history of rectal cancer, but college age children, who has opted to give up coverage (and therefore crucial follow-up screening) in order to pay tuition; a local business owner who struggles to provide insurance to employees, but with major implications to profitability; a payer who defends price by blaming doctor habits; a politician who talks about change (but has he done anything?  Why not?); a lobbyist; a leader from NYS Department of Health; and so on.  At the end of every lunch, students are asked to discuss their responsibilities as physicians to assure a reasonable experience for patients,  and how they can do so.
• Participation as a member of a Bassett Functional Team:  This experience places a student in the core of management and leadership, as a health system tries to balance priorities, improve care, and stay solvent in a very adverse environment.  The students will be on teams addressing non-clinical challenges – everything from how to effectuate better hand hygiene, to how to organize a revenue cycle, to how to integrate an information system to promote safety and parsimony, to how to systematize risk/quality/safety.  Students will see the reality of these difficulties, but also see the invaluable orienting force of “a physician at the table.”
• Participation as a member of a Bassett Functional Team Project Team:  In this extension of the bullet above, students go through all stages of a project, from idea to design in committee to deployment.  The students then follow up by observing front line consequences, see the inevitable need for rapid cycle improvement, and gain insight into creating functional systems.
• Student Colloquia:  Students present their projects and experiences to a mixture of other students, mentors and administrative leaders.  Fundamental similarities are sought across projects.  These presentations are part of the SLIM Lunchtime, above.
• Thesis: Students at Columbia have a concentration, which for Bassett students will usually be the SLIM curriculum (it is part of the basis on which they would select Bassett).  For eight weeks in the final year of medical school, they will pursue a focus from the SLIM concepts, working with a mentor, preferably a non-physician.  Student's array of choices are broad, the intent being to augment the self-shaping of ideas, attitudes and skills as pertains to career choices.

This broad view of health care is complimented by lived experience in the low utilization, comparatively good outcomes setting of Bassett – caring for 650,000 outpatient practitioner encounters, 15,000 inpatient encounters, and substantially caring for a population in an area the size of Connecticut. 

Thus, you hear theory globally, theory locally, and participate in the clumsy process of applying theory to reality.  Here, the essential process of Continuous Quality Improvement  (defining a problem, theorizing a solution, and implementing a solution with rapid cycle measuring and improvement) becomes manifestly evident to students as an indispensable skill.   And students will realize that the SLIM curriculum is one large CQI project enacted upon them:  The summer population research to learn how to define a population problem, small group to learn the vision of solving population problems, and live experiences to learn the awkward realities of implementing solutions, all the while with measurement of your internalization of attitudes and skills.