SLIM Curriculum

Systems, Leadership, Integration & Management

Recent estimates of healthcare performance put accidental deaths in hospitals at a minimum of 200,000 per year and waste at a trillion dollars per year.  Not surprisingly, societal trust in healthcare is at an all time low.  At Columbia-Bassett,  new curriculum has been created to prepare students to be future leaders and agents of transformation, to assist in mitigating these major societal barriers to progress.

Resolving issues of harm, waste and patient dissatisfaction requires knowledge of health policy and health delivery, but that knowledge is both necessary and not sufficient to yield transformation.  Transformation will come when physicians and other healthcare team members know the soft and hard skills of change management and process re-engineering.  Columbia-Bassett has created a non-clinical element of curriculum, comprising about five percent of each student's experience, a major component of which is Lean Six Sigma training in sophisticated healthcare problem-solving - Lean being the Toyota method of eliminating waste, and Six Sigma being the General Electric method of eliminating errors. 

This component is called SLIM, which stands for Systems/Leadership/Improvement/Management. It is conceived to give learners broad knowledge of the forces shaping healthcare, and the specific skills to identify and solve root cause problems.  We have assembled faculty uniquely suited to this task, now honed by eight years of teaching Columbia-Bassett students. Our mission is to empower our students to become doctors who apply the science of performance improvement to healthcare delivery problems at any level, from a malfunctioning system in a clinic to a malfunctioning component of Medicare.

Students are immersed in the following:

  • Overview of healthcare policy and delivery
  • Training in advanced performance improvement techniques
  • Literature on overtreatment, waste, and harm
  • SLIM year long projects during the Major Clinical Year, supervised by Lean Six Sigma Master Black Belts
  • 3 periodic presentations of the SLIM project to senior Bassett physicians and management during the year
  • Systems and Skills Journal Club
  • Health care struggles – guest speakers
  • Research in performance improvement effectiveness and efficiency


SLIM_4 yr schematic_6.28.17.jpg

Detail of Components of the SLIM curriculum include:

  • Pre-clinical Year
    • During the Columbia-Bassett orientation week (which occurs immediately before orientation week at the main campus), students are exposed to their first round of SLIM training. Working with faculty with deep experience in public health and Lean and Six Sigma techniques,  students learn about the healthcare and insurance systems and about the cultural and organizational factors that influence them, and about how to approach complex problem-solving in culturally effective ways.  These two days are an overview of the next three years of SLIM.

    • During the 1.5-year pre-clinical training in NYC, students meet periodically to discuss SLIM concepts with expert faculty and leaders in health care – in the past we have had hospital CEOs and COOs,  insurance company executives, health policy leaders, and so forth.

    • Interested students are able and welcome to pursue research opportunities at any time, including during the summer before matriculation or the summer after their first year, either in Cooperstown or elsewhere. Students can find support from Bassett's Research Institute at Bassett, under the direction of Dr. Anne Gadomski, and conduct research in any of a variety of areas, including on efficiency and effectiveness of performance improvement and effective teaching of performance improvement, as well as other topics relating to emotional trauma and physical disease and other non-PI related topics, whether using Bassett or NYC faculty mentors. These projects can be initiated at any time and may extend throughout the student's medical school career.

  • Major Clinical Year
    • SLIM training week - This occurs after the first 10 weeks of training in the Rapid Inpatient Blocks in Cooperstown. Very few physicians at large possess the knowledge and skills acquired in such a curriculum.  This is preparation for students' roles as leaders of high stakes PI projects at Bassett, chosen by senior leadership for their intrinsic institutional importance.

    • Participation as a co-leader of a Bassett Lean Six Sigma Project TeamIn 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. Examples of projects include an initiative to improve performance and efficiency in the operating room; analysis of the potential benefits and drawbacks of implementing geographic care in the hospital; identification of and reduction of barriers to effective doctor-patient communication; and standardization and dissemination of protocols for the management and tracking of diabetic patients. Students present their projects and experiences to a mixture of other students, mentors and senior administrative leaders on 3 occasions during the year.  This opportunity comprises a full course during the Major Clinical Year, which is 13 months long at Columbia-Bassett as a consequence.

    • Meetings with Bassett Leaders:  Subsumed under the SLIM curriculum are concepts of ethics, evidence-based Medicine, Systems, Leadership, Improvement and Management. During this series of hourly meetings, these themes are discussed and exemplified, in the context of our existing health system and in contrast to others. Students will meet with individual 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

  • Differentiation & Integration
    • Research & Scholarly Project: 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 or emotional trauma/physical disease platform (Columbia-Bassett's other distinct focus).  These projects culminate in a thesis during the final year of medical school. If a student elects to do PI research, projects may be on any relevant topic in the health services research arena, and faculty members from the Bassett Research Institute are available to provide guidance and support. Examples of final projects to which Columbia-Bassett students will be especially well suited include an in-depth study of an optimal practice around use of performance improvement tools and related outcomes; teaching of PI to residents in our and other institutions; or identification of health improvement opportunities in the population Bassett serves and development of a possible new program adjustments.

The broad view of health care provided by SLIM is complemented by lived experience in the low utilization, comparatively good outcomes setting of Bassett – caring for 800,000 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.