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Thinking Big(ger)

03/12/18

Esther Chung, MD, discusses JeffMD, a forward-thinking evolution of SKMC's curriculum

Esther K. Chung, MD, MPH

Esther K. Chung, MD, MPH

GHB faculty co-advisor Esther K. Chung, MD, MPH, is a professor of Pediatrics and director of JeffSTARs (Jefferson Service Training in Advocacy for Students and Residents) program, a multi-organization advocacy and health education initiative offered in conjunction with the Department of Family and Community Medicine. She brings her years of experience as a pediatrician and physician advocate to her work contributing to the health science systems and population health portions of the JeffMD curriculum.

What does a health science systems perspective entail?
It's understanding things like economics, policy, urban planning, and a host of other issues as they pertain to physicians and their patients. It involves a lot of the same methods and theories that we see in population health. I think we often lose the individual agent when we look at things in terms of these vast, impersonal systems, which are essential to care delivery. It's my hope that our students, as future practitioners, will be able to see themselves as an active part of these large organizations and will be able to better advocate on behalf of their patients and themselves. I don't envision every doctor as a lobbyist, but I do believe being able to understand and affect these systems is an increasingly necessary piece of medical practice.

How are you building these skills and perspectives into the curriculum?
With JeffMD, everyone has to do a scholarly inquiry project, which is about choosing an area of interest and really digging into it over the course of a couple years with knowledgeable advisors and mentors. This can be done on any number of different topics and isn't just limited to pop health. The idea isn't necessarily to get some sort of conference paper out of the effort, though that would be awesome. We want students to engage with a question that they're passionate about, so they can immerse themselves and really appreciate the layers of complexity that surround even a very narrowly defined issue.

Can you give an example of how a systems approach might inform the way a student or general practitioner approaches a particular health issue?
Let's take childhood obesity for example. There are so many different factors, but let's take one, maybe less obvious, factor-transportation. Well, people are no longer walking to school. They're taking buses, they're getting rides, and getting less exercise as a result. But how does transportation affect something like fresh produce? It's actually pretty straightforward-imagine a big delivery truck trying to get through the corners of North or South Philadelphia. Why would they drop off five apples at a corner store? And similarly in rural areas, where you won't see a store for miles and miles, why would a large produce truck go there? So they're going to go to the suburbs, where there are big produce stores, and they're going to drop off their hundreds of boxes and go on their merry way.

An obvious solution doesn't come ready-made with this understanding, but now you can begin to effectively address the underlying causes of a given health problem. Ultimately, it enables you to think critically and flexibly in whatever context you find yourself treating patients.