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Looking Back: A Transformative Fellowship in Value-Based Care

Sept. 25, 2018

The following is authored by Andrea Leyton-Mange, 2017-18 Value-Based Health Care Research Fellow in the Department of Surgery and Perioperative Care. Leyton-Mange took a gap year between her third and fourth years of medical school at Columbia University College of Physicians and Surgeons to participate in the fellowship.

On one of my medical school rotations, I spoke with a patient whose discharge had been delayed because of a hospital system error regarding his transportation needs. He begged me to let him go home. I told him that I couldn’t promise to get him out of the hospital any faster, but I did promise that I would try my best to make the system better in the future. I was already sure that I wanted quality improvement and health care administration to play a role in my medical career.

Despite this, I was still unsure of what medical specialty I would want to go into. I considered taking a research year, hoping that the extra time would afford me the opportunity to explore a variety of fields. I thought I might be interested in musculoskeletal medicine, so I also wanted to get some relevant research experience to help my applications for residency. I viewed the research itself as a means to these ends, not imagining that I would also be able to do work I could get excited about.

When an email about the Dell Medical School Department of Surgery and Perioperative Care Value-Based Health Care (VBHC) Research Fellowship was sent to the Columbia University student body, multiple classmates forwarded it to me and told me that it would fit me perfectly. I would get the chance to do research in musculoskeletal health with giants in the field while helping advance the cause of improvement in health care systems. I would be able to split my time between research and a role with the strategy and operations team — an opportunity that I certainly would not get at any other research fellowship. And I would be working in a department employing faculty from orthopaedics, physical medicine and rehabilitation, anesthesiology, general surgery, urology, and emergency medicine — a great opportunity to make contacts and decide on my future career.

After I informed Kevin Bozic, M.D., chair of the Department of Surgery and Perioperative Care and director of the fellowship, that I would accept the position, he told me that my year would be “transformative.” I didn’t believe it at first. Looking back, that was the exact right word to use.

I got involved in around 20 different projects over the course of my fellowship year. I learned how an idea becomes a research question, how a research question becomes a study and how a study moves from its initial phases through to a publication. My research focused on Patient-Reported Outcomes (PROs), which are key to understanding value in health care. Unlike some of the other research fellowships I initially considered, I could see how my research from the VBHC fellowship would relate to a cause that I cared about.

Being part of the strategy and operations team let me apply what I was learning about PROs directly to clinical care. I helped build processes for PRO collection and reporting at UT Health Austin’s brand new Musculoskeletal Institute, and these processes served as an important part of an innovative value-based payment contract for musculoskeletal health. I had the opportunity to take part in health care administration, adopt a leadership role, and learn about the process of building a clinical enterprise — all while still a medical student.

Beyond all this, my VBHC fellowship year was a great experience because of the people I worked with at Dell Medical School. It was exhilarating to be in a community of clinicians, administrators, educators and researchers who are all working together to create positive change. I’m proud to have been part of it and excited to see where they go from here.