The Duke Hotspotting Initiative

Problem: Many medical schools now incorporate meaningful clinical experiences for first-year medical students. However, these clinical placements often fail to teach components of the physician experience, including health care logistics, cost-conscious care, longitudinal patient care, and interaction with an interprofessional team. The Duke Hotspotting Initiative (DHSI) is a student-led elective longitudinal experience for first-year medical students (MS1s) to serve as a patient’s health care liaison to encourage proactive health management and efficient use of resources. Approach: DHSI is a combined didactic-clinical experience at Duke University School of Medicine. Students complete a didactic curriculum to develop relevant skills and maintain weekly contact with a patient in Durham, North Carolina for the duration of the academic year. In their meetings with patients, students help them set and monitor health goals, identify and address barriers to health resources, and efficiently access primary care. Across 2 academic years (2017-2018 and 2018-2019), 54 MS1s were surveyed electronically before and after their participation in DHSI. They were asked about their comfort navigating various patient management scenarios, using communication tools, and assuming clinical responsibilities. Outcomes: DHSI offers MS1s a unique immersive opportunity to gain experience applying the clinical skills they will need in their future careers. Based on comparisons of responses from the 48 students (89%) who completed the pre-DHSI survey and 40 students (74%) who completed the post-DHSI survey, there was a significant increase in comfort with communication and patient advising, managing common chronic diseases, using interview skills, and assuming clinical responsibilities. Next Steps: DHSI continues to expand in both size and scope, with the goal of incorporating team members from other health professions training programs at multiple institutions. Future analysis will investigate the longer-term impact of the program on students’ professional development, objective changes in clinical skills, and outcomes for patients involved with DHSI.