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Vital Signs

Mixing medical students with future CEOs

By Roger P. Smith, Ph.D.

An elective course that remains in a curriculum for more than 30 years must offer something that's valued by students. When health-care economist Michael Zubkoff joined the DMS faculty in 1975 as chair of the Department of Community and Family Medicine, the offer also included an appointment as a professor of economics and management at Dartmouth's Tuck School of Business. One of the first things Zubkoff did was design an elective for secondyear Tuck students called Medical Care and the Corporation (MCC). In the three decades since then, Tuck students have flocked to the course.

The MCC syllabus covers the structure and financing of the U.S. health-care industry; critical issues facing the health-care system—including cost, quality, and access; the implications of variations in the delivery of care and the supply of medical resources; health-care trends that affect business; and national health-policy issues.

The course has long featured guest speakers, including Paul Gardent, former executive vice president of DHMC. In 2006, Gardent stepped down from that position after 27 years to join what is now the Dartmouth Institute for Health Policy and Clinical Practice; at the same time, he joined Zubkoff as a coteacher of MCC.

Easy: It would be easy to become complacent with an initiative as successful as the course has been, but Zubkoff has never been one to shrink from stirring the pot. In 2007, he opened MCC to a much wider audience. Though a few DMS students had audited the course in the past, last fall was the first time they could take it as an elective.M.D. students, residents, fellows, and Dartmouth Institute health-policy graduate students signed up to take it.

Perspectives: The addition of different perspectives and aspirations, Zubkoff says, made for a much more diverse and interactive classroom experience.

MCC also includes a group project, and the new student mix was especially beneficial in that part of the course. The 30 to 40 students in the class are divided into groups of three or four; this year, each of the groups contained some medical students and some Tuck students.

Gardent canvasses area health-care providers to collect potential projects, and then each group picks one. The students have 10 weeks to research their project and prepare a report for presentation to their "client."

For example, the Children's Hospital at Dartmouth (CHaD) asked for help developing underwriting for a program called Come Out to Play. CHaD was hoping to contribute to this national initiative—a campaign to combat childhood obesity that is sponsored by an alliance of 53 children's hospitals—by creating a corporate sponsorship program.

R. Thomas Finn III , a first-year in the M.D.-M.B.A. program, worked on this project with another medical student and two Tuck students.He found it "a truly stimulating . . . environment, which fostered provoking discussions and debates. The clients were so pleased. . . . They suggested we present the [report] to the entire board through a video conference." DMS first-year Dana Lin also worked on the CHaD project. She found the Tuck students not only "adept at crafting sleek PowerPoints and delivering polished talks to clients, but [also] able to think critically on the fly. . . . I was impressed by their professionalism," she says.

Another project involved working with the Dartmouth Hitchcock Advanced Response Team (DHART), which provides air- and land-based medical transportation throughout Northern New England.

DHART wanted an unbiased "report card" evaluating the effectiveness of their services.And they were hoping for a tool that could be used to evaluate any helicopter service, according to uniform standards.

Metrics: Dr. Richard Kutz, a student in the Dartmouth Institute's master's of public health program, was in the group that worked with DHART. "The most difficult part," he jokes, "was finding common time to meet . . . because of the different class schedules." However, he continues, "the project was ideal for a multidisciplinary group. There was a position that fit everyone well. . . . The Tuck students focused on the financial and customer-service portion, while the M.P.H. and medical students dealt with process and outcome metrics. Overall, it was a valuable experience."

It could be a course that will survive for another 30 years.

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