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Introduction Early medical school education has historically focused on teaching basic medical sciences. More recently, medical schools are encouraged to incorporate health systems science (HSS) into early curricula. Addressing all of these components in an overcrowded curriculum remains challenging. Methods We report on the Student Navigator Project (SNaP), a pre-clinical experience where students engage longitudinally with medically and socially complex patients. SNaP is built on a foundation of trust, responsibility, and ownership in the studentpatient relationship. Early learners take an active role in navigating, advocating, and coaching for their patients. In addition, students are integrated as medical assistants into a primary care clinic; complete a mentored, team-based quality improvement project; and engage in evidence-based medicine, teaching, and handoff activities. Results As a result of these activities, students learn firsthand about HSS, contribute meaningfully to their patients' care, and are immersed in a systems-based practice approach early in their medical school education. Preliminary outcomes (2016)(2017)(2018)(2019) show satisfaction with the program and knowledge of program focus areas. Conclusions The authors are engaged in improvement cycles to modify program structure and curriculum in order to promote dissemination in diverse clinical settings. Ultimately, we plan to measure longer-term outcomes, including clerkship and residency preparation, career choice, and practice setting.

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Objective: Previous literature have demonstrated the potential benefit of non-medically indicated induction of labor for nulliparous women at 39 weeks, yet few have studied the impact of this management strategy in different maternal age groups on obstetric outcomes. We sought to assess whether obstetric outcomes among women undergoing non-medically indicated induction of labor at 39 weeks as compared to expectant management vary based on maternal age. Methods: This was a retrospective cohort study of singleton, non-anomalous, term deliveries between 2007-2012 in California. We defined non-medically indicated induction of labor as induction of labor without a specific medical indication and women with planned cesarean sections were excluded. We compared induction of labor to expectant management beyond the gestational age of induction and examined this comparison in different maternal age groups. Numerous maternal and neonatal outcomes were examined. Chi-squared and multivariable logistic regression analyses were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance. Results: A total of 677,727 women-infant dyads met our inclusion criteria and were included in this study. At 39 weeks’ gestation, 6% of women underwent non-medically indicated induction of labor and 94% underwent expectant management. Women 20-34 years old and ≥35 years old had lower odds of cesarean delivery if they underwent induction of labor. Women of all ages undergoing non-medically indicated induction of labor had higher adjusted odds ratios for operative vaginal delivery. Neonatal outcomes were better with non-medically indicated induction of labor, including lower odds of NICU admission and neonatal respiratory distress. Conclusion: Our study demonstrated that obstetric outcomes vary among women undergoing non-medically indicated induction of labor compared to expectant management when stratified by maternal age. These findings illustrate the importance of understanding age-related differences in outcomes associated with non-medically indicated induction of labor.