Systems thinking has come front and center in medical education in recent years, with health systems science (HSS) having gained a foothold in the curricula of dozens of medical schools and residency programs across the U.S.

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Still, for health systems science to complete the jump to the clinical environment, it will need to be developmentally integrated across the continuum from undergraduate to graduate to continuing medical education. That will require constant innovation, refinement and reinforcement of its strategies, noted panelists during a plenary session at the AMA Health Systems Science Summit.

The session was centered on reports from more than a dozen medical schools and residency programs detailing their real-world strategies, from low to high impact, and low to high effort. Those reports coalesced around actions needed in these four key areas.

People should see the effort to deliver health equity “as aligned with what hospital systems are wanting to do,” said Maya M. Hammoud, MD, professor of obstetrics and gynecology and professor of learning health sciences at the University of Michigan Medical School. “This is good clinical care.”

The challenge facing faculty is to develop shared mental models that show HSS is good for their health systems, Dr. Hammoud noted. “They should be asking us to do it.”

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“Without adequate assessment, we can't know when someone's doing it right,” said John Andrews, MD, vice president of graduate medical education (GME) innovations at the AMA. “We have content-based assessments at the undergraduate medical education level, but do we have assessments at the GME level that are meaningful?"

Besides having the technical skill to practice in their discipline, are learners also “displaying the competencies of health systems science that are going to lead them to positively influence patient outcomes going forward?” Dr. Andrews said.

“When this work was launched with the Accelerating Change in Medical Education Consortium, it was imperative that each grant team have a representative from health care system leadership,” said Kimberly Lomis, MD, vice president of undergraduate medical education innovations at the AMA. “That's waned over time, and we need to rekindle that.”

In addition to the solid business case for health systems science, "I truly believe that HSS empowers physicians to not feel like they are victims of the system within which they work, but they can actually contribute to making it better,” Dr. Lomis said.

Health systems science was founded on the principles of improving patient outcomes and clinical care, Dr. Andrews noted.

The educational application of those principles began in GME with the development of systems-based practice competency, but the educational approach has been developed at the undergraduate medical education level because it features a more captive audience for didactic education and assessment. Nevertheless, medical students still sometimes get shut down in the clinical environment when, say, they question whether certain requested diagnostics or procedures fit within the health systems science model. The challenge facing educators is to change the culture of medical education so that systems thinking can survive into practice.

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“We have a responsibility in GME to create an environment where the debate of those issues and raising those principles is welcomed and respected,” Dr. Andrews said.

The AMA released Health Systems Science Education: Development and Implementation, which outlines how to integrate health systems science into the medical education continuum, in December. It also released the second edition of the Health Systems Science textbook, a framework for this third pillar of medical education. A companion, Health Systems Science Review, provides case-based questions followed by discussions of answers and suggested readings.

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