Accelerating Change in Medical Education

7 barriers to implementing a health systems sciences curriculum

Five years in, the AMA’s efforts to remake medical training have made major headway.  

The AMA Accelerating Change in Medical Education Consortium, a partnership between the AMA and medical schools, recently added five new members to the fold, bringing the group’s total membership to 37. One major byproduct of the group’s work: The AMA’s Health Systems Science textbook was developed by the consortium to help students learn how to navigate the changing landscape when they enter practice, especially as the nation’s health care system moves toward value-based care. 

Two additional resources on health systems science were released in recent weeks. The AMA’s new Health Systems Science Review book, published by Elsevier, is the first study tool of its kind to help physicians-in-training and other health professionals, as well as their instructors, evaluate competencies in Health Systems Science. The Association also released a series of free, online education modules to help students develop competencies in Health Systems Science. The first six modules in the new Health Systems Science Learning Series are available for free through the AMA Ed Hub. The six modules cover the following topics: Health Care Delivery Systems, Patient Safety, Population Health, Quality Improvement, Social Determinants of Health, and Systems Thinking.

Speakers presenting during a recent AMA Innovations in Medical Education Webinar revealed progress made on health systems science, known as the third pillar of medical education. A recording of the webinar is available in the resources area of the Accelerating Change in Medical Education Community.

Covering the topic in medical education gives medical students a better understanding of how patients access and receive health care. The recent webinar detailed several programs implementing ground-breaking educational initiatives that cover some of the key tenets of health systems science.

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Jed D. Gonzalo, MD, is an associate dean for health systems education at Penn State College of Medicine. In his role at Penn State, he has led the design and implementation of 12 programs related to teaching medicine’s third pillar. Dr. Gonzalo offered some insight on the barriers programs may encounter along the way when implementing a successful health systems science curriculum.

Nomenclature. “Health systems science is not the same as quality improvement,” he said. “It is not the same as high-value care. It is a comprehensive third pillar of med ed. We need to focus more on this as we transition and blend the systems based practice competency language as well.”

Local curriculum developers and leaders. “A lot of schools that call me, they say we don't have the person to lead this,” Dr. Gonzalo said. “And you know, that may be a challenge because the local champion not only needs to have a little bit of expertise in health systems science. But, to me, more important is the fact that there's new curriculum being developed and that team of individuals or that individual needs some educational expertise.”

Finding space in the curriculum. “The first question I get from folks who call me, they say, ‘Well, how did you work it into the curriculum?’” Dr. Gonzalo said. “And certainly, this is a challenge when we are in a content coverage mindset on how to integrate it in. With the basic and clinical sciences, there's limited time within medical school and the learning experiences that it is a real authentic issue.”

Education leadership. “When the individuals asking about curriculum or where [health systems science fits within it], my next question to them is who's your education dean?” he said. “What is their philosophy? Are they behind this? Do they believe in this? Because I believe that if you have an education dean or leadership who believes that this is important as a three-pillar model, they will help navigate the curricular integration, higher order competencies and local curriculum development efforts.”

Faculty knowledge, skills and engagement. “There's plenty of faculty who are fully engaged and they are early innovators and adopters, but certain faculty have not been brought up in this,” Dr. Gonzalo said. “They do not believe that this is ... critical. They don't think the system's broken and they say, ‘Look at me, I'm doing just fine.’ And that creates some challenges because ... all of our faculty are key role models for our learners.”

Student engagement. Students “will score it very high on a clinical relevance score, but their engagement, whether it be due to the boards as 7% of the boards is related to a systems concept or what their perception of what a physician's identity is or role modeling,” Dr. Gonzalo said. “Many of the health systems science competencies get marginalized. Many students are fully engaged, and I think it's raising questions about our admissions processes.”

Paradigm shift in “medical professionalism.” “What I believe underlies all the challenges with implementation is a new professionalism in health care,” Dr. Gonzalo said. “And for physicians, that says physicians are not only about being altruistic and trustworthy with individual patients, but it's also about their relationship with the health care system itself and being in a symbiotic relationship, being a steward, being an ambassador of health care resources.”