A new practice-based science can help prepare medical students to be the best physicians possible, but several barriers stand in the way of successfully incorporating it into students’ educations.
Medical students recognize that learning about health systems science (HSS)—including population health, health systems improvement and high-value care—will help them be better physicians. But students say that preparing to pass their medical licensing board examinations and place in the best residency programs overshadows HSS, a new study shows.
As a founding member of the AMA’s Accelerating Change in Medical Education Consortium, Penn State University College of Medicine has been implementing a new curriculum that involves HSS.
The goal has been to align medical education with the needs of health systems through a new course that focuses on topics such as insurance, cost, value, care coordination, population health, public health, health care performance, teamwork and leadership.
To underscore the relevance of this classroom-based course, the program includes a component in which students are embedded in health systems in south-central Pennsylvania as patient navigators. In that role, students help patients work through complex health care systems to get the care they need and are involved in efforts to reduce health care disparities.
This curriculum comes after medical literature and interviews with residents and educators over the past five to eight years suggested that medical school graduates are not prepared to hit the ground running when they begin residency, the study’s principal investigator Jed D. Gonzalo, MD, an internist and assistant professor of medicine and public health sciences at the Penn State University College of Medicine said in a podcast.
Residents “are very good, clinically astute physicians in doing the traditional diagnostics and therapeutics,” Dr. Gonzalo said. “But from a patient-centered lens or from understanding the health context and the health system in which our patients live and our health care is delivered, the knowledge and skills there may be insufficient.”
In 2014, Dr. Gonzalo and his colleagues talked to 12 focus groups with 50 medical students across all years of medical school about the planned HSS curriculum at Penn State University College of Medicine. Students told researchers they believed an HSS curriculum would allow them to gain new knowledge and skills, enhance their understanding of patients’ perspectives, and improve their learning through hands-on roles.
But the students also said they are feeling pressure to perform well on examinations and position themselves to match into their preferred residencies, making studying HSS a lower priority because HSS concepts are not on the exams.
“As a result HSS is viewed as peripheral and non-essential, greatly limiting student engagement,” study authors concluded.
Researchers identified four categories of barriers to HSS studies:
- Medical board licensing examinations foster a view of basic science as “core”
- Systems concepts are important but not essential
- Students lack sufficient knowledge and skills to perform systems roles
- Current medical education and clinical systems culture does not support systems education
Study authors said “successfully addressing and working with this tension will require candid exploration of educational goals, competing commitments and rationales, along with careful testing of underlying assumptions.”
Dr. Gonzalo said he and his colleagues have used the feedback to tweak the way they are implementing HSS. For example, educators tell students that they recognize that they are studying for other things. But they remind students about the oaths they took when they came to medical school, identifying the reasons they were going into medicine and expressing the type of physicians they wanted to become. For most students, understanding HSS is essential to them in becoming that physician, Dr. Gonzalo said.
“We haven’t mastered this yet. We are two years into the program,” Dr. Gonzalo said. “It is a continuous improvement cycle.”