Traditionally, physicians in training have focused on basic and clinical sciences on their path to earning an MD or DO, but in recent years, a third pillar of medical education—health systems science (HSS)—has emerged. The discipline is better preparing future physicians to practice in the medical environment that awaits them, and their patients are better served because of the students’ experiences, experts say.
HSS focuses on the principles, methods and practice of improving quality, outcomes and costs of health care delivery for patients and populations within systems of medical care. The curriculum ensures students learn about things such as leadership, root-cause analysis, working in teams, care coordination, care transitions, the social and economic determinants of health, error disclosure and using health information technology, electronic health records and other technological tools that were not available in the past.
In a recent webinar hosted by the AMA’s Accelerating Change in Medical Education Consortium, faculty members from three of the consortium’s 32 schools explained the work their institutions have done to incorporate HSS into their curricula.
At Mayo Clinic School of Medicine’s two four- year campuses in Minnesota and Arizona, students experience HSS training throughout their four years of medical school, blending online modules with classroom, simulation and clinical experiences. Stephanie R. Starr, MD, director of science of health care delivery education there, said HSS is broad and that students need to see connections.
Mayo Clinic is teaching students to practice and lead within patient-centered, multidisciplinary teams to deliver high-value care. Dr. Starr said when the program revamped its curriculum to add HSS, faculty members discovered they were already teaching a number of “orphan” preclinical topics that were HSS subjects. Using a conceptual framework for teaching HSS helps students see connections across multiple topics.
At Pennsylvania State University College of Medicine, students are learning to demonstrate an awareness of, and responsiveness to, the system of health care. Students learn to call on other resources in the system to provide patients with optimal care, said Jed D. Gonzalo, MD, associate dean of health systems education at Penn. Residents are also involved in HSS.
In an internal medicine clinic, first-year students, a care manager, social worker and physician mentor work together. In one case, in-clinic sessions, telephone calls and home visits to an 84-year-old woman led to students discovering a wide scope of factors contributing the woman’s poor health and well-being. Ultimately, the students helped the woman apply for public assistance and obtain a motorized wheelchair and an in-home ramp, among other things. Dr. Gonzalo said the HSS curriculum has expanded the school’s educator bench, noting that a new culture is required in medical education and health care to meet today’s needs
At A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA), the HSS curriculum was incorporated into a total-immersion-training model the institution is pioneering with the National Association of Community Health Centers.
In students’ second, third and fourth years, they are embedded in contextual learning environments at 12 community health center campuses spread across the country in rural and urban settings. That allows HSS education to be emphasized in authentic settings, explained Joy H. Lewis, DO, PhD, chair of public health and director of practice-based research at ATSU-SOMA. She said students receive significant HSS training including the study of epidemiology, biostatistics and preventive medicine.
In these year-long courses they develop and complete community-oriented primary care projects focused on the social determinants of health. They identify a problem, develop and implement interventions and conduct ongoing evaluations of process and outcomes to improve the health of a community.
A question-and-answer session with experts was held following the webinar in the AMA Accelerating Change in Medical Education Community. Slides and video from the webinar are available there as well.
The webinar is part of a bimonthly webinar series, “Innovations in Medical Education,” which highlights innovative approaches emerging from medical schools across the country.