ChangeMedEd Initiative

How health systems science transforms future-physician training

Andis Robeznieks , Senior News Writer

With almost half of U.S. allopathic medical schools accomplishing “meaningful integration” of health systems science (HSS) into their curriculum, the nature of future-physician training is being transformed.

“Health systems science focuses on improving the patient experience and overall health of populations, as well as ways in which health care professionals work together to deliver care,” said Judee Richardson, PhD, the AMA’s director of medical education research and program evaluation. 

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“It includes content on the social drivers of health, health equity and ways to reduce cost and increase value of care,” she added. “Health systems science also illustrates ways in which health care systems can be a part of these changes in care and delivery—it covers all levels of the system.”

Specifically, as the “third pillar” of medical education, HSS compliments basic and clinical sciences “through a systems-thinking approach and health care delivery-content domains: value-based care, inter- and intraprofessional teamwork, quality improvement, health care policy and population health,” Richardson and her colleagues wrote in an Academic Medicine study.

“As the needs of patients, communities, and population health evolve, medical educators must lead change by developing innovative content, training and education,” the study adds. “It is critical that students be competent in approaches and content such as HSS and understand why it is essential for better patient care and doctoring.”

Richardson and colleagues surveyed 140 of the 155 U.S. allopathic medical schools and found meaningful integration of HSS at 47% of them, with 14% accomplishing “deep integration,” 33% had “moderate” integration,Integration was described as “siloed” at 28% and as “sparse” at 25%.

Integration levels were determined through analysis of curriculum maps, class descriptions, school websites, the Association of American Medical Colleges’ 2020 data snapshot, and interviewee responses.

“These institutions are changing the way in which future physicians are trained by including this content,” said Richardson, who is also an adjunct lecturer at the University of Illinois at Chicago College of Medicine.

She and her co-authors also determined that 59% of those accomplishing HSS-content integration had done so longitudinally and 43% did it as a health system science thread. Meanwhile, 26% held HSS intersessions or workshops.

In interviews, 30% of institutions reported “major curriculum reform,” at time of interview, 12% within one to three years, and 18%  within the past four to six years.

“We learned that institutions may not have the space or support to cover all content domains of health systems science,” Richardson said. “This means there is variation of content across institutions.”

In addition to finding space in an already packed curriculum, other challenges institutions face include finding guidance on design and integration of HSS such as content-specific expertise and support. 

“They’d appreciate teaching resources such as case studies, online tools and evidence-supported best practices,” Richardson said, noting “faculty development is needed, but a challenge to implement.”

Opportunities for collaboration would also be appreciated, Richardson said.

She also noted that there are many HSS “champions” who are “responsible for the results we are seeing.”

This includes the AMA’s medical education business unit and its ChangeMedEd Initiative, which funds HSS research, content development and resource distribution.

“These results illuminate the success of these collective efforts,” Richardson said.

This is the first survey of its kind and establishes a baseline for future measurements.

“Meaningful curriculum integration also provides evidence for the transformational nature of health systems science as the third pillar of medical education,” said Richardson, who served as principal investigator for the study.

The AMA has released Health Systems Science Education: Development and Implementation, which outlines how to integrate health systems science into the medical education continuum.

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.