Concerns and Responses for Integrating Health Systems Science Into Medical Education

Abstract

With the aim of improving the health of individuals and populations, medical schools are transforming curricula to ensure physician competence encompasses health systems science (HSS), which includes population health, health policy, high-value care, interprofessional teamwork, leadership, quality improvement, and patient safety. Large-scale, meaningful integration remains limited, however, and a major challenge in HSS curricular transformation efforts relates to the receptivity and engagement of students, educators, clinicians, scientists, and health system leaders. The authors identify several widely perceived challenges to integrating HSS into medical school curricula, respond to each concern, and provide potential strategies to address these concerns, based on their experiences designing and integrating HSS curricula. They identify two broad categories of concerns: the (1) relevance and importance of learning HSS-including the perception that there is inadequate urgency for change; HSS education is too complex and should occur in later years; early students would not be able to contribute, and the roles already exist; and the science is too nascent-and (2) logistics and practicality of teaching HSS-including limited curricular time, scarcity of faculty educators with expertise, lack of support from accreditation agencies and licensing boards, and unpreparedness of evolving health care systems to partner with schools with HSS curricula. The authors recommend the initiation and continuation of discussions between educators, clinicians, basic science faculty, health system leaders, and accrediting and regulatory bodies about the goals and priorities of medical education, as well as about the need to collaborate on new methods of education to reach these goals.

State of the Science: Interprofessional Approaches to Aging, Dementia, and Mental Health

“…In addition, the Seattle Care Pathway is a novel online resource for dental practitioners caring for older adults that provides a “care pathway” or algorithm for varying levels of “dependency” and disability related to aging and multimorbidity . These examples of profession‐specific innovations for older adults with dementia highlight possibilities for their inclusion within IPE curricula and for alignment with the newly recognized discipline of health systems science, which includes a team‐based care domain and a focus on value‐based care, patient safety, and population health …”

Reply

“…Kraft echoes sentiments expressed by some practitioners and some academicians, 4 especially those who trained in the "high-touch" era (late 1940s to mid-1970s). 5,6 The reframing movement embraces traditional clinical skills, views them as crucial to good patient care, and does not attempt to replace or abandon them.…”

Reframing Medical Education

“…23 Many medical schools are struggling to allocate requisite resources, find space in an already overly packed curriculum, and find educators trained in HSS. 24 Student engagement in these curricular areas will vary somewhat, because current board examinations and selection of residency applicants focus on traditional clinical knowledge and skills. 25 In addition, students currently entering clinical learning environments are not encountering the required breadth of role modeling of HSS principles necessary for their knowledge and ultimate skills.…”