Educating for the 21st-Century Health Care System: An Interdependent Framework of Basic, Clinical, and Systems Sciences

Abstract

In the face of a fragmented and poorly performing health care delivery system, medical education in the United States is poised for disruption. Despite broad-based recommendations to better align physician training with societal needs, adaptive change has been slow. Traditionally, medical education has focused on the basic and clinical sciences, largely removed from the newer systems sciences such as population health, policy, financing, health care delivery, and teamwork. In this article, authors examine the current state of medical education with respect to systems sciences and propose a new framework for educating physicians in adapting to and practicing in systems-based environments. Specifically, the authors propose an educational shift from a two-pillar framework to a three-pillar framework where basic, clinical, and systems sciences are interdependent. In this new three-pillar framework, students not only learn the interconnectivity in the basic, clinical, and systems sciences but also uncover relevance and meaning in their education through authentic, value-added, and patient-centered roles as navigators within the health care system. Authors describe the Systems Navigation Curriculum, currently implemented for all students at the Penn State College of Medicine, as an example of this three-pillar educational model. Simple adjustments, such as including occasional systems topics in medical curriculum, will not foster graduates prepared to practice in the 21st-century health care system. Adequate preparation requires an explicit focus on the systems sciences as a vital and equal component of physician education.

Educating patient-centered, systems-aware physicians: a qualitative analysis of medical student perceptions of value-added clinical systems learning roles

“…The new curriculum included two components: (1) a health systems course (> 100 contact hours) in the first year focusing on topics such as insurance, cost, care coordination, population and public health, social determinants of health, high-value care, teamwork, and leadership, and, (2) an authentic clinical systems learning role as a patient navigator [ 2 ]. The patient navigator role is distinctly different from traditional clinical or service-learning rotations, and fulfills several criteria: 1) provides an authentic clinical community of practice experience, 2) allows for direct experience with core HSS concepts, and, 3) creates the opportunity for students to view the system from the perspective of the patient [ 22 ]. Patient navigation has historically used outreach workers to explore patients’ barriers to care and help patients navigate complex health care systems to obtain required care and reduce disparities [ 23 ].…”

The African Genomic Medicine Training Initiative (AGMT): Showcasing a Community and Framework Driven Genomic Medicine Training for Nurses in Africa

“…Noteworthy, is that developing continents including Africa have been largely underrepresented in such competency development initiatives or curricula development initiatives (Jenkins and Calzone, 2007;Korf et al, 2014). This may be partly due to outdated and static curricula which make the alignment with competencies very difficult because it cannot respond appropriately to societal challenges and needs (Gonzalo et al, 2017).…”

Science of health care delivery milestones for undergraduate medical education

“…To address these gaps, physician education in novel domains within the Accreditation Council for Graduate Medical Education (ACGME) Systems-Based Practice and Practice-Based Learning and Improvement competencies is needed [ 4 – 7 ]. The content of these novel domains is broad and includes topics such as systems improvement, clinical informatics, high-value care, systems and human factors engineering, health policy, and population health [ 4 , 8 ]. Taken together, this content has been referred to as the third science [ 8 ], healthcare delivery science [ 9 ], health systems science [ 10 ], and herein, the science of health care delivery (SHCD) [ 11 ].…”

“…The content of these novel domains is broad and includes topics such as systems improvement, clinical informatics, high-value care, systems and human factors engineering, health policy, and population health [ 4 , 8 ]. Taken together, this content has been referred to as the third science [ 8 ], healthcare delivery science [ 9 ], health systems science [ 10 ], and herein, the science of health care delivery (SHCD) [ 11 ]. Although the terms vary, all refer to a new set of physician capabilities essential for practice that extend beyond the basic sciences and clinical skills traditionally taught in medical schools [ 12 ].…”