“Finding My Piece in That Puzzle”: A Qualitative Study Exploring How Medical Students at Four U.S. Schools Envision Their Future Professional Identity in Relation to Health Systems

Abstract

PurposeHealth systems science (HSS) curricula equip future physicians to improve patient, population, and health systems outcomes (i.e., to become "systems citizens"), but the degree to which medical students internalize this conception of the physician role remains unclear. This study aimed to explore how students envision their future professional identity in relation to the system and identify experiences relevant to this aspect of identity formation. MethodBetween December 2018 and September 2019, authors interviewed 48 students at 4 U.S. medical schools with HSS curricula. Semistructured interviews were audiorecorded, transcribed, and analyzed iteratively using inductive thematic analysis. Interview questions explored how students understood the health system, systems-related activities Abbreviations

A Pilot Study Assessment of Medical Student Knowledge and System Citizenship Attitudes Pertaining to Health Systems Science

“…Indeed, one recent study used qualitative techniques to examine how medical students "envision their future professional identity in relation to the system" and found that there are a variety of factors that contribute to student views on system citizenship, including the fact that some students were "more likely to view systems expertise as distributed within interprofessional teams". 31 This study finding appears to be congruent with the fact that M4 students in our study were more likely to agree that other health care professionals can sometimes lead a clinical team. The construct of system citizenship is not yet well-defined and is therefore challenging to assess.…”

“…This possibility is consistent with a qualitative study wherein “influential experiences before medical school” were found to have an impact on the aspirations of medical students related to future involvement in efforts to impact health systems. 31 Whether these experiences prior to medical school could also impact the scores of a given group of medical students on the HSS subject exam is an intriguing question. Although our study protocol did not allow us to examine these class characteristics, this would seem to be an important consideration for future studies.…”

“… 5 , 34 A qualitative study of second- and fourth-year medical students at four different schools revealed that past, present and future-oriented experiences and considerations shaped how the students viewed their own future identities as clinicians engaged with the health system, with the added complexities of social context, affinities, abilities and practice context. 31 Related aspects of the goal to produce system-ready clinicians include the need for medical education to reinforce the social contract between the medical profession and society at large, the ongoing examination of clinical care delivery models and their impact on various constituent groups, and the concept of communities of practice and interprofessional teamwork in the workplace. 4 , 35 Perhaps, our pilot study using a newly developed survey instrument designed to gain insight into students’ views on health system citizenship will make a contribution to ongoing dialogue on this topic within the medical education community.…”