![]() | The examples and perspective in this article may not represent a worldwide view of the subject.(May 2024) |
Health systems science (HSS) is a foundational platform and framework for the study and understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. [1] It is one of the three pillars of medical education along with the basic and clinical sciences. [2] HSS includes the following core foundational domains: health care structure and process; health system improvement; value in health care; population, public, and social determinants of health; clinical informatics and health technology; and health care policy and economics. [1] It also includes four functional domains: ethics and legal; change agency, management, and advocacy; teaming; and leadership. [1] Systems thinking links all of these domains together. [1] Patient, family, and community are at the center of HSS. [3]
HSS, which was originally referred to as systems-based practice, emerged in response to the growing recognition that effective health care delivery requires more than just clinical expertise. It acknowledges that health care systems are complex, adaptive systems influenced by a multitude of factors, including social determinants of health, policy decisions, organizational structures, and patient preferences. [4]
The World Health Organization first recognized the need to educate physicians about the link between health and the systems in which people live, work, and play in 1978. [5] The quality and patient safety movement of the 1980s and 1990s further reinforced the need for physicians to understand systems thinking. [6] [7] [8] [9] The Association of American Medical Colleges' Core Entrustable Professional Activities for Entering Residency (CEPAERs) started including identifying system failures and making contributions to a culture of safety and improvement in 1999. [10] That year, the Accreditation Council for Graduate Medical Education also included systems-based practice as one of its six core competency domains. [11] In 2001, the Health Resources and Services Administration funded an 18-medical-school consortium to launch several pilots related to systems-based education. [12] In 2005, the book, Professionalism in Tomorrow's Healthcare System, outlined several aspects of the systems-based practice competency. [13]
Medical schools and residency and fellowship programs, however, struggled to teach these competencies. [14] The framework for HSS was developed to address this struggle and is built on a foundation of systems thinking and the biopsychosocial model developed by George L. Engel. [4] It aims to educate physicians to become systems citizens. [15]
From 2013 to 2015 the American Medical Association's (AMA) Accelerating Change in Medical Education consortium of 11 U.S. medical schools worked to identify a comprehensive framework for HSS training. [16] In 2017, a review of 30 grant submissions to the AMA Accelerating Change in Medical Education initiative and an analysis of the HSS-related curricula at the 11 medical schools that were members of the Accelerating Change in Medical Education consortium formed the groundwork toward the development of a potential comprehensive HSS curricular framework with domains and subcategories. [4]
Barriers to incorporating HSS into medical education include student resistance because it is not always viewed as essential to passing physician licensing and credentialing exams [17] and limitations in the number of medical school faculty with expertise to teach HSS domains. [18]
An increasing number of new medical schools have created their initial curriculum with HSS fully integrated including Kaiser Permanente Bernard J. Tyson School of Medicine, [19] which matriculated its first class in July 2020, and the Alice L. Walton School of Medicine, which is expected to matriculate its first class in 2025. [20]
As health care continues to evolve, the importance of HSS is expected to grow. [21] Efforts to integrate HSS into medical education and practice will be essential for preparing physicians to navigate the complexities of modern health care delivery, advocate for their patients, and contribute to improving the health of populations. [22]
HSS is also expanding to other health professions. In 2023, the National Academies of Sciences, Engineering, and Medicine hosted a series of workshops focused on integrating HSS across the learning curriculum. [23] HSS has been expanding to physician assistants, [24] nurses, and other health care professionals. [25]
The Korean Association of Medical Colleges has proposed replacing medical humanities with health systems science in that country's medical education system, although critics say that it needs adaptation to the Korean health system. [26]
The American Medical Association collaborated with the University of Witwatersrand to customize health systems science for the South African health system. [27]
Health systems science is also referred to as clinical governance in the United Kingdom, although this does not include all the domains included in the American HSS framework. [28]
Susan Skochelak, MD, MPH, creator of the Accelerating Change in Medical Education initiative [29] and lead editor of the first and second editions of the Health Systems Science textbook.
Schools involved in the AMA Accelerating Change in Medical Education initiative [16] that helped create the HSS framework:
Internal medicine, also known as general internal medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of internal diseases in adults. Medical practitioners of internal medicine are referred to as internists, or physicians in Commonwealth nations. Internists possess specialized skills in managing patients with undifferentiated or multi-system disease processes. They provide care to both hospitalized (inpatient) and ambulatory (outpatient) patients and often contribute significantly to teaching and research. Internists are qualified physicians who have undergone postgraduate training in internal medicine, and should not be confused with "interns", a term commonly used for a medical doctor who has obtained a medical degree but does not yet have a license to practice medicine unsupervised.
A Physician Assistant or Physician Associate (PA) is a type of healthcare professional. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes between smaller jurisdictions such as states or provinces. Depending on location, PAs practice semi-autonomously under the supervision of a physician, or autonomously perform a subset of medical services classically provided by physicians.
The Warren Alpert Medical School is the medical school of Brown University, located in Providence, Rhode Island. Originally established in 1811, it was the third medical school to be founded in New England after only Harvard and Dartmouth. However, the original program was suspended in 1827, and the four-year medical program was re-established almost 150 years later in 1972, granting the first MD degrees in 1975.
The Association of American Medical Colleges (AAMC) is a nonprofit organization based in Washington, D.C. that was established in 1876. It represents medical schools, teaching hospitals, and academic and scientific societies, while providing services to its member institutions that include data from medical, education, and health studies, as well as consulting. The AAMC administers the Medical College Admission Test and operates the American Medical College Application Service and the Electronic Residency Application Service. Along with the American Medical Association (AMA), the AAMC co-sponsors the Liaison Committee on Medical Education (LCME), the accrediting body for all U.S. MD-granting medical education programs.
NYU Grossman School of Medicine is a medical school of New York University (NYU), a private research university in New York City. It was founded in 1841 and is one of two medical schools of the university, the other being the NYU Grossman Long Island School of Medicine. Both are part of NYU Langone Health.
Medical education is education related to the practice of being a medical practitioner, including the initial training to become a physician and additional training thereafter.
The University of Missouri–Kansas City School of Medicine, established in 1971, is one of three medical schools located near downtown Kansas City and only one of two public medical schools in the state of Missouri. The school offers an accelerated combined B.A./M.D. program based on a six-year curriculum. The school of medicine admits students into the program directly from high school and within six years, the graduates attain a baccalaureate and a Doctor of Medicine degree (B.A./M.D.) from UMKC. The curriculum integrates the liberal arts, basic sciences, and clinical sciences with a team approach to learning. More than 4,000 physicians have graduated from the University of Missouri–Kansas City School of Medicine, with the majority being in the six-year combined degree program.
Medical education in the United States includes educational activities involved in the education and training of physicians in the country, with the overall process going from entry-level training efforts through to the continuing education of qualified specialists in the context of American colleges and universities.
The Accreditation Council for Graduate Medical Education (ACGME) is the body responsible for accrediting all graduate medical training programs for physicians in the United States. It is a non-profit private council that evaluates and accredits medical residency and internship programs.
The University of Minnesota Medical School is a medical school at the University of Minnesota. It is a combination of two campuses located in Minneapolis and Duluth, Minnesota.
The National Board of Medical Examiners (NBME), founded in 1915, is a United States non-profit which develops and manages assessments student physicians. Known for its role in developing the United States Medical Licensing Examination (USMLE) in partnership with the Federation of State Medical Boards (FSMB), USMLE examinations for medical students and residents are used by medical licensing authorities in the U.S. to help determine qualifications to grant and recognize medical licenses. NBME also creates assessments and materials that are used by medical students, medical educators, practicing physicians, and for state testing of physicians already holding licenses.
Wendy Levinson MD is a Canadian physician and academic. She is the Chair of Choosing Wisely Canada, "a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures". She is also Professor of Medicine at the University of Toronto.
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The Mayo Clinic Alix School of Medicine (MCASOM), formerly known as Mayo Medical School (MMS), is a research-oriented medical school based in Rochester, Minnesota, with additional campuses in Arizona and Florida. MCASOM is a school within the Mayo Clinic College of Medicine and Science (MCCMS), the education division of the Mayo Clinic. It grants the Doctor of Medicine (M.D.) degree, accredited by the Higher Learning Commission (HLC) and the Liaison Committee on Medical Education (LCME). In November 2018, the school was renamed in honor of a $200 million donation from businessman Jay Alix.
Vineet M. Arora is an American medical researcher who is the Herbert T. Abelson Professor of Medicine and Dean for Medical Education at the University of Chicago Pritzker School of Medicine. She is a Fellow of the National Academy of Medicine. Her research considers clinical medicine and medical education, with a focus on the improvement of the quality of care in teaching hospitals.
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