Trying to fit any new topic, even a small one, into an undergraduate or graduate medical education curriculum can be daunting.
So when educators contemplate adopting something as comprehensive as health systems science (HSS)—an 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—they might conclude it’s simply not feasible.
The good news? It’s not a wholly new domain.
“When you think about health systems science, it covers so many things, including value-based care, quality improvement and patient safety, evidence-based medicine, communication, patient-centeredness, interprofessional collaboration, ethics,” said Rosalyn Maben-Feaster, MD, MPH, associate professor of obstetrics and gynecology at Michigan Medicine and former director of the health systems science curriculum at University of Michigan Medical School.
Health systems science “includes many domains, but thankfully many of these are covered to some extent at almost every medical school.”
Dr. Maben-Feaster is also co-editor of Health Systems Science Implementation: Development and Implementation, a first-of-its-kind, instructor-focused field book from the AMA that shows educators how to implement HSS comprehensively and effectively across the curriculum.
The book covers, among other things:
- In-depth guidance on implementing health systems science in pre-clerkship, clerkship and residency curricula.
- The role of interprofessional education and collaborative practice in health systems science curricula.
- Assessment and evaluation.
In an interview with the AMA, Dr. Maben-Feaster discussed the challenges that come with implementing health systems science and how the University of Michigan Medical School overcame them.
AMA: How did you and your colleagues begin the process of implementing health systems science into your curriculum?
Dr. Maben-Feaster: Around 2017, our institution was undergoing curriculum redesign and we were thinking about how to incorporate all the content that our students needed to learn. Interprofessional education and leadership were already big parts of that, but with the creation of HSS we were able to take a broader, more inclusive view of all the content our students needed to learn to understand how the system works and how to improve it. Health systems science was still a very new term, though, so we invested a lot of time and effort up front in what you might call a road show to explain to people what it was and why we were doing it.
AMA: Beyond having that baseline understanding of what health systems science is, what are the biggest initial barriers to implementing it in a curriculum?
Dr. Maben-Feaster: For starters, just having space for it. UME [undergraduate medical education] and GME [graduate medical education] curricula are already crowded, and you have to be very thoughtful about how to fit it in so you don’t detract from the other things that are required. So we did a needs assessment where we looked through all the areas we wanted to cover and also what already existed— because it's not that we weren't covering any of the topics, it just wasn't put together in a clear content map.
Also, when you look at how broad HSS is, it requires either having faculty who are comfortable teaching unfamiliar content or having access to experts who are willing to take on a new project. For our quality-improvement curriculum, for example, we leaned a lot on our institution’s quality department to provide content and also to serve as facilitators and coaches, because they were already passionate about that work and doing it day to day.
AMA: Did you find that you had to drop something else from the curriculum to make room for health systems science? Or does HSS give you a way of teaching more within the same amount of space?
Dr. Maben-Feaster: There wasn’t anything that we pulled out specifically to make room for health systems science. What we’ve tried to do is to tie it to what learners are already doing or make the information somewhat just in time.
For example, there’s an undergraduate rotation on transition to clerkships where students get a lot of basic information about, among other things, how the EHR works. Some of that is about what they need to do their jobs day to day, but some of it is also about health system science topics, such as professionalism and patient protections.
Similarly, when we take students through our universal skills training, which is a safety training that everyone at the institution does as part of our journey to become a high-reliability organization, we get students to think about how they can be good citizens within the system.
AMA: How does University of Michigan’s health systems science curriculum differ today from when you got started?
Dr. Maben-Feaster: I’m a person who really likes to do continuous improvement, so we’re always making little tweaks, but the biggest transition was in 2020, coincidentally around the time of the COVID-19 pandemic. Previously, we had about a dozen first-year sessions focused on health system science content which was delivered by our “Path of Excellence” directors, who are experts in many of these content areas. However, each session stood on its own, but wasn’t directly tied to the basic and clinical science content they were receiving simultaneously.
We realized that, even if the content is good, if students don't understand how it's all connected, it will be hard for them to fully comprehend the implications of it. So we restructured the sessions to be more thoughtful about the order in which the content was presented and to ensure the learning cases aligned with the basic or clinical science curriculum.
AMA: What other advice would you give to those just getting started on incorporating health systems science?
Dr. Maben-Feaster: It takes a lot of time to restructure a curriculum, and it’s hard for an institution to move forward with initiative like this if it hasn't protected, and budgeted, time for people to do the work. This is not something you can just do on the side when you have time. It’s a time-consuming endeavor—but worth the investment.
