Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA.
Office of Medical Education, Penn State College of Medicine, Hershey, Pennsylvania, USA.
Med Educ. 2016 May;50(5):523-31. doi: 10.1111/medu.12957.
Although a critical component of educational reform involves the inclusion of knowledge of and skills in health systems science (HSS) (including population health, health system improvement and high-value care) many undergraduate medical education programmes focus primarily on traditional basic and clinical sciences. In this study, we investigated students' perceptions of the barriers to, challenges involved in and benefits of the implementation of a HSS curriculum.
In 2014, we conducted 12 focus groups with 50 medical students across all years of medical school. Group interviews were audio-recorded and transcribed verbatim. We used thematic analysis to explore students' perceptions of a planned HSS curriculum, which was to include both a classroom-based course and an experiential component. We then identified themes and challenges from the students' perspective and agreed upon results and quotations.
Students identified four barrier-related themes, including (i) medical-board licensing examinations foster a view of basic science as 'core', (ii) systems concepts are important but not essential, (iii) students lack sufficient knowledge and skills to perform systems roles and (iv) the culture of medical education and clinical systems does not support systems education. Students also identified several perceived benefits of a systems curriculum, including acquisition of new knowledge and skills, enhanced understanding of patients' perspectives and improved learning through experiential roles. The major unifying challenge related to students' competing priorities; one to perform well in examinations and match into preferred residencies, and another to develop systems-based skills.
Students' intrinsic desire to be the best physician possible is at odds with board examinations and desired residency placements. As a result, HSS is viewed as peripheral and non-essential, greatly limiting student engagement. New perspectives are needed to effectively address this challenge.
尽管教育改革的一个关键组成部分涉及纳入卫生系统科学（HSS）的知识和技能（包括人群健康、卫生系统改进和高价值护理），但许多本科医学教育计划主要侧重于传统的基础和临床科学。在这项研究中，我们调查了学生对实施 HSS 课程的障碍、挑战和收益的看法。
2014 年，我们对全校各年级的 50 名医学生进行了 12 次焦点小组讨论。小组访谈进行了录音，并逐字记录下来。我们使用主题分析来探讨学生对计划中的 HSS 课程的看法，该课程将包括基于课堂的课程和体验式课程。然后，我们从学生的角度确定了主题和挑战，并对结果和引文达成一致。
学生确定了四个与障碍相关的主题，包括（i）医学委员会执照考试促使人们认为基础科学是“核心”，（ii）系统概念很重要但不是必不可少的，（iii）学生缺乏足够的知识和技能来承担系统角色，（iv）医学教育和临床系统的文化不支持系统教育。学生还确定了一些系统课程的预期收益，包括获得新知识和技能、增强对患者观点的理解以及通过体验式角色提高学习效果。最大的挑战是学生的竞争优先事项；一个是在考试中取得好成绩并匹配到首选的住院医师实习，另一个是发展基于系统的技能。
学生成为最好的医生的内在愿望与委员会考试和理想的住院实习相冲突。因此，HSS 被视为次要和非必要的，极大地限制了学生的参与度。需要新的视角来有效地应对这一挑战。
