J.D. Gonzalo is associate professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0003-1253-2963.
A. Chang is professor of medicine and Gold-Headed Cane Endowed Education Chair in Internal Medicine, University of California, San Francisco School of Medicine, San Francisco, California.
Acad Med. 2020 Sep;95(9):1362-1372. doi: 10.1097/ACM.0000000000003400.
Medical education exists in the service of patients and communities and must continually calibrate its focus to ensure the achievement of these goals. To close gaps in U.S. health outcomes, medical education is steadily evolving to better prepare providers with the knowledge and skills to lead patient- and systems-level improvements. Systems-related competencies, including high-value care, quality improvement, population health, informatics, and systems thinking, are needed to achieve this but are often curricular islands in medical education, dependent on local context, and have lacked a unifying framework. The third pillar of medical education-health systems science (HSS)-complements the basic and clinical sciences and integrates the full range of systems-related competencies. Despite the movement toward HSS, there remains uncertainty and significant inconsistency in the application of HSS concepts and nomenclature within health care and medical education. In this Article, the authors (1) explore the historical context of several key systems-related competency areas; (2) describe HSS and highlight a schema crosswalk between HSS and systems-related national competency recommendations, accreditation standards, national and local curricula, educator recommendations, and textbooks; and (3) articulate 6 rationales for the use and integration of a broad HSS framework within medical education. These rationales include: (1) ensuring core competencies are not marginalized, (2) accounting for related and integrated competencies in curricular design, (3) providing the foundation for comprehensive assessments and evaluations, (4) providing a clear learning pathway for the undergraduate-graduate-workforce continuum, (5) facilitating a shift toward a national standard, and (6) catalyzing a new professional identity as systems citizens. Continued movement toward a cohesive framework will better align the clinical and educational missions by cultivating the next generation of systems-minded health care professionals.
医学教育服务于患者和社区，必须不断调整其重点，以确保实现这些目标。为了缩小美国健康结果的差距，医学教育正在稳步发展，以更好地培养具有领导患者和系统层面改进所需的知识和技能的提供者。系统相关能力，包括高价值护理、质量改进、人口健康、信息学和系统思维，是实现这一目标所必需的，但在医学教育中通常是课程孤岛，取决于当地情况，并且缺乏统一的框架。医学教育的第三个支柱——卫生系统科学（HSS）——补充了基础和临床科学，并整合了所有系统相关的能力。尽管向 HSS 迈进，但在医疗保健和医学教育中，HSS 概念和命名法的应用仍然存在不确定性和显著的不一致。在本文中，作者（1）探讨了几个关键系统相关能力领域的历史背景；（2）描述了 HSS，并突出了 HSS 与系统相关的国家能力建议、认证标准、国家和地方课程、教育者建议和教科书之间的模式交叉；（3）阐述了在医学教育中使用和整合广泛的 HSS 框架的 6 个理由。这些理由包括：（1）确保核心能力不被边缘化，（2）在课程设计中考虑相关和综合能力，（3）为全面评估和评价提供基础，（4）为本科-研究生-劳动力连续体提供明确的学习途径，（5）促进向国家标准的转变，以及（6）催化作为系统公民的新的专业身份。朝着凝聚力框架的持续推进将通过培养下一代具有系统思维的医疗保健专业人员，更好地协调临床和教育使命。
