M.K. Singh is professor of medicine, Jerome Kowal, MD Designated Professor for Geriatric Health Education, Veterans Affairs Northeast Ohio Healthcare System, and former assistant dean, Health Systems Science, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0001-8235-4272 .
H.L. Gullett is associate professor and Charles Kent Smith, MD and Patricia Hughes Moore, MD Professor in Medical Student Education in Family Medicine, Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-3984-517X .
Acad Med. 2021 Sep 1;96(9):1282-1290. doi: 10.1097/ACM.0000000000004141.
The term "health systems science" (HSS) has recently emerged as a unifying label for competencies in health care delivery and in population and community health. Despite strong evidence that HSS competencies are needed in the current and future health care workforce, heretofore the integration of HSS into medical education has been slow or fragmented-due, in part, to a lack of evidence that these curricula improve education or population outcomes. The recent COVID-19 pandemic and the national reckoning with racial inequities in the United States further highlight the time-sensitive imperative to integrate HSS content across the medical education continuum. While acknowledging challenges, the authors highlight the unique opportunities inherent in an HSS curriculum and present an elaborated curricular framework for incorporating health care delivery and population health into undergraduate medical education. This framework includes competencies previously left out of medical education, increases the scope of faculty development, and allows for evidence of effectiveness beyond traditional learner-centric metrics. The authors apply a widely adopted 6-step approach to curriculum development to address the unique challenges of incorporating HSS. Two examples-of a module on quality improvement (health care delivery) and of an introductory course on health equity (population and community health)-illustrate how the 6-step approach can be used to build HSS curricula. The Supplemental Digital Appendix (at http://links.lww.com/ACADMED/B106) outlines this approach and provides specific examples and resources. Adapting these resources within local environments to build HSS curricula will allow medical educators to ensure future graduates have the expertise and commitment necessary to effect health systems change and to advocate for their communities, while also building the much-needed evidence for such curricula.
“卫生系统科学”（HSS）这一术语最近成为医疗服务和人群及社区卫生领域能力的统一标签。尽管有强有力的证据表明，HSS 能力是当前和未来医疗保健工作者所需要的，但迄今为止，HSS 已经融入医学教育的速度缓慢或零散，部分原因是缺乏证据表明这些课程可以改善教育或人口结果。最近的 COVID-19 大流行和美国对种族不平等的全国性反思进一步强调了必须在整个医学教育连续体中整合 HSS 内容的紧迫时间。尽管作者承认存在挑战，但他们强调了 HSS 课程固有的独特机会，并提出了一个详细的课程框架，将医疗服务和人群健康纳入本科医学教育。该框架包括以前未纳入医学教育的能力，增加了教师发展的范围，并允许超出传统以学习者为中心的指标的有效性证据。作者采用广泛采用的 6 步课程开发方法来解决整合 HSS 的独特挑战。一个关于质量改进（医疗服务）的模块和一个关于健康公平（人群和社区健康）的入门课程的两个示例说明了如何使用 6 步方法来构建 HSS 课程。补充数字附录（http://links.lww.com/ACADMED/B106）概述了这一方法，并提供了具体示例和资源。在当地环境中利用这些资源来构建 HSS 课程将使医学教育工作者能够确保未来的毕业生拥有必要的专业知识和承诺，以实现卫生系统的变革，并为他们的社区发声，同时也为这些课程建立急需的证据。
