Leep Hunderfund Andrea N, Kumbamu Ashok, O'Brien Bridget C, Starr Stephanie R, Dekhtyar Michael, Gonzalo Jed D, Rennke Stephanie, Ridinger Heather, Chang Anna
A.N. Leep Hunderfund is associate professor of neurology and director, Learning Environment and Educational Culture, Mayo Clinic Alix School of Medicine, Rochester, Minnesota.
A. Kumbamu is assistant professor of biomedical ethics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Acad Med. 2022 Dec 1;97(12):1804-1815. doi: 10.1097/ACM.0000000000004799. Epub 2022 Jul 5.
Health systems science (HSS) curricula equip future physicians to improve patient, population, and health systems outcomes (i.e., to become "systems citizens"), but the degree to which medical students internalize this conception of the physician role remains unclear. This study aimed to explore how students envision their future professional identity in relation to the system and identify experiences relevant to this aspect of identity formation.
Between December 2018 and September 2019, authors interviewed 48 students at 4 U.S. medical schools with HSS curricula. Semistructured interviews were audiorecorded, transcribed, and analyzed iteratively using inductive thematic analysis. Interview questions explored how students understood the health system, systems-related activities they envisioned as future physicians, and experiences and considerations shaping their perspectives.
Most students anticipated enacting one or more systems-related roles as a future physician, categorized as "bottom-up" efforts enacted at a patient or community level (humanist, connector, steward) or "top-down" efforts enacted at a system or policy level (system improver, system scholar, policy advocate). Corresponding activities included attending to social determinants of health or serving medically underserved populations, connecting patients with team members to address systems-related barriers, stewarding health care resources, conducting quality improvement projects, researching/teaching systems topics, and advocating for policy change. Students attributed systems-related aspirations to experiences beyond HSS curricula (e.g., low-income background; work or volunteer experience; undergraduate studies; exposure to systems challenges affecting patients; supportive classmates, faculty, and institutional culture). Students also described future-oriented considerations promoting or undermining identification with systems-related roles (responsibility, affinity, ability, efficacy, priority, reality, consequences).
This study illuminates systems-related roles medical students at 4 schools with HSS curricula envisioned as part of their future physician identity and highlights past/present experiences and future-oriented considerations shaping identification with such roles. These findings inform practical strategies to support professional identity formation inclusive of systems engagement.
卫生系统科学（HSS）课程旨在使未来的医生能够改善患者、人群和卫生系统的结局（即成为“系统公民”），但医学生将这种医生角色观念内化的程度仍不明确。本研究旨在探讨学生如何设想自己未来与系统相关的职业身份，并确定与这一身份形成方面相关的经历。
2018年12月至2019年9月期间，作者对美国4所开设HSS课程的医学院校的48名学生进行了访谈。半结构化访谈进行了录音、转录，并采用归纳主题分析法进行反复分析。访谈问题探讨了学生如何理解卫生系统、他们设想作为未来医生参与的与系统相关的活动，以及塑造他们观点的经历和考虑因素。
大多数学生预计未来会扮演一个或多个与系统相关的角色，可分为在患者或社区层面开展的“自下而上”努力（人文主义者、连接者、管理者）或在系统或政策层面开展的“自上而下”努力（系统改进者、系统学者、政策倡导者）。相应的活动包括关注健康的社会决定因素或为医疗服务不足的人群提供服务、将患者与团队成员联系起来以解决与系统相关的障碍、管理医疗资源、开展质量改进项目、研究/教授系统主题以及倡导政策变革。学生将与系统相关的抱负归因于HSS课程之外的经历（例如低收入背景、工作或志愿者经历、本科学习、接触影响患者的系统挑战、支持性的同学、教师和机构文化）。学生还描述了促进或削弱对与系统相关角色认同的未来导向性考虑因素（责任、亲和力、能力、效能、优先级、现实、后果）。
本研究阐明了4所开设HSS课程的医学院校的医学生设想为其未来医生身份一部分的与系统相关的角色，并突出了塑造对这些角色认同的过去/现在经历和未来导向性考虑因素。这些发现为支持包括系统参与在内的职业身份形成的实用策略提供了信息。
