Challenges and Barriers to Integrating Health Systems Science in Medical School Curricula

A study conducted by the American Medical Association (AMA) assesses the integration of health systems science (HSS) into US allopathic medical schools, finding that while progress has been made, challenges and barriers still exist in implementing HSS into the curriculum. 

HSS focuses on various aspects of care delivery such as value-based care, teamwork, quality improvement, health care policy, and population health. HSS is meant to complement basic and clinical sciences as an essential component of medical education. The AMA launched the Accelerating Change in Medical Education initiative in 2013 to promote innovative training methods and improve the learning environment, health care systems, and patient care. This study examines how US allopathic schools are integrating HSS into their educational programming and explores the challenges and barriers faced in the process. 

The AMA partnered with a health care research firm to reach out to 155 US allopathic medical schools via email. They aimed to explain the research's purpose and invite the school's curriculum leader to participate in a 15-minute interview. If interview attempts were unsuccessful, the schools were alternatively offered an online survey. The questions in the interviews and surveys focused on topics such as familiarity and integration of HSS, curriculum content and reform, academic coaching programs, integration of master adaptive learning, as well as challenges and opportunities for improvement.  

After collecting the data, the researchers further analyzed each school by utilizing publicly available information, including institutional websites and the AMA Colleges Snapshot 2020, which allowed for a comparative assessment of self-reported information across schools and the inclusion of nonparticipating schools. 

Out of 155 schools, 140 (90.3%) completed interviews, with 38 schools participating online and 15 failing to respond. During the interviews, 30% (47 schools) reported major curriculum reforms, with 12% implementing changes within 1 to 3 years, and 18% implementing changes within 4 to 6 years. HSS integration within institutions varied, with 59% integrating content longitudinally, 43% utilizing a HSS thread, and 26% using HSS intersessions or workshops.  

Qualitative analysis found meaningful integration of HSS in 47% of schools, with 14% achieving deep integration and 33% achieving moderate integration. Alternative methods of integration included 28% isolating HSS and 25% having sparse integration. The primary focus of HSS was in the pre-clerkship phase, and the inclusion of HSS domains varied among schools. Consortium schools had a stronger emphasis on health care system-related topics. Challenges and suggestions included limited curricular space, the need for guidance in designing and integrating HSS, the requirement for domain-specific expertise and support, teaching resources, faculty development, and assessments for HSS competencies and collaborative opportunities.  

Increasing the uptake of HSS in medical schools requires addressing the difficulty of integrating it into an already full curriculum. Training and resources can aid in the implementation of innovative approaches toward educating future physicians at a system level.  

“As the needs of patients, communities, and population health evolve, medical educators must lead change by developing innovative content, training, and education,” said researchers. “It is critical that students be competent in approaches and content such as HSS and understand why it is essential for better patient care and doctoring.”  

Reference

Richardson J, Markie G, Pacis R, et al. Health systems science: Insights from 155 U.S. allopathic medical schools, 2020–2021. Academic Medicine. 2023;98(11S):S214-S215. doi:10.1097/ACM.0000000000005416