Defining Successful Practice Within Health Systems Science Among Entering Residents: A Single-Institution Qualitative Study of Graduate Medical Education Faculty Observations

Abstract

PurposeThe American Medical Association's Accelerating Change in Medical Education consortium defined health systems science (HSS) as the study of how health care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. This framework is increasingly being incorporated into medical school curricula. Graduate medical education (GME) had previously elevated systems-based practice (SBP) as a core competency, but expectations are defined by specialty-specific milestones. The lack of a shared competency framework between undergraduate medical education (UME) and GME makes it challenging to ensure that entering residents are prepared to implement HSS/SBP concepts in the workplace. The authors explored GME faculty observations of residents exemplifying successful practice across HSS domains to inform targets for UME training and assessment.

Demonstrating Health Systems Science Across Residency Learning Environments: A Multi-Institutional Qualitative Study of Graduate Medical Education Faculty Observations

“…This multi-institutional study supports the previously described Logic model framework for HSS 4,5 and reinforces that precurricular background including medical school exposures to HSS are preparatory for residency. This study suggests that GME learning environments, rather than specialties, are the determining factor in whether faculty observe specific HSS skills in the workplace.…”

“Finding My Piece in That Puzzle”: A Qualitative Study Exploring How Medical Students at Four U.S. Schools Envision Their Future Professional Identity in Relation to Health Systems

“…[19][20][21][22][23] Existing research suggests medical students prefer patient care activities over systems improvement activities, 24,25 and residents struggle to understand the vision and purpose of quality improvement within health systems. 26 While some residents excel within particular HSS domains, 27 milestone-based ratings of performance during internship do not differ between graduates of medical schools with and without HSS curricula. 28 This could in part reflect a limited sensitivity of milestone-based assessments 28 and also suggests that factors outside the HSS curriculum may contribute to identification with systems-related roles.…”

“…[61][62][63][64] and variable uptake and understanding of systems-related activities among residents and practicing physicians. 26,27,[65][66][67][68] Professional identity formation transforms learners from members of the lay public into professionals who "think, act, and feel" like a physician. 29,30 Prior studies have identified formative experiences contributing to this process.…”

“…61–64 and variable uptake and understanding of systems-related activities among residents and practicing physicians. 26,27,65–68…”

Disruption and Dissonance: Exploring Constructive Tensions Within Research in Medical Education

“…As Ridinger and colleagues demonstrated, we have much to learn on how to teach and prepare trainees for long-valued but seldom well-taught foundational disciplines like health systems science. 18 Their realist-inspired study of faculty members' experiences in training residents in health systems sciences provides a conceptual road map for the design of future curricula in health systems science.…”