Using Kern's 6-Step Approach to Integrate Health Systems Science Curricula Into Medical Education.
Journal
Academic medicine : journal of the Association of American Medical Colleges
ISSN: 1938-808X
Titre abrégé: Acad Med
Pays: United States
ID NLM: 8904605
Informations de publication
Date de publication:
01 09 2021
01 09 2021
Historique:
pubmed:
6
5
2021
medline:
9
9
2021
entrez:
5
5
2021
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 33951679
doi: 10.1097/ACM.0000000000004141
pii: 00001888-202109000-00030
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1282-1290Informations de copyright
Copyright © 2021 by the Association of American Medical Colleges.
Références
Berwick DM, Nolan TW, Whittington J. The triple aim: Care, health, and cost. Health Aff (Millwood). 2008;27:759–769.
Braveman P, Egerter S, Williams DR. The social determinants of health: Coming of age. Annu Rev Public Health. 2011;32:381–398.
Adler NE, Cutler DM, Fielding JE, et al. Addressing social determinants of health and health disparities: A vital direction for health and health care. NAM Perspectives. Discussion Paper. 2016Washington, DC: National Academy of Medicine; https://doi.org/10.31478/201609t . Accessed April 22, 2021.
Daniel H, Bornstein SS, Kane GC; Health and Public Policy Committee of the American College of Physicians.. Addressing social determinants to improve patient care and promote health equity: An American College of Physicians position paper. Ann Intern Med. 2018;168:577–578.
Chen JT, Krieger N. Revealing the unequal burden of COVID-19 by income, race/ethnicity, and household crowding: US county vs ZIP code analyses. Harvard Center for Population and Development Studies Working Paper Series. https://www.hsph.harvard.edu/population-development/research/working-papers/harvard-pop-center-working-paper-series . Published April 21, 2020 Accessed April 22, 2021.
Quinn A, Laws M. Addressing community needs and preparing for the secondary impacts of Covid-19 [published online ahead of print June 25, 2020]. NEJM Catal Innov Care Deliv. doi:10.1056/CAT.20.0186
doi: 10.1056/CAT.20.0186
Berwick DM, Finkelstein JA. Preparing medical students for the continual improvement of health and health care: Abraham Flexner and the new “public interest.” Acad Med. 2010;85(9 suppl):S56–S65.
Boelen C, Blouin D, Gibbs T, Woollard R. Accrediting excellence for a medical school’s impact on population health. Educ Health (Abingdon). 2019;32:41–48.
GBD 2016 Healthcare Access and Quality Collaborators. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016. Lancet. 2018;391:2236–2271.
Lieberman-Cribbin W, Tuminello S, Flores RM, Taioli E. Disparities in COVID-19 testing and positivity in New York City. Am J Prev Med. 2020;59:326–332.
Raifman MA, Raifman JR. Disparities in the population at risk of severe illness from COVID-19 by race/ethnicity and income. Am J Prev Med. 2020;59:137–139.
Maani N, Galea S. COVID-19 and underinvestment in the health of the US population. Milbank Q. 2020;98:239–249.
Wear D, Zarconi J, Aultman JM, Chyatte MR, Kumagai AK. Remembering Freddie Gray: Medical education for social justice. Acad Med. 2017;92:312–317.
Bailey ZD, Krieger N, Agenor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: Evidence and interventions. Lancet. 2017;389:1453–1463.
Lucey CR. Medical education: Part of the problem and part of the solution. JAMA Intern Med. 2013;173:1639–1643.
Skochelak SE, Hammoud MM, Lomis KD, et al, eds. Health Systems Science. 20202nd ed. Philadelphia, PA: Elsevier; 1.
Gonzalo JD, Caverzagie KJ, Hawkins RE, Lawson L, Wolpaw DR, Chang A. Concerns and responses for integrating health systems science into medical education. Acad Med. 2018;93:843–849.
Gonzalo JD, Ogrinc G. Health systems science: The “broccoli” of undergraduate medical education. Acad Med. 2019;94:1425–1432.
Gonzalo JD, Haidet P, Papp KK, et al. Educating for the 21st-century health care system: An interdependent framework of basic, clinical, and systems sciences. Acad Med. 2017;92:35–39.
Gonzalo JD, Chang A, Dekhtyar M, Starr SR, Holmboe E, Wolpaw DR. Health systems science in medical education: Unifying the components to catalyze transformation. Acad Med. 2020;95:1362–1372.
Thomas PA, Kern DE, Hughes MT, Chen BY, eds. Curriculum Development for Medical Education: A Six-Step Approach. 2016.3rd ed. Baltimore, MD: Johns Hopkins University Press;
Ornt DB, Aron DC, King NB, et al. Population medicine in a curricular revision at Case Western Reserve. Acad Med. 2008;83:327–331.
Gonzalo JD, Ahluwalia A, Hamilton M, Wolf H, Wolpaw DR, Thompson BM. Aligning education with health care transformation: Identifying a shared mental model of “new” faculty competencies for academic faculty. Acad Med. 2018;93:256–264.
Westerhaus M, Finnegan A, Haidar M, Kleinman A, Mukherjee J, Farmer P. The necessity of social medicine in medical education. Acad Med. 2015;90:565–568.
Holmes SM, Hansen H, Jenks A, et al. Misdiagnosis, mistreatment, and harm—When medical care ignores social forces. N Engl J Med. 2020;382:1083–1086.
Interprofessional Education Collaborative.Core Competencies for Interprofessional Collaborative Practice: 2016 update. 2016Washington, DC: Interprofessional Education Collaborative; https://hsc.unm.edu/ipe/resources/ipec-2016-core-competencies.pdf . Accessed April 22, 2021.
Guralnick S, Ludwig S, Englander R. Domain of competence: Systems-based practice. Acad Pediatr. 2014;14(suppl 2):S70–S79.
Frank JR, Snell L, Sherbino J, eds. CanMEDS 2015 Physician Competency Framework. 2015Ottawa, ON, Canada: Royal College of Physicians and Surgeons of Canada; http://canmeds.royalcollege.ca/uploads/en/framework/CanMEDS%202015%20Framework_EN_Reduced.pdf . Accessed April 22, 2021.
Moran KM, Harris IB, Valenta AL. Competencies for patient safety and quality improvement: A synthesis of recommendations in influential position papers. Jt Comm J Qual Patient Saf. 2016;42:162–169.
Kruszewski BD, Spell NO III. A consensus approach to identify tiered competencies in quality improvement and patient safety. J Grad Med Educ. 2018;10:646–650.
Gonzalo JD, Davis C, Thompson BM, Haidet P. Unpacking medical students’ mixed engagement in health systems science education. Teach Learn Med. 2020;32:250–258.
O’Connell MT, Rivo ML, Mechaber AJ, Weiss BA. A curriculum in systems-based care: Experiential learning changes in student knowledge and attitudes. Fam Med. 2004;36(suppl):S99104.
Curry RH. Medical students as health coaches, and more: Adding value to both education and patient care. Isr J Health Policy Res. 2017;6:65.
Gonzalo JD, Graaf D, Ahluwalia A, Wolpaw DR, Thompson BM. A practical guide for implementing and maintaining value-added clinical systems learning roles for medical students using a diffusion of innovations framework. Adv Health Sci Educ Theory Pract. 2018;23:699–720.
Leep Hunderfund AN, Starr SR, Dyrbye LN, et al. Value-added activities in medical education: A multisite survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. 2018;93:1560–1568.
Stewart T, Wubbena ZC. A systematic review of service-learning in medical education: 1998-2012. Teach Learn Med. 2015;27:115–122.
Mitchell TD. Traditional vs. critical service learning: Engaging the literature to differentiate two models. Mich J Community Serv Learn. 2008;14:50–65.
Gillis A, Mac Lellan MA. Critical service learning in community health nursing: Enhancing access to cardiac health screening. Int J Nurs Educ Scholarsh. 2013. https://doi.org/10.1515/ijnes-2012-0031 .
doi: 10.1515/ijnes-2012-0031
Strasser R, Worley P, Cristobal F, et al. Putting communities in the driver’s seat: The realities of community-engaged medical education. Acad Med. 2015;90:1466–1470.
Wilkins CH, Alberti PM. Shifting academic health centers from a culture of community service to community engagement and integration. Acad Med. 2019;94:763–767.
Petty J, Metzl JM, Keeys MR. Developing and evaluating an innovative structural competency curriculum for pre-health students. J Med Humanit. 2017;38:459–471.
Donald CA, DasGupta S, Metzl JM, Eckstrand KL. Queer frontiers in medicine: A structural competency approach. Acad Med. 2017;92:345–350.
Metzl JM, Petty J, Olowojoba OV. Using a structural competency framework to teach structural racism in pre-health education. Soc Sci Med. 2018;199:189–201.
Buttress A, German D, Holtgrave D, Sherman SG. The Wire and urban health education. J Urban Health. 2013;90:359–368.
Albers B, Pattuwage L. Implementation in Education: Findings From a Scoping Review. 2017.Victoria, TX: Centre for Evidence and Implementation;
Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38:65–76.
Frye AW, Hemmer PA. Program evaluation models and related theories: AMEE guide no. 67. Med Teach. 2012;34:e288–e299.
Kirkpatrick JD, Kirkpatrick WK. Kirkpatrick’s Four Levels of Training Evaluation. 2016.Alexandria, VA: Association for Talent Development Press;
American Medical Association in collaboration with National Board of Medical ExaminersAt-A-Glance: Health Systems Science (HSS) Examination. https://nbme.org/sites/default/files/2020-01/HSS-Exam-At-A-Glance.pdf . Accessed April 22, 2021.
Carney PA, Palmer RT, Fuqua Miller M, et al. Tools to assess behavioral and social science competencies in medical education: A systematic review. Acad Med. 2016;91:730–742.
Reid J, Stone K, Brown J, et al. The Simulation Team Assessment Tool (STAT): Development, reliability and validation. Resuscitation. 2012;83:879–886.
Singh MK, Ogrinc G, Cox KR, et al. The Quality Improvement Knowledge Application Tool Revised (QIKAT-R). Acad Med. 2014;89:1386–1391.
Dumenco L, Monteiro K, George P, Rougas S, Dollase R. Outcomes of a longitudinal quality improvement and patient safety preclerkship curriculum. Acad Med. 2019;94:1980–1987.
Leenstra JL, Beckman TJ, Reed DA, et al. Validation of a method for assessing resident physicians’ quality improvement proposals. J Gen Intern Med. 2007;22:1330–1334.
Van Tartwijk J, Driessen EW. Portfolios for assessment and learning: AMEE guide no. 45. Med Teach. 2009;31:790–801.
Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013;88:1088–1094.
Eckstrand KL, Potter J, Bayer CR, Englander R. Giving context to the physician competency reference set: Adapting to the needs of diverse populations. Acad Med. 2016;91:930–935.
Swing SR. The ACGME Outcome Project: Retrospective and prospective. Med Teach. 2007;29:648–654.
Carraccio C, Englander R. Evaluating competence using a portfolio: A literature review and web-based application to the ACGME competencies. Teach Learn Med. 2004;16:381–387.
Arenas DJ, Lett LA, Klusaritz H, Teitelman AM. A Monte Carlo simulation approach for estimating the health and economic impact of interventions provided at a student-run clinic. PLoS One. 2017;12:e0189718.
Kirch DG, Prescott JE. From rankings to mission. Acad Med. 2013;88:1064–1066.
Rourke J. Social accountability: A framework for medical schools to improve the health of the populations they serve. Acad Med. 2018;93:1120–1124.
Reeve C, Woolley T, Ross SJ, et al. The impact of socially-accountable health professional education: A systematic review of the literature. Med Teach. 2017;39:67–73.
Woolley T, Clithero-Eridon A, Elsanousi S, Othman AB. Does a socially-accountable curriculum transform health professional students into competent, work-ready graduates? A cross-sectional study of three medical schools across three countries. Med Teach. 2019;41:1427–1433.