Send to

Choose Destination
Acad Med. 2017 Jan;92(1):123-131. doi: 10.1097/ACM.0000000000001177.

Health Systems Science Curricula in Undergraduate Medical Education: Identifying and Defining a Potential Curricular Framework.

Author information

J.D. Gonzalo is assistant professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania. M. Dekhtyar is senior research assistant, Medical Education Outcomes, American Medical Association, Chicago, Illinois. S.R. Starr is assistant professor of pediatric and adolescent medicine and director of science of health care delivery education, Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota. J. Borkan is chair and professor of family medicine and assistant dean for primary care-population health program planning, Alpert Medical School of Brown University, Providence, Rhode Island. P. Brunett is clinical professor, Department of Emergency Medicine, and associate dean for graduate medical education, Oregon Health & Science University School of Medicine, Portland, Oregon. T. Fancher is associate professor, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California. J. Green is assistant professor of medicine and pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. S.J. Grethlein is professor of clinical medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. C. Lai is professor of medicine, University of California San Francisco School of Medicine, San Francisco, California. L. Lawson is assistant dean for curriculum, assessment, and clinical academic affairs and assistant professor of emergency medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina. S. Monrad is clinical assistant professor, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan. P. O'Sullivan is professor of medicine and director of research and development in medical education, University of California San Francisco School of Medicine, San Francisco, California. M.D. Schwartz is professor of population health and medicine and vice chair for education and faculty affairs, Department of Population Health, New York University School of Medicine, New York, New York. S. Skochelak is group vice president of medical education, American Medical Association, Chicago, Illinois.



The authors performed a review of 30 Accelerating Change in Medical Education full grant submissions and an analysis of the health systems science (HSS)-related curricula at the 11 grant recipient schools to develop a potential comprehensive HSS curricular framework with domains and subcategories.


In phase 1, to identify domains, grant submissions were analyzed and coded using constant comparative analysis. In phase 2, a detailed review of all existing and planned syllabi and curriculum documents at the grantee schools was performed, and content in the core curricular domains was coded into subcategories. The lead investigators reviewed and discussed drafts of the categorization scheme, collapsed and combined domains and subcategories, and resolved disagreements via group discussion.


Analysis yielded three types of domains: core, cross-cutting, and linking. Core domains included health care structures and processes; health care policy, economics, and management; clinical informatics and health information technology; population and public health; value-based care; and health system improvement. Cross-cutting domains included leadership and change agency; teamwork and interprofessional education; evidence-based medicine and practice; professionalism and ethics; and scholarship. One linking domain was identified: systems thinking.


This broad framework aims to build on the traditional definition of systems-based practice and highlight the need for medical and other health professions schools to better align education programs with the anticipated needs of the systems in which students will practice. HSS will require a critical investigation into existing curricula to determine the most efficient methods for integration with the basic and clinical sciences.

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center