Health systems science education: The new post-Flexner professionalism for the 21st century

Abstract

The foundations of medical education have drawn from the Flexner Report to prepare students for practice for over a century. These recommendations relied, however, upon a limited set of competencies and a relatively narrow view of the physician’s role. There have been increasing calls and recommendations to expand those competencies and the professional identity of the physician to better meet the current and future needs of patients, health systems, and society. We propose a framework for the twenty-first century physician that includes an expectation of new competency in health systems science (HSS), creating ‘system citizens’ who are effective stewards of the health care system. Experiential educational strategies, in addition to knowledge-centered learning, are critically important for students to develop their professional identity as system citizens working alongside interprofessional colleagues. Challenges to HSS adoption range from competing priorities for learners, to the need for faculty development, to the necessity for buy-in by medical schools and their associated health care systems. Ultimately, success will depend on our ability to articulate, encourage, support, and evaluate system citizenship and its impact on health care and health care systems.

Keywords:

• Professionalism
• health systems science
• system citizen
• medical education

Acknowledgments

The authors would like to thank their home institutions, the American Medical Association’s (AMA) Accelerating Change in Medical Education Consortium, and the AMA for their support in promoting health systems science and innovation in medical education at the local and national level.

The AMA Supplement is sponsored and supported by The American Medical Association.

Disclosure statement

The authors report no declarations of interest except the following: Some of the work that contributed to this publication was performed with funding from the American Medical Association as part of the Accelerating Change in Medical Education initiative as well as with financial support from the Josiah Macy Jr. Foundation.

Disclaimers

The content of and views expressed in this paper reflect the views of the authors and do not necessarily represent the views of the AMA, Josiah Macy Jr. Foundation, or other participants in the Accelerating Change in Medical Education initiative. Other disclosures: M. Hammoud, J Borkan, J.D. Gonzalo, S. Starr, and L. Lawson are coeditors of a textbook on health systems science (Elsevier, 2020) and J. D. Gonzalo is coeditor of the textbook health systems science review (Elsevier, 2019).

Additional information

Notes on contributors

Jeffrey M. Borkan

Jeffrey M. Borkan, MD, PhD, Department of Family Medicine The Warren Alpert Medical School Pawtucket, RI, USA.

Maya M. Hammoud

Maya M. Hammoud, MD, MBA, University of Michigan Medical School Ann Arbor, MI, USA.

Elizabeth Nelson

Elizabeth Nelson, MD, University of Texas Dell Medical School Austin, Texas, USA.

Julie Oyler

Julie Oyler, MD, University of Chicago Chicago, Illinois, USA.

Luan Lawson

Luan Lawson, MD, MAEd, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.

Stephanie R. Starr

Stephanie R. Starr, MD, Mayo Clinic Alix School of Medicine Rochester, Minnesota, USA.

Jed D. Gonzalo

Jed D. Gonzalo, MD, MSc, Penn State College of Medicine Hershey, Pennsylvania, USA.