Harvard Macy Community Blog

Fostering the ongoing connectedness of health professions educators committed to transforming health care delivery and education.

Health Systems Science: The future of medical education and the solution to improving health care

This is an exciting time in medical education – as educators we have realized the importance of medical education reform and are in the process of rethinking how we educate our learners. There are many exciting innovators and innovations – but none with more potential and direct applicability than the implementation of Health Systems Science into medical education curricula.

What is Health Systems Science? Also known as the Science of Health Care Delivery, it refers to the critical competencies that are necessary for us to deliver the highest quality value-based health care in a manner that is both patient and population centered. It is how we can operationalize the education necessary to meet the Triple Aim of health care. Many of the hot topics currently being addressed in both the undergraduate medical education and graduate medical education spheres already encompass some Health Systems Science competencies. These competencies include population health (social determinants and healthcare equity), value-based care, health care policy and economics, interprofessional skills, informatics, and health system improvement. 

Why is Health Systems Science so important? In order to move beyond Flexner and truly embrace the continuum of medical education, we need to start thinking about foundational knowledge and clinical knowledge in a synthetic fashion and move away from the traditional 2+2 medical education model.  We have an opportunity to truly integrate the foundational sciences and clinical knowledge that our learners need, to use pedagogical approaches that will facilitate the integration of their foundational and clinical learning, and to ensure our students acquire the knowledge and skills necessary to be excellent physicians. Threads now incorporated into many curricula such as clinical reasoning, leadership, professionalism, and reflection are all critical subcompetencies of each of the Health Systems Science competency domains. Health Systems Science is the scaffolding upon which competency based medical education will thrive and ensure that our future physicians have the knowledge and skills to meet the needs of their patients. 

What are some early outcomes of Health Systems Science? As with any change in approach to medical education, innovative change without program evaluation impedes meaningful dissemination. Some of the early outcomes that speak to the importance and value of Health Systems Science have been the adaptation and implementation of the components of Health Systems Science into Undergraduate Medical Education programs. Some examples include:

1) Design of curricular frameworks for Health Systems Science

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F.O.C.U.S.E.D on Improving on the Dental Education

It is 5 pm on a Friday in the pre-doctoral dental clinic at your institution. A procedure has taken 5 hours, when it seemingly could have taken 90 minutes. Frustrated and exhausted, the student cannot seem to apply the content that they have learned in the classroom into real life. As an instructor you can’t help but think “What could we, as dental educators, have done to prevent this?”

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Pedagogy and Discharge Instructions: Do We Practice What We Preach?

“OK, so we think you have pleurisy. Your D-dimer was negative. You should take ibuprofen, rest and stay hydrated, then follow-up with your primary care physician. Any questions?”

My daughter reached for her discharge papers as she slid off the exam table and we thanked the staff as we made our way out of the urgent care part of a local emergency department.

She was eighteen at the time, a college freshman studying sociology. She called me to tell me she had been experiencing two days of pleuritic chest pain and felt a little short of breath. Because our logical, medical brains turn into parent brains when our child is sick, I dropped everything I was doing to go and see her. She looked fine, the pain was probably just musculoskeletal; she is a ballet dancer and these minor aches and pains are common. But, I thought, “What about a pulmonary embolism?” “Not likely” I thought, “but I’m here so let’s go get it checked out”.

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Technology in education: Transforming how we connect and build our learning communities

Working through the online pre-course materials for the Harvard Macy course “Health Care Education 2.0 – Transforming your Teaching for the Digital Age” we could not help but wonder if technology has evolved to the point that courses such as this might soon be delivered in an entirely online format. As a busy health professions educator, perhaps this thought has occurred to you as well, as you pack your suitcase for yet another flight, set your away message again, and put your projects, clinics, patients or meetings on a temporary hold to attend professional conferences or courses. If you teach in the classroom, then you may have received similar feedback from your own students such as our favorite, “Next time, can this session just be available online? I prefer to watch lectures at night on 2x speed.”

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The Role of Emotionality in Teaching and Learning

Emotion and learning have been viewed largely as separate entities, often with the role of emotions in learning (e.g. anxiety) as hindering. However, recent research has pointed to the interdependence between emotions and learning, suggesting that emotions are important, and perhaps even central to the cognitive learning process. Biologically, emotions are powerful motivators of learning because they activate brain mechanisms (e.g amygdala) that originally evolved to manage our basic survival. When reflecting on past educational experiences, the best teacher most quickly recalled is usually one with whom an emotional bond existed. To maximize student understanding and transfer of educational experiences into real-world skills and careers, medical educators must find ways to leverage the emotional aspects of learning by:

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Can we be Consciously Unbiased?

Implicit biases are associations between different concepts that develop over time, and influence us outside of our conscious awareness. The topic of implicit bias has entered mainstream conversation, and is the subject of discourse and debate. Some believe that implicit biases can be eliminated, and individuals can become consciously unbiased. Others suggest that implicit biases are impossible to change, and that attempting to recognize or manage biases is an exercise in futility.

Can we break our biased habits?

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A Millennial Learner’s Journey to Becoming a Physician Assistant

Growing up, I was often surrounded by health professionals as I accompanied my mother and brother to numerous medical appointments. I was immersed in the healthcare field starting at a very young age and that inspired me to work as a healthcare professional. The physician assistant profession was created in the mid-1960’s to ultimately expand the primary care workforce and address the shift of physicians training to provide specialty care. Over the last forty years, physician assistants have demonstrated that they are effective partners in a changing health care environment and have the ability to fill provider gaps and new roles in interprofessional team-based delivery systems. As a cohort, millennials aspire to have a career that allow us to be mission-driven, have good work-life integration, and experience personal happiness as well as professional success. These are just some of the reasons I - in addition to many other millennials - am drawn to pursuing a career as a physician assistant. In this blog post, I articulate the goals I have developed for my upcoming physician assistant training.

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Behind the Curtain with Senthil Rajasekaran: Developing a Global Competency Framework for Universal Health Care

Recently, Senthil Kumar Rajasekaran was invited by the World Health Organization (WHO) to be a part of a small working group of health professions education experts to develop a global competency framework for universal health coverage. As an alumnus of the 2013 “Leading Innovations in Healthcare and Education” course – who has also served as course faculty - we thought we would sit down with Senthil and ask him some questions about this meeting, his participation, the team’s recommendations and to learn about the global competency framework as it applies to health professions education 

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The Role of "Instructor Talk" in the Classroom

You can impact student success simply by the way you speak in the classroom! Instructor Talk is a term coined by researchers who looked at the impact non-content related language had on student success. Non-content language is the little things we say to students during a class session that foster a positive learning environment. Just by switching up how we talk to students can impact their perceptions. For example, switching from, “I have extended the deadline for the project” to “I have extended the deadline for the project to give you additional timeor from “We will begin today discussing . . .” to “To get you prepared, we will begin today discussing . . .” can help.

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Digital Storytelling: Bringing the Power of Narratives to Life

Digital storytelling refers to the use of real-life experiences, stories and adventures combining narrative with digital content. This can include images, sounds, and videos to create a short movie, typically with a strong emotional component to help engage learners in learning. Digital storytelling is a powerful medium for teaching because it can increase engagement and retention of learning, and has been used in medical education.

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The Power of Interprofessional Education

The pager on my hip beeped at 1:22 am with a call from the ICU. The nurse on the other end asked if I would please come down and pronounce a patient who had passed away. “I’ll be right there,” I responded, put down the admission note I was writing, and set off toward the ICU. This was my first inpatient medicine rotation as an intern, so I was embracing this task with a mix of overconfidence and not knowing what I didn’t know. I was also trying not to disturb my senior resident who was either addressing some important tasks or sleeping. Hitting the wall plate to open the double doors to the ICU, a nurse behind a desk pointed in the direction of one of the patient rooms. As I approached the room, I realized that I didn’t actually know how to pronounce a patient and had never been taught how to do so in medical school.

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A New Year, A New You: What's Your Intention?

The rollout of a new year results once again in countless goals established that over time are soon forgotten. While goal setting is key, taking a step back first and reflecting upon “who do I want to become (e.g., intention)” is essential to achieve your goals. Goals are specific, external achievements that can be easily presented on a checklist versus intentions which are the inner relationship with yourself and others. It’s greater than any goal; it’s about who you are at the moment.

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Connecting our Community - A Social Media Update from the Harvard Macy Institute

In 2015, the Harvard Macy Institute made the decision to ‘go social’ to connect our worldwide community via Twitter, LinkedIn, and Facebook, under the leadership of inaugural social media strategist Holly Gooding. We started our community blog, with the mission to “foster the ongoing connectedness of health professions educators committed to transforming health care delivery and education.” Our efforts were intended to bring our alumni up to date news in health professions education, to promote the inquiry and scholarship that the Harvard Macy Institute values, and to celebrate the global and diverse Harvard Macy Institute community of practice.

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Reflecting Upon My Harvard Macy Journey

In this post, I will share a brief story of my journey since I first joined the Harvard Macy Institute community in 2015. I have heard from other faculty that it can take a few years after attending a Harvard Macy Institute course to establish real change at our local institutions. Certainly, this was true for me, as I embarked upon the challenge to develop a new nursing department at Swinburne University in Melbourne, Australia. There is no doubt that this was not for the faint hearted, as starting a new department in nursing education at a University with no history of healthcare professions education was a real challenge! We are now at the end of our first year of our undergraduate nursing program with plans to move into the postgraduate space within the next three years! So far, all signs indicate that this has been a very successful process as our students and industry partners have provided us with really positive evaluations. I believe there have been a number of ‘secrets to our successes’, and I will spotlight three significant ones in this post:

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Interactive Video Blog Series: Worldwide Innovations in Healthcare Delivery

Interactive Video Blog Series: Worldwide Innovations
in Healthcare Delivery

​ In this video, Drs. Tom Aretz and Michael Wilkes discuss worldwide innovations in healthcare delivery, including an increased emphasis on quality management and continuous professional development. They discuss such vexing questions as: How can we combat the human resource challenges in healthcare worldwide for both systems-based and community care? What are some opportunities for and barriers to offering integrated interprofessional care? How can we work together to ensure that trainees who will be taking care of patients in community and outpatient settings have the skills needed when they train at tertiary care institutions? And perhaps most importantly, what leadership will be required to ensure these efforts are impactful on a global scale?

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Question Bursts: An Innovative Strategy to Address the Wicked Problem of Gender Inequity within Academic Medicine

This #MedEdPearls highlights the problem solving workshop facilitated by Linda Love, Gary Beck Dallaghan, Carrie Bowler, Shanu Gupta, Larry Hurtubise, Kari Simonsen, Jessica Snowden, and David Way at The Generalists in Medical Education - #TGME18.

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Interactive Video Blog Series: Support Students and Faculty through Application of Learning Sciences

How can we apply the wealth of research from the cognitive sciences to improve teaching and learning? In these 3 short videos, Dr. Holly Gooding interviews Dr. Jennifer Meka, Director of the Woodward Center for Excellence in Health Sciences Education and Cognitive Skills Programs at Penn State College of Medicine Director, to find answers to this key question. They review spaced education, retrieval practice, time management skills, metacognition, and more in this series of video blogs.

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Building the Emergency Department...from scratch!

The project I brought to the Harvard Macy Institute Leading Innovations in Healthcare and Education course was to create a model emergency service in Kuwait from what had historically been a clinic run by internists. This emergency service will include an “ideal” emergency department (ED). I had to take a step back and analyze what that means to me - and more importantly - my patients.

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Blockchain Mania

Have you recently found yourself wondering “What is Blockchain? And why do I keep hearing about it?” If you answered yes, then this blog is for you! To begin, Blockchain is not the answer to everything. It also isn’t miraculously a savior for the problems we have in healthcare. Also, there is no universal definition for it. What it is though, in relation to health, would primarily be in advancing securityand trust in data.

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Assessing Clinical Reasoning: Identifying the GAP

At the end of a case presentation, you ask your learner “what’s the patient diagnosis?”, and you think to yourself “what’s the learner diagnosis?” 

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