Rethinking Medical Training for a Broken System
Health Systems Science: Recent events, including the shocking murder of a health care CEO, have sparked public debate. While many pressing health care issues demand attention, this tragedy underscores a deeper systemic problem. The U.S. health care system is fractured, prioritizing executives over patient care. If future physicians are not equipped early with the knowledge to fix it, this expensive and inefficient system will persist.
Medical education in the U.S. has evolved significantly—from holistic approaches in the 1700s to structured programs influenced by the Flexner Report in the 1900s. However, despite these advancements, medical schools primarily focus on two pillars: basic sciences and clinical sciences. The third pillar, health systems science (HSS), remains largely neglected. Educators recognize the importance of a systemic approach to health care, yet struggle to integrate HSS effectively into medical curricula. Future physicians must learn these concepts early to understand health care as a system, not just a series of individual patient encounters.
The Importance of Health Systems Science
Health Systems Science provides a framework for improving the quality, outcomes, and cost-effectiveness of patient care. It encompasses collaboration among health professionals, ethics, patient safety, social determinants of health, population health, public health, value-based care, quality improvement, technology, and artificial intelligence. Despite its significance, HSS topics are often inserted sporadically into medical education due to limited curriculum time. Now is the moment to reassess priorities. Should biochemistry and basic sciences take precedence over preparing students to navigate and reform a failing system?
Evidence for Early Integration of HSS
A landmark article, Health Systems Science: The ‘Broccoli’ of Undergraduate Medical Education, argues that students may not initially recognize the value of HSS, but they need it to drive change in health care. Instead of hiding the “broccoli” in medical education, educators should embrace and emphasize it. Proper exposure to HSS not only prepares future physicians to lead systemic reform but also protects them from “burnout,” which is often better described as “moral injury.”
Overcoming Barriers to Change
Reforming medical education is challenging. Academic calendars, limited instructional hours, excessive testing, and board exam requirements all make HSS integration difficult. However, without prioritizing HSS, we risk failing to develop physician leaders who can address our health system’s dysfunctions. The time for incremental changes has passed—what’s needed is a comprehensive reform, akin to the transformation that followed the Flexner Report over a century ago.
A Call for Systemic Educational Reform
We cannot fix the U.S. health care system without first reforming how we train medical students. An overemphasis on board scores and traditional basic sciences ignores the bigger picture. It is time for medical educators to demand meaningful reform. Perhaps what we need now is a Broccoli Report, prescribing a balanced “stir-fry” of medical knowledge that includes HSS as a key ingredient—not hidden, but celebrated as an essential component of physician training. Future leaders in health care should include not just administrators and executives, but also well-informed physicians and advocates who can champion systemic improvements. Education and advocacy, not drastic actions, will pave the way for a better health care future.
For more insights on improving physician training, visit Stanford Physician Advocate. To explore further research on HSS, check out the American Medical Association’s Health Systems Science Resources.