Medical school expands curriculum to include health systems science; names co-leaders

The Virginia Tech Carilion School of Medicine's Interprofessionalism domain has been expanded and renamed Health Systems Science and Interprofessional Practice. Cynthia Morrow, an internist and public health professional who is a faculty member at the school, and Natalie Karp, a urogynecologist with Carilion Clinic who is the ob-gyn clerkship director, have been named co-leaders for the domain.

Simply put, health systems science is the study of how health care is delivered with the end goal of improving the quality of health care for patients and populations. It is often referred to as the third pillar of medical education — the other two being basic science and clinical science — and includes topics in population health, quality and safety, health systems analysis, health care finance, value-based care, informatics, and health disparities.

The current pandemic is a clear example of why this training is needed. COVID-19 has called upon the expertise of many professions and sciences, from doctors, nurses and other health care providers to biomedical researchers, public health specialists, epidemiologists, emergency management professionals, and policy makers, just to name a few. These experts have been functioning individually and collectively as part of the pandemic health care system.

Successfully addressing the pandemic threats we now face requires a coordinated response by multiple systems at the local, regional, national, and global levels. Optimizing how these systems function and interact requires an understanding of health systems science.

The wheels were in motion prior to COVID-19 for the Virginia Tech Carilion School of Medicine to provide health systems science training. Soon after his arrival in July 2019, Dean Lee Learman identified health systems science education as essential for fulfilling the school’s mission of training future physician thought leaders.  

Planning started last summer using a framework comprising 12 curricular domains that support the development of systems thinkers.  One of these, interprofessional education, already existed as a core domain in the medical school.

“The additional focus on health systems science will grow the impact of the interprofessional education domain for which our school has become a national leader,” said Learman. “Our students will emerge with a better understanding of the way health care is delivered and how to make a positive impact on the health of patients and populations.”

Karp noted that medical education by nature is dynamic. “It has to change to adapt to the needs of our patients and our health care system. We have recognized that and see it as an opportunity to take a system that already had a really strong foothold in interprofessional education and expanding it to encompass something a lot broader.”

According to David Musick, senior dean for faculty affairs, who co-chaired a task force on implementing the transition, there has been gradual recognition over recent years that U.S. medical students were lacking an understanding of how health systems work.

“Medical students entering residency are very sharp clinically,” he said. “They know what to do; they know how to take care of patients. But what they don’t know a lot about is the context in which they’re going to actually put those clinical skills to work.”

Richard Vari, senior dean for academic affairs added, “This expanded curricular component will provide our students a program across all four years of medical school, that will better equip them to deal with the challenges of health systems in practice. This will impact patient care in a very positive way.”

The transition to health systems science will begin with the new class matriculating this summer. Details of the new curriculum are being developed through course design teams, and will likely include an experiential learning component where students will be assigned opportunities to observe and work in health care settings early on in their studies to begin to learn firsthand how health systems operate. The medical school will continue its partnership with Radford University Carilion for its interprofessional education activities.

“We are thankful to have Carilion Clinic as our health system partner and that senior leadership is enthusiastic about our transition to a health systems science curriculum,” Learman said. "Carilion’s focus on value-based care, population health, and community service creates unparalleled opportunities for our students to experience examples of health systems science in action.”

Morrow said that through teaching medical students, she has seen a hunger to understand what it’s like to be a physician.

“Health systems science can help medical students understand that working in a health system isn’t just about where you go to work,” she said. “It’s about understanding how that system is optimized to improve the health of the community that it serves.”

Morrow, who served as a county health commissioner in New York state, cited health inequity as an example of a critical problem that needs to be addressed by providers and policy makers who understand how health systems science can be part of the solution.

“We feel strongly about making sure that we create a learning environment that shows our students that as physicians, they can enact change and make a difference,” she said.

Virginia Tech Carilion School of Medicine’s class size allows it to offer innovative educational experiences in more aspects of its curriculum than most other medical schools. 

“We have the potential to really make this curriculum something that our students will look back on as being transformative,” Karp said. “Some of them may pursue educational leadership or health administration. But ultimately, the goal is to make our health care system better.”