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Assessment for Systems Learning: A Holistic Assessment Framework to Support Decision Making Across the Medical Education Continuum

Bowe, Constance M. MD; Armstrong, Elizabeth PhD

doi: 10.1097/ACM.0000000000001321

Viewing health care from a systems perspective—that is, “a collection of different things which, working together, produce a result not achievable by the things alone”—raises awareness of the complex interrelationships involved in meeting society’s goals for accessible, cost-effective, high-quality health care. This perspective also emphasizes the far-reaching consequences of changes in one sector of a system on other components’ performance. Medical education promotes this holistic view of health care in its curricula and competency requirements for graduation at the undergraduate and graduate training levels. But how completely does medical education apply a systems lens to itself?

The continuum of medical training has undergone a series of changes that have moved it more closely to a systems organizational model. Competency assessment criteria have been expanded and more explicitly defined for learners at all levels of training. Outcomes data, in multiple domains, are monitored by external reviewers for program accreditation. However, translating increasing amounts of individual outcomes into actionable intelligence for decision making poses a formidable information management challenge.

Assessment in systems is designed to impart a “big picture” of overall system performance through the synthesis, analysis, and interpretation of outcomes data to provide actionable information for continuous systems improvement, innovation, and long-term planning. A systems-based framework is presented for use across the medical education continuum to facilitate timely improvements in individual curriculum components, continuous improvement in overall program performance, and program decision making on changes required to better address society’s health care needs.

C.M. Bowe is codirector, Systems Approach to Assessment in Health Professions Education, Harvard Macy Institute, senior consultant, Partners Health Care International, and professor emeritus, Clinical Neurology, University of California, Davis, School of Medicine, Sacramento, California.

E. Armstrong is director, Harvard Macy Institute, and clinical professor, Pediatrics, Harvard Medical School, Boston, Massachusetts.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Constance M. Bowe, Harvard Macy Institute, 100 Cambridge St., 20th Floor, Boston, MA 02114; telephone: (617) 535-6483; e-mail:

© 2017 by the Association of American Medical Colleges