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Health Systems Science: The “Broccoli” of Undergraduate Medical Education

Gonzalo, Jed D. MD, MSc; Ogrinc, Greg MD, MS

doi: 10.1097/ACM.0000000000002815

Health system leaders are calling for reform of medical education programs to meet evolving needs of health systems. U.S. medical schools have initiated innovative curricula related to health systems science (HSS), which includes competencies in value-based care, population health, system improvement, interprofessional collaboration, and systems thinking. Successful implementation of HSS curricula is challenging because of the necessity for new curricular methods, assessments, and educators and for resource allocation. Perhaps most notable of these challenges, however, is students’ mixed receptivity. Although many students are fully engaged, others are dissatisfied with curricular time dedicated to competencies not perceived as high yield. HSS learning can be viewed as “broccoli”—students may realize it is good for them in the long term, but it may not be palatable in the moment. Further analysis is necessary for accelerating change both locally and nationally.

With over 11 years of experience in global HSS curricular reform in 2 medical schools and informed by the curricular implementation “performance gap,” the authors explore student receptivity challenges, including marginalization of HSS coursework, infancy of the HSS field, relative nascence of curricula and educators, heterogeneity of pedagogies, tensions in students’ perceptions of their professional role, and culture of HSS integration. The authors call for the reexamination of 5 issues influencing HSS receptivity: student recruitment processes, faculty development, building an HSS academic “home,” evaluation metrics, and transparent collaboration between medical schools. To fulfill the social obligation of meeting patients’ needs, educators must seek a shared understanding of underlying challenges of HSS innovations.

J.D. Gonzalo is associate professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID:

G. Ogrinc is professor of medicine, Dartmouth Institute for Health Policy and Clinical Practice, and senior associate dean for medical education, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

Funding/Support: The work at the Penn State College of Medicine was partly funded by the American Medical Association and the Josiah Macy Jr. Foundation.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Jed D. Gonzalo, Division of General Internal Medicine, Penn State Hershey Medical Center–HO34, 500 University Dr., Hershey, PA 17033; telephone: (717) 531-8161; email:; Twitter: @Jed_Gonzalo15.

Copyright © 2019 by the Association of American Medical Colleges