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Letters to the Editor

In Reply to Weissman

Borkan, Jeffrey MD, PhD; George, Paul MD, MHPE; Tunkel, Allan R. MD, PhD

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doi: 10.1097/ACM.0000000000002712
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We thank Dr. Weissman for his thoughtful comments on our article. We do not denigrate the need for students to understand the human body, including its states of health and disease, but feel that health systems science (HSS) has a critical role in preparing medical students for careers as physicians. Students are already learning critical HSS knowledge, attitudes, and skills in medical school, from the effective use of evidence-based medicine to electronic health records and teamwork. HSS competencies, such as health care financing and quality improvement, are vital to most physicians in practice and should be routinely included in continuing medical education and board examinations. However, this material may currently be conveyed in a hidden curriculum, taught in an unsystematic and potentially flawed manner, or just passed down from student to student without faculty input. It is important for students and trainees to develop analytical skills and utilize lifelong learning skills in gaining competency in HSS to prepare them for their future careers. HSS learning should be integrated across the entire spectrum of medical education and training.

Seamless integration of HSS into the basic and clinical sciences is crucial. If HSS is taught separately from the basic and clinical sciences, the lessons and insights may not effectively take hold in future physicians’ minds and practices. For example, students and trainees need to know to inquire about whether the patient received the right care, at the right place, and at the right time and understand the cost implications of workup and treatment. When dissecting a cadaver, why not teach about the ethics of body procurement and the policy implications?

The addition of HSS to medical school curricula is not only theoretically feasible but, in fact, a proven reality. At the Warren Alpert Medical School of Brown University, we are graduating our first class of 15 students in the Primary Care–Population Medicine program. This cohort has been able to succeed in the standard medical school curriculum while successfully completing nine integrated master’s courses related to HSS and a thesis. We believe that all medical students can achieve sufficient levels of mastery in HSS knowledge, attitudes, and skills, preparing them for residency and future practice. To exclude HSS as part of the medical school experience would be a disservice—not only to our trainees but also to our patients and society.

Jeffrey Borkan, MD, PhD
Assistant dean, Primary Care–Population Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Jeffrey_Borkan@brown.edu.
Paul George, MD, MHPE
Associate dean, Medical Education, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Allan R. Tunkel, MD, PhD
Senior associate dean, Medical Education, Warren Alpert Medical School of Brown University, Providence, Rhode Island.

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