While medical students have an already packed learning schedule, researchers at the Keck School of Medicine of USC think it’s worth adding one more thing to their academic plate: a course in health systems science, a field that explores how patients navigate the complex systems that encompass U.S. health care.
Their work on developing, implementing and evaluating this curriculum is described in an article published recently in the journal Healthcare. The lead author is Surabhi Reddy, a fourth-year medical student who was advised by Sonali Saluja, MD, MPH, an assistant professor of clinical medicine at the Keck School.
“As students, we spend a lot of time on rare, esoteric conditions but very little time on understanding whether a patient can afford their copay, how changes to the Affordable Care Act affect their ability to get coverage or the broader societal impacts of a public health crisis like COVID-19,” Reddy said. “These are things medical students want to know and need to know.”
To address that gap, Saluja and other faculty members worked with community health experts, health economists and patient advocates to develop a curriculum for first-year medical students. Introduced in 2017, the nine-session course includes guest lectures, group discussions, readings, case studies and patient interviews.
To evaluate the curriculum’s effectiveness, the researchers used an online survey to measure students’ interest in and knowledge of health systems before and after the sessions. Third-year med students, who did not have the opportunity to take the new curriculum, were surveyed for comparison.
In terms of knowledge, first-year students scored significantly higher on a health systems quiz after taking the course. They also showed significantly higher test scores than third-year students who did not complete the curriculum.
Saluja said this knowledge will empower the next generation of medical providers to advocate for patients as they navigate a rapidly changing and increasingly complex health care system.
“We’ve received really positive feedback from medical students who are realizing how many structural and systems-based barriers exist when it comes to people being able to access health care,” Saluja said. “For example, many students are realizing how expensive out-of-pocket costs can be for patients, or how hospitals and clinics can refuse to take care of a patient based on their health insurance plan.”
Reddy said he hopes the study will offer guidance to other medical schools looking to formalize health systems education.
“Despite the challenges of squeezing a new course into an already packed academic schedule, we have shown that it is possible to deliver an effective program that students see value in. I think it’s only a matter of time until we see similar offerings at all medical schools.”
— Sarah Nightingale
In addition to Reddy and Saluja, authors were: Allie Obremskey, MD, who graduated in May 2020 and is now a Pediatrics resident at the University of Washington; Michael Hochman, MD, MPH, associate professor of clinical medicine; Pamela Schaff, MD, associate professor of clinical medical education, family medicine and pediatrics; and Gregory Harlan, MD, MPH, associate professor of clinical pediatrics.
The work was supported by the Keck School’s Humanities, Ethics/Economics, Arts and the Law (HEAL) Program, the USC Gehr Family Center for Health Systems Science and Innovation, part of Keck Medicine of USC, and the USC Leonard D. Schaeffer Center for Health Policy and Economics.