Health Systems Education: A Call for National Medical Curriculum Reform

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The importance of health systems and health policy education has been recognized for more than 40 years but has yet to become integrated into U.S. medical education nationally.2 In order to effectively function within a health system, a physician needs to be able to recognize health care cost burdens, understand models of care management, work with health information technology, and implement quality improvement measures.2 With health care waste, including unnecessary or inefficiently delivered services, constituting 30% of national health care spending, our system can no longer afford to have physicians who are untrained in providing cost-effective care.3 The Medicare payment advisory commission has allocated $3.5 billion dollars for systems-based practice education, and systems-based practice is one of the six Accreditation Council for Graduate Medical Education core competencies.1 These measures indicate that this is a national priority for medical education, yet its true integration in the curriculum remains elusive.
Recent efforts to provide health systems education have been inconsistent and fragmented, and we need a concerted national effort to effectively educate future physicians. We propose the implementation of a nationally standardized health systems curriculum in every medical school and residency program. Preclinical courses should include foundational knowledge about health care systems and health policy. Clerkships and residencies should provide opportunities for students to apply systems-based knowledge in a clinical setting. Representation of these topics on national board exams, such as the United States Medical Licensing Examination and the National Board of Medical Examiners tests, would drive national curricular change and hold programs accountable for meeting educational standards. Collaboration with interdisciplinary experts, such as health economists and health policy analysts, would be key to creating comprehensive and updated curricula.2
Health systems education is no longer a niche knowledge base for administrators. Knowledge of insurance, finances, care management models, and other systems-related topics is critical for future physicians to provide quality health care. By implementing these proposed changes to the undergraduate and graduate medical curriculum, we will prepare our next generation of physicians to meet the challenges faced by our modern health care system.
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