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Background: Hackensack Meridian School of Medicine (HMSOM) was founded on a vision of addressing the determinants of health (DoH) in the daily practice of medicine. The school has an active learning curriculum partially conducted through a small group modified problem-based-learning entitled Patient Presentation Problem-based-learning Curriculum (PPPC). This course includes a Monday discussion of a patient case and a Friday small group session includes concept mapping of the week's basic, clinical, and health systems science (HSS) content. To help students contextualize and bring HSS principles into practice, PPPC at HMSOM requires that concept maps include not just basic science content from the week but also explicitly HSS topics and the DoH., Methods: We reviewed group concept maps from 7 pre-clerkship courses. There were an average of 18.9 group concept maps per course available to review, with roughly 8 students per group. We reviewed concept maps for inclusion of DoH icons and HSS content and followed the trend throughout each course of the pre-clerkship curriculum., Results: HSS content appeared in 45% of group concept maps in the first pre-clerkship course, but did not appear in any concept maps in subsequent courses. DoH content was inconsistently present in group concept maps throughout the first three courses, increased towards the end of the first academic year, and then showed a steady decline towards the end of the pre-clerkship curriculum., Conclusions: Students sometimes include DoH on their concept maps and this improves from the first three courses towards the end of the first academic year. However, students do not prioritize inclusion of DoH in their concept maps at the end of the pre-clerkship curriculum. HSS content is included in less than half of the concept maps in the first course, and then is not included in any group concept maps for the remainder of the curriculum. This may be due to a decreased focus on DoH and HSS, or related to students' tiring of pre-clerkship curricular activities including concept mapping. Providing feedback to students on inclusion of DoH and HSS in concept mapping may help improve this skill prior to the start of clerkships., Competing Interests: Declarations. Ethics approval and consent to participate: Study compliant/adhered to Helsinki Declaration; Study received ethical approval (IRB exempt, category 1 (educational settings)) by Hackensack Meridian Health Institutional Review Board Pro2024-0244; Risk Level: no greater than minimal risk; Need for consent to participate was waived by Hackensack Meridian Health Network IRB under Protocol Pro2024-0244. Consent for publication: There are no identifying images or other personal or identifying details of participants that would compromise anonymity in the study thus this is not applicable to our study. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Medical education has traditionally relied on physician educators. With expanding Health Systems Science competencies, non-physician healthcare providers are required. To investigate preceptor-role types, communication frequency, and importance of preceptors in value-added patient navigator roles (PN) and clinical preceptorships (CP). Using a mixed-methods approach, medical students participating in PN and CP during the first year of medical school ( n =191) identified individuals with whom they communicated and communication frequency (1=never, 7=frequently), and importance of preceptors to work/education (1=not important, 7=extremely important; open-ended responses). Quantitative data were analyzed via repeated measures using a mixed-effects model and McNemar's test; effect size was calculated via Cohen's d or Cohen's h; qualitative data was analyzed using thematic analysis. Comparing ratings for non-physicians to physician healthcare professionals in PN, communication frequency (5.54 vs 3.65; p <0.001, d=1.18), importance to work (5.77 vs 4.28, p <0.001, d=0.89) and education (5.02 vs 4.12, p <0.001; d=0.49) were higher for non-physician educators. Comparing ratings for non-physicians to physician healthcare professionals in CP, communication frequency (4.93 vs. 6.48, p <0.001, d=1.33), importance to work (5.12 vs 6.61 vs, p <0.001, d=1.29) and education (4.32 vs 6.55, p <0.001, d=1.89) were higher for physician educators. Qualitative analysis indicated that non-physician healthcare providers in PN focused on Health Systems Science concepts, including social determinants of health and healthcare delivery. In PN, students observed collaboration from the perspective of multiple providers. In CP, healthcare providers, mainly physicians, focused on physician-centric clinical skills and interprofessional collaboration from the physician's perspective. Educational benefits of non-physician healthcare professionals related to Health Systems Science in work-based clinical settings - or Landscapes of Practice - can help students understand systems-based concepts such as social determinants of health, healthcare delivery systems, and interprofessional collaboration. Differences in the educational value of non-physician healthcare educators perceived by students should be further explored.

Introduction: Many medical schools engage students in health system improvement (HSI) efforts. Evaluation of these efforts often focuses on students' learning outcomes and rarely considers the impact on health systems, despite the significant commitment health systems make to these efforts. Our study identified and evaluated system-level outcomes of pre-clerkship medical students' engagement in HSI efforts., Methods: We used an instrumental case study approach to examine the effects of pre-clerkship medical students' engagement in HSI projects as part of a 15-month experiential curriculum. We extracted data from 53 project summaries and posters completed during the 2017-18 academic year and follow-up survey data collected in May 2019 from physician coaches and health system professionals who mentored students, contributed to these projects, and worked in the clinical microsystems where the projects occurred., Results: We identified three categories and ten indicators of health system outcomes relevant to medical student engagement in HSI. Using these indicators, our evaluation found multiple benefits to the microsystems in which projects occurred. These included achievement of project aims, perceived immediate and sustained project impact on the health system, and development and implementation of projects with aims that aligned with national and health system priorities., Conclusion: Evaluation of HSI curricula needs to include effects on health systems so that program design can optimize the experience for all involved. Our study offers a framework others can use to evaluate system-level effects of project-based HSI curricula and shows several ways in which students' engagement can add value to health systems., (© 2022. The Author(s).)

Purpose: To explore how early meaningful experiential learning in community settings impacted medical students' application of systems thinking, their perceptions of systems navigation, and their professional identity as health system change agents., Methods: Following an immersive Health Systems Science course, first-year medical students partnered with veterans or newly arrived refugee families and served as health system patient navigators embedded within primary care teams for a year. Across two cohorts, fifty-six students participated in the elective. Three voluntary focus groups were conducted each year for a total of six groups with 50 patient navigator students. Inductive content analysis of focus group transcripts was conducted., Results: Qualitative analysis produced three major themes: program impact on students, student impact on patients, and student perceptions of the role of healthcare providers. Students reported a rich understanding of social determinants of health. By improving patient awareness of health and well-being, building capacity to understand medical issues, and increasing medication adherence through teaching, students recognized their impact on patient care. The importance of interprofessional collaboration with social workers also emerged and helped shape students' understanding of how they as physicians are part of a coordinated team working toward better patient care., Conclusion: The Case Western Reserve University WR2 curriculum teaches students how to address complex determinants of health and how to consider their role in dynamic health systems. This study highlights rich themes that emerged from students as they recognized the context that creates health for both individuals and communities. It underscores the role of such experiences in reinforcing systems thinking and development of change agency, both contributing to their professional identity formation as physicians., (© 2021. Society of General Internal Medicine.)

In this analysis, we describe medical student interest in and knowledge of health systems science (HSS) during the launching of a new curriculum. We surveyed first year students (MS1s) before and after exposure to a new HSS curriculum. MS1s demonstrated a 16% increase in HSS knowledge post-curriculum. Interest in HSS was high in MS1s before (90%) and after (88%) the curriculum when compared to MS3s (72%). The implementation of a longitudinal HSS curriculum may increase knowledge and maintain interest in the subject., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Phenomenon: Medical education is better aligning with the needs of health systems. Health systems science competencies, such as high-value care, population health, and systems thinking, are increasingly being integrated into curricula, but not without challenges. One challenge is mixed receptivity by students, the underlying reasons of which have not been extensively explored. In this qualitative study, we explored the research question: "How do students perceive health systems science curricula across all four years, and how do such perceptions inform the reasons for mixed quality ratings?" Approach: Following large-scale health systems science curricular changes in their medical school, we used students' open-ended comments obtained from course evaluations related to 1 st -, 2 nd -, and 4 th -year courses and performed a qualitative thematic analysis to explore students' perceptions. We identified themes, synthesized findings into a conceptual figure, and agreed upon results and quotations. Findings: Five themes were identified: (1) perceived importance and relevance of health systems science education, (2) tension between traditional and evolving health systems science-related professional identity, (3) dissatisfaction with redundancy of topics, (4) competition with basic and clinical science curricula, and, (5) preference for discrete, usable, testable facts over complexity and uncertainty. The relationship between themes is described along a continuum of competing agendas between students' traditional mindset (which focuses on basic/clinical science) and an emerging medical education approach (which focuses on basic, clinical, and health systems science). Insights: Health systems science education can be viewed by learners as peripheral to their future practice and not aligned with a professional identity that places emphasis on basic and clinical science topics. For some students, this traditional identity limits engagement in health systems science curricula. If health systems science is to achieve its full potential in medical education, further work is required to explore the adoption of new perspectives by students and create activities to accelerate the process.

Background: Medical schools have a critical need to develop roles for students that are "value-added," defined as "…experiential roles that can positively impact health outcomes while also enhancing student knowledge, attitudes, and skills in Clinical or Health Systems Science." Following implementation of value-added clinical systems learning roles for all first-year students, authors investigated student perceptions of the educational value from these patient-centered experiences., Methods: Between 2014 and 16, authors collected logs from students following their working with patients; authors also performed six, 1:1 student interviews, which were audio recorded and transcribed verbatim. Authors used thematic analysis to explore students' perceptions of the experience and educational benefits from these roles. Authors identified themes, and agreed upon results and quotations., Results: A total of 792 logs from 363 patients and six interviews were completed and analyzed. Students reported six educational benefits of performing value-added clinical systems learning roles in the health system, including enhanced understanding of and appreciation for a patient's perspective on health care and his/her health, barriers and social determinants of health, health care systems and delivery, interprofessional collaboration and teamwork, clinical medicine, and approach to communicating with patients., Conclusions: Students' reported educational benefits from value-added clinical systems learning roles span several learning areas that align with clinical and Health Systems Science, i.e. the needs of future physicians. These roles have the potential to shift learning from the physician-centric identity to one more fully aligned with patient-centered, team-based providers, while also potentially improving health today.