Leveraging Health System Science to Meet Accreditation Needs 

Throughout this series on Health System Science, we’ve iterated several topics readily addressed by understanding the “science” of the health system with a focus on patient safety, quality improvement, error, and bias. In the example of health inequities, we have also explored how systems—social, political, and health care systems—intersect with the societies in which we live and further affect health outcomes. I hope we have set the stage for why HSS is an important topic for your curriculum, but how do you find the time in our accelerated programs?

The purpose of this article is to provide a series of questions to explore HSS in your own programs, as well as to give some advice on how to leverage HSS to augment activities/assignments you may already be doing in your educational spaces. 

Accreditation standards for medical education programs now ask for curricula that are built on program-derived competencies. PA programs may adopt the PAEA Core Competencies for New PA Graduates¹, lean into the AAMC’s Entrustable Practice Activities² or Physicians Competency Reference Set,³ or generate their own competencies that must ultimately inform a curriculum that supports the 5^th Edition Standards of Accreditation.

The ARC-PA standard that most directly addresses HSS is B2.16- patient safety, prevention of medical errors, quality improvement, and risk management. But don’t overlook B2.14 (reimbursement practices, documentation, and health policy), B2.15 (public health concepts including population health), and B2.10 regarding collaborative care.  

As you consider how your program can meet these standards, ask yourself a few guiding questions: 

•  What courses in my program address these standards? (B2.14, B2.15, B2.16) 
•  How are they being addressed? Is there a specific activity? (B2.14, B2.15, B2.16) 
•  Since health training programs all include some degree of health system science, could there be a way to collaboratively cover these topics in our university? (B2.10, B2.14, B2.15, B2.16) 
•  How is health system science assessed by our programming and curriculum? (B4.01a)

Here are seven ways to incorporate health system science in your classrooms you may not have considered as HSS before. 

1. Activity: individual reflective iSMART goal setting with follow up (B2.16c). Assessment: Follow up reflection at spaced intervals throughout the program.  
2.  At the beginning of a new unit, take time to introduce students to the team members they may need to implement care for these patients in referral or coordination of care (B2.10a-c).  Assessment: multiple choice and/or open-ended assessments regarding care referral
3.  Create your next interprofessional activity (synchronous or asynchronous) as a “Room of Ruins” where interprofessional teams explore errors in an exam room that could cause patient harm (B2.10c, B2.16a, b, d). (Hint: make sure you have a score sheet of how many errors there are!) Assessment: B2.16—scoring (individual) B2.10—improved scoring when work together 
4.  After a simulated clinical encounter (OSLER/OSCE), consider an “integrity check.” Have students review the SOAP note they completed against a recorded review of the exam they just performed (B2.14b, B2.16a, c, d). Assessment: self- or peer-assessment with feedback
5.  In a unit about hypertension, have learners explore inequities in access to fresh fruits and vegetables in the local community or in a community they plan to serve after graduation (B2.15a, c). Assessment: reflection or written assignment
6. Present a team of learners (or interprofessional learners) with a real-world problem preferably with data involved and let them design sprint  for a potential solution (B2.15d). Assessment: a deliverable addressing their potential solution 
7. In a professional issues or ethics course, provide learners with a current health policy and ask them to use a Tidal Equality Equity Sequence ™  to determine if people are being disadvantaged by the policy and if revision should be considered for patient advocacy (B2.14d, B2.15c). This can be done as individuals, teams, or interprofessional teams (add B2.10c).  Assessment: a written deliverable or debrief 

We hope you can implement your ideas for success in meeting accreditation standards. In the meantime, if you have an activity that meets the HSS related standards, consider posting it in the Digital Learning Hub to share with others through the Curriculum Exchange Channel and join the new Curriculum Exchange Professional Learning Community (PLC) to stay up do date as new items are added.  

The other stories in this series can be found on the PAEA website. The first story is here, the second story is here, the third story is here, the fourth story is here, and the fifth story is here.

References 

1.  PA Education Association. Core Competencies for New PA Graduates. https://paeaonline.org/our-work/current-issues/core-competencies.  Accessed June 21, 2023.  
2.  Obeso V, Brown D, Aiyer M, Barron B, Bull J, Carter T, Emery M, Gillespie C, Hormann M, Hyderi A, Lupi C, Schwartz M, Uthman M, Vasilevskis EE, Yingling S, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program. Toolkits for the 13 Core Entrustable Professional Activities for Entering Residency. Washington, DC: Association of American Medical Colleges; 2017. www.aamc.org/initiatives/coreepas/publicationsandpresentations     
3.  Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013; 88:10881094.