Cultivating physician change agents by foregrounding systems: experiential learning in health systems science

Background Medical schools are incorporating didactic and experiential components of Health Systems Science (HSS) in order to impart skills necessary to improve health systems and population health. Experiential HSS curricula typically embed students in clinical settings that center direct patient care. Students are less frequently embedded in nonclinical settings that center system-level challenges. We describe an innovative HSS curriculum, guided by principles of authentic learning, that foregrounds real-world, system-level issues to teach students how to improve complex health systems. Methods Students explore HSS topics through two required four-week Selectives. HSS Selectives embed students in healthcare systems or the broader health ecosystem where they address real-world, system-level problems. To assess students’ experience and the impact of this curriculum, we reviewed course evaluation data routinely collected by the school including end of course surveys and curricular feedback sessions conducted with students. We generated descriptive statistics of evaluation ratings and thematically analyzed transcripts from curricular feedback sessions using authentic learning theory as a sensitizing concept. Finally, we reviewed project-based deliverables and other assignments submitted by students as part of the assessment process. Results In three years (2022–2025), 128 students participated in 26 Selectives. Most respondents agreed that instructional materials (88.6%) and teaching (93.6%) supported their learning. Among those who completed projects, most agreed that the project supported their learning (96%) and made a valuable contribution to their host organization (88%). Respondents valued the ability to apply HSS concepts to real-world issues that they had previously experienced as vague or abstract in didactics or other classroom-based activities. Students identified authenticity of the health system context, authenticity of problem-solving activities, access to system experts, and exposure to different system roles and perspectives as impactful on their learning. Conclusion HSS Selectives exposed students to complex systems and engaged them in system change efforts. Our experience suggests that authentic, system-foregrounded experiential HSS curricula can foster system-thinking skills and promote roles for physicians as contributors to and leaders of system transformation. This approach may help other medical schools create effective HSS learning experiences.