APMA News - January/February 2023 - 21

science to clinical science. We anticipate that they
will see the big picture as they understand how the
health-care system functions, and we hope they
will be able to generate innovative ideas to formulate
plans and advocate for their patients and our
profession in the future.
What is your favorite part of the
HSS curriculum?
Dr. Choate: It's all quite exciting. I am thrilled that
we finally have some structure around all these
professionalism behaviors and skills. I am also very
excited to be teaching students about the profession
that they have chosen. The small-group discussions
we have had about health equity and advocacy
have provided powerful, moving moments.
The HSS topics allow the humanity of medicine to
be at the forefront of our discussions. Something
as mundane as evaluating each student's health
insurance card/benefits leads to practical learning.
We are now empowering our students and giving
them tools to be day-to-day leaders and really help
not only their patients from a holistic perspective
but also each community.
Dr. Shih: My favorite subject in HSS is the social
determinants of health. It is a topic the government
has begun paying attention to. Healthy
People 2030 [a project of the US Department of
Health and Human Services that sets data-driven
national objectives to improve health and well-being
over the next decade] sets social determinants
of health as one of many indicators used to gauge
the health of the population. In a 2021 research
paper published in JAMA[7]
, the US was ranked
last among 12 developed countries in overall
health outcomes even among adjusted for higher
income population, although we spent the most
money per capita on health care. While this result
is multifactorial, the idea that zip code is more
important to a person's health than their genetic
code certainly has a role in their health care. If we
continue to spend thousands of dollars advancing
medical technology for treatments instead
of addressing the social determinants of health,
it is hard to see the cost of health-care decline
anytime soon.
What are your next steps with the
HSS curriculum?
Dr. Choate: The next steps involve integrating HSS
concepts into clinical rotations. Our clinical faculty
is addressing HSS issues on a daily basis, and we
want our students to learn from these experiences.
It is imperative that we recognize the value of
preparing students to become functional members
of health-care systems and health-care teams.
As patients are the center of our care, they will
certainly benefit the most from our students who
have received HSS education.
Dr. Shih: In addition to integrating HSS subjects
into clinical rotations, I am hoping to continue
sharing our experiences and student feedback
so more faculty at other teaching institutions will
become aware of this curriculum. Hopefully, HSS
will become a standard curriculum in medical
education, particularly in podiatric medicine and
surgery. Without advancing medical education, it
will be impossible to prepare the next generation
of podiatric physicians and surgeons to be ready
to face the complex and constantly evolving
health system.
References
1. Flexner A. Medical Education in the United States
and Canada. Washington, DC: Science and Health
Publications, Inc.; 1910
2. Cooke M, Irby D, O'Brien B. Educating Physicians:
a call for reform of medical school and residency.
San Francisco: Jossey-Bass; 2010.
3. Skochelak, Susan E., ed. Health Systems Science.
Elsevier Health Sciences, 2020.
4. Lomis, K. D., Santen, S. A., Dekhtyar, M., Elliott,
V. S., Richardson, J., Hammoud, M. M., ... &
Skochelak, S. E. (2021). The accelerating change
in medical education consortium: key drivers
of transformative change. Academic Medicine,
96(7), 979-988.
5. Jeffrey M. Borkan, Maya M. Hammoud,
Elizabeth Nelson, Julie Oyler, Luan Lawson,
Stephanie R. Starr & Jed D. Gonzalo (2021).
Health systems science education: The new
post-Flexner professionalism for the 21st
century, Medical Teacher, 43:sup2, S25-S31,
DOI: 10.1080/0142159X.2021.1924366
6. Dekhtyar M, Ross LP, D'Angelo J, et al. Validity
of the Health Systems Science Examination:
Relationship Between Examinee Performance and
Time of Training. American Journal of Medical
Quality. 2020;35(1):63-69. doi:10.1177/
1062860619853349
7. Emanuel EJ, Gudbranson E, Van Parys J, Gørtz
M, Helgeland J, Skinner J. Comparing Health
Outcomes of Privileged US Citizens With Those
of Average Residents of Other Developed
Countries. JAMA Intern Med. 2021;181(3):339-344..
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