From aviation to economics, “third pillar” expands med ed’s view

Health systems science—an understanding of how to deliver care in a complex health system—is a topic of growing emphasis in medical schools across the country. A first-of-its-kind textbook promoting health systems science as the third pillar of medical education and providing a framework for its implementation nationwide has been covered in-depth by AMA Wire®. Here are our most read and most relevant stories on the topic from the past year.

What airplane deicing has to do with teamwork in health care. On a winter day in 1982, Air Florida Flight 90 took off from Washington National Airport en route to Florida. It flew only about a mile before stalling, crashing into the 14th Street Bridge then falling into the Potomac River. Seventy-eight people died in the accident, determined to be the result of improper deicing.

The crash became a seminal moment in the study of teamwork in “high-reliability organizations.” Such organizations are increasingly becoming a focus of health systems science because, due to their focus on teams, they represent a model approach to the “third pillar” of medical education.

Editor's note: This story is part of a new topic hub that centralizes the AMA’s essential tools, resources and content to help you in Training the Physicians of Tomorrow. Explore other Medical Topics That Matter.

Going beyond clinic’s 4 walls to address health’s social roots. In an 1848 report, entitled “On the Typhus Epidemic in Upper Silesia,” German physician and anthropologist Rudolf Virchow noted that inhabitants of an impoverished Prussian province died quicker and got sicker than their peers elsewhere in the country. His research presented a problem medical professionals are still struggling to solve: Addressing the social determinants of health means confronting the reality that the health of an individual patient, or a population of patients, is not treated exclusively within the four walls of medical setting.

Value-based care, an elusive concept, enters the curriculum. As the U.S. health care system shifts from payment based on volume to payment based on value, physicians need to learn value-based care at every level of their training, but gaps in the knowledge base exist across the continuum of medical education. The instructional basis for incorporating value-based care into the curricula for those training to become physicians and other health care professionals starts by defining an elusive term: value.

Better care through deeper understanding of policy and economics. Physicians go through years of preparation for their roles as healers, but one domain with significant clinical implications receives little or no emphasis in medical training: health care policy and economics. Fortunately, medical schools don’t need to reinvent their curricula to accommodate health care policy and economics.

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