Lessons learned from implementing health systems science and community service course for fourth-year medical students

Background: With the call to integrate health systems science (HSS) in medical education curriculum comes the need for more practical guidance from implementation experiences. In June 2020, the University of Texas Medical Branch John Sealy School of Medicine implemented a required course entitled “Health Systems Science and Community Service (HSS)” for fourth-year medical students. This quality improvement study describes the course and the lessons learned in the first four iterations. Methods: The course was formatted as a 10-month-long, asynchronous course that ran concurrently with post-clerkship rotations. Throughout the four iterations, we used close- and open-ended questions to systematically collect students’ feedback twice annually. Descriptive analysis of quantitative data was performed, and general themes were drawn from qualitative items from the evaluations. In addition, the National Board of Medical Examiner (NBME) HSS Subject Examination was administered in the course during the third and fourth iterations; student performance was analyzed. The course contents were iteratively revised each year to incorporate more HSS and community service components. Results: The course cohorts 1 through 4 from each iteration had 234, 221, 220, and 217 students, respectively. The response rates for the end-of-year course evaluations were 91% for cohorts 1, 2, and 3, and 94% for cohort 4. Most students reported that the amount of material they were required to cover was reasonable across all four iterations. While most respondents from cohorts 1, 2, and 4 found the number of community service hours reasonable, the majority of respondents in cohort 3 indicated it was excessive. The common themes from students’ responses across cohorts included that some of the course content should have been taught in earlier years of their medical training, that community service activities are valuable but should have been optional, and that students appreciated the flexibility of the course. Student performance on the NBME exam was comparable to national performance. We summarized the iterative changes for each cohort based on feedback. Conclusions: We described the implementation of a post-clerkship course on health systems science integrating with community service and service-learning. A major lesson learned was the need to take an iterative approach in building components like service-learning and addressing challenges, including student buy-in.