A needs assessment for clerkship students’ learning and practice of health systems science

Health systems science (HSS), known as the science of healthcare delivery, is a pillar of medical education. We conducted a needs assessment to investigate clerkship students’ learning expectations and experiences to refine the development and implementation strategy of a health systems science (HSS) curriculum without compromising local clinical workflow.

An anonymous paper-based survey was distributed to all 3rd-year medical students during orientation week of the second clerkship ring of the academic year. Survey questions explored three assessment domains: learning and HSS self-efficacy, resource utilization, and career interests. Descriptive statistics and ANOVA were used to analyze the data.

A total of 172/197 students (87.3%) completed the survey and 34.8% (60/172) had completed surgery clerkship as their first rotation of the academic year. Most clerkship students lacked explicit understanding of clerkship learning expectations (mean 3.05 [95% CI 2.90, 3.20]) and showed low self-efficacy in navigating themselves through the healthcare system, identifying team expectations/role, and maintaining work–life balance. Students who had completed surgery clerkships reported significantly lower self-efficacy in finding supporting resources (3.75 < 3.99, p = 0.05) and carrying out self-directed learning (3.87 < 4.14, p = 0.03) when compared to other students. Overall, most students (91.2%) favored “individualized coaching support” during clerkship training and preferred seeking help from peers (81.4%) and residents (79.1%). Perceived career enjoyment of residents/faculty was the most frequently cited factor (77.3%) influencing students’ future career interests.

Our study suggests that the development of HSS curriculum for clerkship students should focus on enhancing students’ ability to navigate themselves through healthcare systems and identify team expectations/ individual roles in various clinical settings. Strategies such as a new focus on improving the quality of student-to-student service handoff systems, a “clerkship HSS coach”, and providing just-in-time/on-the-go surgical clerkship resources may offer ways to optimally deliver specialty-specific HSS knowledge and skills to clerkship learners, ultimately increasing their levels of HSS efficacy.