Using a Massive Open Online Course Format to Engage Health Professions Students Regarding Health Systems Science and the U.S. Healthcare System

Abstract

As the U.S. healthcare system undergoes significant transformation, providers who have been traditionally viewed as the nexus of care delivery inside the healthcare system, are struggling to effectively participate in system-wide reform due to challenges related to their ability to navigate the complexities of the system beyond the delivery of individual patient care. In this new era, healthcare providers must become oriented around systems-based practice (SBP) and be more adequately equipped to consider these issues in their patient care decision making. To achieve this goal, they require competencies in contextualizing and operationalizing their role in order to effectively navigate the larger U.S. healthcare system.

Medical educators have proposed transforming the health professions school curricula by introducing a “third pillar” of medical education, termed Health Systems Science (HSS) to address knowledge, attitudes, and skills in SBP. The field of HSS is particularly nascent but quickly advancing. While learning about HSS and the U.S. healthcare system is increasingly being acknowledged as an essential part of health professions education, large proportions of graduating health professions students report it is insufficiently addressed in their curricula. Lack of training regarding healthcare systems may put recent health professions school graduates at a disadvantage as they enter their respective professional workforces, often requiring them to spend time and effort learning the health care system as they transition to their role as practicing clinicians. These findings suggest that efforts to amplify the HSS curriculum in health professions education can be an important way to improve student knowledge and confidence regarding health policy and health care systems.

To address these challenges, we developed a 6-week HSS massive open online course (MOOC) for interprofessional learners entitled, "Understanding and Improving the U.S. Healthcare System". Learners engage with material predominantly in an asynchronous, learner-determined setting using short-form videos (each ≤ 15 minutes) with a variety of pedagogical techniques.

The aim of my dissertation is to understand how HSS can be more readily integrated into health professions education through the use of a MOOC based curriculum. My primary hypothesis is that delivering HSS curriculum in this flexible format provides students with the opportunity to increase objective knowledge of the healthcare system, increase confidence in healthcare system-related knowledge, and become more optimistic about opportunities to improve the healthcare system in the future. In Chapters 1 and 2, I assess associations of exposure to this curriculum with students’ objective knowledge of the healthcare system, confidence in healthcare system-related knowledge, and optimism about opportunities to improve the healthcare system in the future for those who participated in the course and by comparing outcomes to a control group. In Chapter 3, I assess how students applied knowledge they obtained from the HSS MOOC through an analysis of participation in CHAT (Choosing Healthplans All Together), a simulation game designed to provide them with the opportunity to design an insurance plan as an individual and then on behalf of a stakeholder group.

In toto, my research contributes to the growing need for health professions schools to identify ways to more effectively integrate HSS into their curricula and evaluate outcomes related to HSS curricular inclusion as HSS education and training has the potential to impact individual and population health by giving future providers a greater ability to contextualize their roles as central stakeholders in the larger U.S. healthcare system.