Curricular Transformation in Health Systems Science: The Need for Global Change.

In this Invited Commentary, the authors propose a counterperspective to the article by Borkan and colleagues, who advocate for a circumscribed, piloted, choice-focused approach to introducing curricular redesign options in undergraduate medical education, particularly in the area of health systems science. In making this case, Borkan and colleagues cluster several kinds of innovative curricular changes that the authors of this commentary believe are best separated by the scope of change and associated educational strategy: (1) innovations customized to student interest and motivation, which are best served by focused programmatic interventions; (2) innovations such as longitudinal integrated clerkships that represent creative and needed educational strategies but may be difficult to expand because of complex barriers; and (3) innovations that are truly transformational, with critical connections far beyond the boundaries of the medical school curriculum, which must be addressed in a comprehensive approach-despite the challenges, frustrations, and difficulties. The authors situate health systems science squarely into the third category, and address three important questions addressing the nature and demands of this change. In making these arguments, the authors draw from experiences at the Penn State College of Medicine and collaborations with other U.S. medical schools related to large-scale curricular transformation and challenges that impact this change. The authors contend that medical education needs to navigate this major change for all students in a way that not only succeeds for learners but, more important, addresses the needs of patients seeking care in rapidly evolving systems of care.