With the ever-increasing complexity in healthcare delivery, an understanding of the structural context of the broader healthcare system is important as medical trainees learn how to provide high quality care to patients. Health systems science (HSS) is a concept that includes a collection of domains, such as clinical informatics, medical ethics, population health, policy, health economics, social determinants of health, and leadership.1 Formal teaching on health systems science topics is often limited, as it competes with traditional medical school curricula. With the aim of closing this educational gap and taking advantage of a curricular opportunity that arose because of a change in educational schedules from the COVID-19 pandemic, we designed and implemented a novel course at Emory University School of Medicine for second year medical students. One of our authors has also developed educational activities at the graduate medical education level for medical house staff on design thinking (DT) at Beth Israel Deaconess Medical Center. We hope that our interactive educational approaches to teaching health systems science and DT principles provide ideas and inspiration to educators at other institutions in the teaching of these topics.
Our health systems science module at Emory University School of Medicine consisted of a two-week course prior to second year medical students starting on clinical clerkships. A primary component of our course was a team-based hackathon, in which small teams of medical students identified educational or clinical problems of interest and developed and proposed solutions to these problems. Approximately 140 medical students divided into 29 student teams participated in the course and worked on 19 unique problems related to HSS domain areas (13 clinical and six educational). Teams selected problems from a list generated by faculty or proposed a problem that course faculty approved. Examples included shared decision-making for cancer treatment, identification of underrepresented candidates for kidney transplants, co-production of the patient health record, addressing food insecurity in patients, and connection of patients and learners to community resources. During the hackathon, student teams received coaching from faculty mentors and were encouraged to reach out to independent stakeholders, such as end-users in the community, to gather user feedback and suggestions as they worked on their solutions. We intentionally incorporated principles of DT into the hackathon structure and curriculum. Students read an article from the business literature on DT.2 To aid students in applying DT principles to their projects, we crafted a worksheet for teams to use, which included exercises such as identifying existing solutions for the problem, understanding user needs, and describing how their solution would fit into the broader system. Students were encouraged to consider social equity aspects of their proposed solutions, and many of the teams directly addressed social determinants of health.
Alongside hands-on hackathon project work, students completed the American Medical Association’s Health Systems Science online modules1,3 in an asynchronous manner during the first week of the course. To complement these modules and the project-based work, we recruited three Emory faculty members with first-hand experience in healthcare product design or innovation to give talks describing their development processes. Our goal was to share inspiration from physician leaders with the medical students on ways that DT and innovation can be incorporated alongside direct patient care in their medical careers.
The hackathon culminated with each student team crafting their “MVP,” or minimal viable product, and developing a brief pitch describing the problem they chose to work on, a demonstration of their proposed solution, and their iterative design process. Many pitches included innovative multimedia proposals such as design mockups of smartphone apps, workflow demonstrations, or sample curricula. Through peer judging, a few teams were selected to present an extended pitch in the second round. Our goal with incorporating a time-constrained pitch requirement, a common feature in hackathons, was for students to practice efficiently and succinctly communicating their iterative ideation and problem-solving process.
Incorporating training on DT into graduate medical education can complement education at the medical student level. Although DT is a relatively new modality in health care, it is used widely in industry by leading organizations to create and refine products and services. Importantly, DT methods are specifically designed to understand the human emotional and behavioral experience in a complex system, surface the most pressing unmet needs among users of the system, and facilitate creative problem solving among teams through co-design with users. When applied to healthcare problems, DT fosters a “human-centered” mindset that harnesses the intrinsic motivations and values of the healthcare workforce to improve care for people and can complement other process-centered methods including contemporary QI modalities.4
A hackathon combined with design thinking exercises offers an interactive project and team-based approach for medical trainees to learn and engage with health systems science topics that often are underemphasized in the traditional medical school curriculum. By combining the problem-solving format of a hackathon with cutting-edge methods from DT, we created a context for learners that closely replicates the experience of solving real-world systems issues. We believe that this approach engages the creativity of learners and can be applied to a variety of topics in medical education.