Integrating Well-Being Into a Health Systems Science Curriculum

The Quadruple Aim identified improving provider well-being as an extension of the Triple Aim (enhance patient experience, improve population health, and reduce costs). Despite this expansion, health system science (HSS) and well-being training in graduate medical education remain taught as parallel rather than interconnected topics, as suggested by the Quadruple Aim. To address this gap, the authors integrated well-being into an HSS curriculum and evaluated the effect on trainee HSS knowledge and attitudes, well-being, and learning pedagogy.

In this mixed-methods study, quantitative survey data (QI proficiency self-assessment, Mini-Z burnout assessment) and qualitative interview data were collected at Oregon Health & Science University between October and November 2021 for curriculum graduates, approximately 18 or 6 months after course completion for interns in academic years 2019 to 2020 and 2020 to 2021, respectively, to evaluate general experiences, satisfaction, skills and attitudes, and behaviors.

A total of 68 residents completed the course. Improvement was noted in all 9 variables of self-assessed QI proficiency (lowest mean [SD] score of 2.07 [1.03] in month 1 and highest mean [SD] score of 3.98 [0.67] in month 11 [3.98]; P < .001 for all variables). Qualitative interviews with 25 residents (35.2%) 6 to 18 months after course completion demonstrated longitudinal retention of systems thinking principles and improved empathy for multidisciplinary colleagues. Participants perceived the well-being curricular component as having created a tone of programmatic support, being deisolating, and assisting trainees in recognizing system effects on well-being. Residents perceived burnout, however, as unchanged and caused by factors unmodifiable by HSS. Contextualization, conversations, reflection, and actualization with projects were key elements of learning.

An integrated HSS and well-being curriculum allowed trainees to see the role systems play in multiple domains, including their well-being. Trainees developed longitudinal systems, teamwork, error-reporting skills, systems thinking, and well-being skills.