Lean Health Care Internships: A Novel Systems-Based Practice Education Program for Undergraduate Medical Students.

Abstract

Given the United States' urgency for systemic-level improvements to care, advancing systems-based practice (SBP) competency among future physicians is crucial. However, SBP education is inadequate, lacks a unifying framework and faculty confidence in its teaching, and is taught late in the medical education journey. The Oklahoma State University Center for Health Systems Innovation (CHSI) created an SBP program relying on Lean Health Care for a framework and targeted medical students before their second year began. Lean curricula were developed (lecture and simulation) and a partnership with a hospital was secured for work-based practice. The CHSI developed a skills assessment tool for preliminary evaluation of the program. In June 2022, 9 undergraduate medical students responded to a Lean Health Care Internship (LHCI) presentation. Student SBP skills increased after training and again after work-based practice. All 9 students reported that their conceptualization of problems in health care changed "extraordinarily," and they were "extraordinarily" confident in their ability to approach another health care problem by applying the Lean method. The LHCI fostered an awareness of physicians as interdependent systems citizens, a key goal of SBP competency. After the internship concluded, the Lean team recommendations generated a resident-led quality assurance performance improvement initiative for bed throughput. The LHCI was effective in engaging students and building SBP skills among undergraduate medical education students. The levels of student enthusiasm and skill acquisition exceeded the Lean trainers' expectations. The researchers will continue to measure LHCI's effect on students' rotation experiences to better evaluate the long-term benefit of introducing SBP concepts earlier in medical education. The program's success has spurred enthusiasm for continued collaboration with hospital and residency programs. Program administrators are exploring how to broaden access.