卫生系统科学(health system science,HSS)是研究卫生系统如何为患者提供卫生保健、患者如何接受和获得卫生保健以及卫生系统如何促进健康的科学。作为美国医学会的核心创新成果之一,HSS教育于2013年开始在美国医学院校试行。HSS与基础医学和临床医学相协同、互补,在患者保健和群体保健中发挥着重要的作用。本文介绍了美国的卫生系统科学的产生、其所包含的知识模块以及在美国医学院校中的实施情况;同时,结合我国医学教育的现状,对我国医学院校开展卫生系统科学教育进行了思考。
Health system science (HSS) is a science that studies how the health system provides health care for patients, how patients receive and obtain health care, and how health systems promote health. As one of the core innovations of the American Medical Association (AMA) recently, health system science has been implemented in the American medical education since 2013. As the third pillar of medical education, HSS plays an important role in patient and population health and care by cooperating and complementing with basic medicine and clinical medicine. This paper introduces the emergence, knowledge domains and development of HSS in American medical education. Furthermore, combined with the current situation of medical education in China, some ideas and suggestions for developing HSS in Chinese medical schools will be put forward.
[1] Duffy TP. The Flexner Report--100 years later [J]. Yale J Biol Med, 2011, 84(3):269-276.
[2] Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost[J]. Health Aff (Millwood), 2008, 27(3):759-769. DOI: 10.1377/hlthaff.27.3.759.
[3] Porter ME. What is value in health care? [J]. N Engl J Med, 2010, 363(26):2477-2481. DOI: 10.1056/NEJMp1011024.
[4] Skochelak SE, Hawkins RE. Healthsystem science [M].Philadephia: Elsevier, 2017:26-40.
[5] Trevisi L, Orav JE, Atwood S, et al. Integrating community health representatives with health care systems: clinical outcomes among individuals with diabetes in Navajo Nation[J]. Int J Equity Health, 2019, 18(1):183. DOI: 10.1186/s12939-019-1097-9.
[6] Pines AR, Khurana A, Mastorakos GM, et al. A prognosis for health systems science courses: observations from current students [J].Acad Med, 2018, 93(10):1434-1436.DOI: DOI:10.1097/ACM.0000000000002369.
[7] Lawson L, Lake D, Lazorick S, et al. Developing tomorrow's leaders: a medical student distinction track in health system transformation and leadership[J]. Acad Med,2019,94(3): 358-363.DOI: 10.1097/ACM.0000000000002509.
[8] Gonzalo JD, Dekhtyar M, Starr SR, et al. Health systems science curricula in undergraduate medical education: identifying and defining a potential curricular framework[J]. Acad Med, 2017, 92(1):123-131.DOI: 10.1097/ACM.0000000000001177.
[9] Rajab MH, Villamaria FJ, Rohack JJ. Evaluating the status of “translating research into practice” at a major academic healthcare system[J]. Int J Technol Assess Health Care, 2009, 25(1):84-89.DOI: 10.1017/S0266462309090114.
[10] Baxley EG, Lawson L, Garrison HG,et al. The teachers of quality academy: a learning community approach to preparing faculty to teach health systems science[J]. Acad Med, 2016, 91(12):1655-1660. DOI: 10.1097/ACM.0000000000001262.
[11] Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world[J]. Rev Peru Med Exp Salud Publica, 2011, 28(2):337-341. DOI: 10.1590/s1726-46342011000200023.
[12] 孙宝志,王县成.“5+3”模式培养临床医学人才胜任力阶梯标准及医学考试方法研究[M]. 北京:人民卫生出版社,2018:231.
[13] 田蕾,孙宝志.对我国七省市抽样调查临床医生岗位胜任力的现状及其评价[J].医学教育管理,2015,1(1):29-33. DOI: 10.3969/j.issn.2096-045X.2015.01.007.
[14] 吕立夏, 曹金凤, 杨文卓, 等. TRIZ创新思维对医学生创新创业教育的启示——以同济大学医学院为例[J].创新创业理论研究与实践,2018(9):1-3.
[15] Detmer DE, Shortliffe EH. Clinical informatics: prospects for a new medical subspecialty [J]. JAMA, 2014, 311(20):2067-2068. DOI: 10.1001/jama.2014.3514.
[16] Brown MM, Brown GC, Sharma S. Value-based medicine and vitreoretinal diseases [J]. Curr Opin Ophthalmol, 2004, 15(3):167-172. DOI: 10.1097/01.icu.0000120675.27548.d5.
[17] 凌子平. 价值医学的医疗价值与实现路径[J].医学与哲学, 2016, 37(4B):1-3. DOI:10.12014/j.issn.1002-0772.2016.04b.01.
[18] 吴凡, 汪玲.大健康视域下的医学人才培养“组合拳”[J].中国卫生资源,2020,23(1):1-6. DOI:10.13688/j.cnki.chr.2020.20051.
[19] 闻德亮. 由新冠肺炎疫情防控引发的医学教育思考[J]. 中国高教研究, 2020(5):43-47 DOI:10.16298/j.cnki.1004-3667.2020.05.07.
[20] 王维民, 文历阳. 致敬医学精神 做好顶层设计 服务全民健康[J]. 中华医学教育杂志, 2020,40(4): 241-247.DOI: DOI: 10.3760/cma.j.cn115259-20200307-00281.
[21] 何珂, 汪玲. 健康中国背景下“新医科”发展战略研究[J]. 中国工程科学, 2019, 21(2):98-102. DOI:10.15302/J-SSCAE-2019.02.007.