Integrating Well-Being into a Health Systems Science Curriculum

Purpose 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. Method 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. Results 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. Conclusions 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.