DOI
https://doi.org/10.1080/10401334.2017.1398654

Summary
In this paper a study on how educators in medicine, physical therapy, physician assistant, nursing, and speech-language pathology education programs teach and assess systems thinking and systems-based practice (SBP) is presented.
Four major levels of systems are identified in healthcare delivery: the patient, the care team (including health care professionals, family members, and others), the organizations in which care is delivered, and the environment (regulatory, market, and policy). Effective SBP is sensitive to all levels and interactions and the application of systems thinking is key to understanding interrelationships shaping the behavior of systems.
The aims of this study were to:
1. identify how the various health professions define, teach, and assess systems thinking and SBP;
2. articulate the gaps and challenges in current teaching and assessment practices; and
3. recommend improvements in teaching and assessing systems-based thinking and SBP.
Twenty-six educators from seven different degree programs across the five professions were interviewed and program descriptions and relevant course syllabi were reviewed. Qualitative analysis was iterative and incorporated inductive and deductive methods as well as a constant comparison of units of data to identify patterns and themes. Six themes were identified in which participants confirmed the lack of a shared definition and noted that the drivers were external to academia. Participants also described a variety of learning activities associated with these concepts and discussed various teaching and assessment strategies but believed that learning occurred primarily informally and experientially. Finally, all welcomed a structured framework and perceived its use with an interprofessional approach could enhance current teaching and assessment of systems thinking.
The authors conclude that capitalizing on existing tools, techniques, and taxonomies from across the health professions as well as outside healthcare may enhance teaching and assessment of systems thinking and SBP and ultimately clinical practice, although these would need to be adapted and refined for use in healthcare. Further training needs to occur at all levels from student to clinician.

Relevance for Complex Systems Knowledge
This paper deals with system thinking and system-based practice (SBP) across the health professions. SBP is a core competency for medical and health science professionals alike and is essential for maximizing the quality and safety of patient care. In this paper an inquiry into definitions, teaching practices, and assessment is presented.

Point of Strength
The point of strength of this paper is that it highlights the need for development of new curricula around systems thinking in the health professions and recommends improvements in teaching and assessing systems-based thinking and SBP.