Triple-loop learning as a framework for advancing health systems science in medical education: a transformational change approach

Purpose: The American Medical Association has recently adopted health systems science (HSS) as the third pillar of medical education to provide comprehensive and holistic patient care. The purpose of this paper is to propose a novel organizational learning perspective in considering how medical schools can facilitate a transformational HSS curriculum change. Design/methodology/approach: This is a conceptual paper seeking to present triple-loop learning as a potential approach to HSS curriculum change. Findings: Due to its potential for structural accountability and sustainability stemming from the inclusion of diverse voices, the authors argue that HSS curriculum change, guided by the principles of triple-loop learning, is likely to lead to the development of medical curricula that are more adaptive and responsive to the constantly changing health-care landscape. The authors advocate for the deliberate inclusion of stakeholders who have historically been excluded or marginalized in the HSS curriculum change process, such as patients and those in sentinel roles (e.g. nurses, social workers). The authors also suggest an integrated, multilevel transformation that involves collaboration among medical schools, accreditation organizations, licensing boards and health-care systems. Originality/value: To the best of the authors’ knowledge, this paper represents the first attempt to apply the theory of triple-loop learning in the context of HSS curriculum change. It highlights how this critical systemic learning approach uniquely contributes to HSS curriculum change, and subsequently to the necessary, larger cultural changes demanded in medical education as a whole.