{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:12:45Z","timestamp":1785413565470,"version":"3.56.0"},"reference-count":33,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Board of Medical Examiners (NBME) Edward J. Stemmler, Medical Education Research Fund grant"},{"id":[{"id":"https:\/\/ror.org\/04tsmra86","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Systems"],"abstract":"<jats:p>Today\u2019s medical professionals function within an increasingly complex landscape\u2014one that is medical, scientific, social, cultural, political, ethical, and technological in nature. Responding to these complexities, U.S. medical education has emphasized Systems-Based Practice and Health Systems Science competencies to prepare learners to deliver excellent patient-centered care within dynamic clinical environments. Despite recognition of these competencies and broader calls for developing health systems citizens, operationalized and scaffolded learning and assessment across undergraduate medical education remain limited, with few validated assessment tools or defined learning trajectories to help novices become experts. In this conceptual synthesis article, the authors argue for the relevance of health systems thinking to everyday clinical situations and introduce a metacognitive systems thinking framework to conceptualize how professionals navigate systems-level complexities embedded in daily work. Drawing from the literature across disciplines, the framework highlights three related yet distinct processes: recognizing salient features of a complex situation (sensemaking), aligning and coordinating relevant knowledge, skills, and attitudes (integration), and making decisions and taking action in response (action). Emphasizing these as separable processes enables scaffolding learning and assessment as well as targeted formative feedback. The authors further integrate this framework with an evidence-centered design approach, associating concrete and measurable knowledge and skills with each process. This structure allows health systems thinking to be elicited and evaluated across diverse clinical scenarios (e.g., objective structured clinical examinations), supporting intentional development of systems-informed, reflective, and adaptive clinicians.<\/jats:p>","DOI":"10.3390\/systems14060635","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:17:31Z","timestamp":1780467451000},"page":"635","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Systems Thinking in US Medical Education: Relevance and a Conceptual Framework to Scaffold Learning and Assessment"],"prefix":"10.3390","volume":"14","author":[{"given":"Jacob","family":"Grohs","sequence":"first","affiliation":[{"name":"Department of Engineering Education, Virginia Tech, Blacksburg, VA 24061, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9952-9614","authenticated-orcid":false,"given":"Brock","family":"Mutcheson","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2157-8872","authenticated-orcid":false,"given":"Natalie","family":"Karp","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3554-9015","authenticated-orcid":false,"given":"Andrew","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Engineering Education, Virginia Tech, Blacksburg, VA 24061, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Lane","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4590-5335","authenticated-orcid":false,"given":"David","family":"Musick","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6587-7001","authenticated-orcid":false,"given":"Matthew","family":"Norris","sequence":"additional","affiliation":[{"name":"Department of Engineering Education, Virginia Tech, Blacksburg, VA 24061, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Parker","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jed","family":"Gonzalo","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1080\/0142159X.2021.1924366","article-title":"Health Systems Science Education: The New Post-Flexner Professionalism for the 21st Century","volume":"43","author":"Borkan","year":"2021","journal-title":"Med. 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