Introduction

In 2011, the Institute of Medicine and the Academy of Engineering published a treatise entitled ‘Engineering a Learning Healthcare System: A Look at the Future’.1 The original report and a 2021 follow-up define a learning healthcare system (LHS) as ‘a system in which science, informatics, incentives and culture are aligned for continuous improvement, innovation and equity’ in healthcare delivery.1 2

In 2020, Scobie et al published, ‘Implementing LHS in the UK NHS…’, based on a decade of efforts to use electronic health data to improve healthcare.3 Despite the US and UK LHS goal to improve healthcare, the 2021 Commonwealth Fund Report did not reflect progress.4 The Commonwealth Fund data are an important snapshot of healthcare quality and outcomes in 10 developed countries. The US and UK ranked 10 and 9, respectively, for healthcare outcomes.4 While we focus on the US and UK, we believe the worldwide need for healthcare optimisation, illustrated by the international shortfall of managing the COVID pandemic, make improving the LHS a universal call to action.2

The aspirational goal of achieving the LHS is iterative, evolving over time in matrixed systems with complicated governance and organisational structures. To this end, all learning-oriented activities should be leveraged in support of improved patient care. Among health professions education programmes, medical education is an important example of this, and the focus of this paper.

Given the importance and urgency of improving healthcare, we explore (1) a novel approach to examining the LHS through the lens of known systems experts and (2) envisioning the teaching and training of healthcare professionals to work in systems and to continue this throughout practice. To accomplish this, health professions education must become an integral focus of the LHS and education leaders must be represented in the LHS leadership. In …