Systems Thinking with Causal Loop Diagrams in Medical Education: An Exploratory Study

Systems · 2026-04-01

Medical literature is replete with diagrammatic representations of systems, yet lacks standardised nomenclature and consistent symbolic conventions. In an introductory system dynamics course for health science students, causal loop diagrams (CLDs) are used to support systems thinking. Notwithstanding recognised limitations, CLDs provide a coherent heuristic for representing multivariate systems with feedback. We studied 55 first-year volunteers enrolled in the course to compare understanding of systems presented as CLDs versus typical journal diagrams. Two endocrine systems were selected from open-access, peer-reviewed literature: calcium homeostasis and glucose homeostasis. Participants were shown either the original journal diagram for one system and a CLD for the other, or vice versa, and answered twelve true/false questions—six per system. A mixed-model, two-way repeated measures ANOVA revealed a significant interaction between Diagram (CLD vs. journal diagram) and System (Calcium vs. Glucose). Post hoc comparisons showed significantly higher performance with CLDs for both Calcium (0.84 vs. 0.38) and Glucose (0.83 vs. 0.63), p < 0.001. A Fisher’s Exact Test also indicated a higher proportion of questions favouring CLDs. These findings suggest that training in CLDs may enhance understanding of complex systems compared to standard journal diagrams. Further work is needed to address limitations including the small sample size, use of a single cohort, and a restricted set of diagrams.

Can computational modeling in medical education support a constructionist educational framework? Insights from the seminal literature in Papertian constructionism and system dynamics

Frontiers in Education · 2026-04-13

Introduction The inclusion of a system dynamics course in our medical school curriculum was designed to encourage systems thinking through computational modeling. From anecdotal observations, it soon became evident that something more profound was occurring—rather than simply learning, our students appeared to be constructing knowledge by building computational models in a way that is consistent with Papert's constructionism. Approach In the absence of a reliable tool to identify constructionism, we examine the seminal literature of Forrester's system dynamics and Papert's constructionism by extracting key excerpts to look for evidence supporting the hypothesis that computational modeling may constitute a constructionist activity. Observations The literature suggests that there is substantial convergence between the educational approach of constructionism and the activity of constructing models in system dynamics. Discussion An examination of the seminal literature suggests that system dynamics modeling has features that are consistent with a constructionist approach. By extension, other approaches such as agent-based modeling also embody constructionist principles, and the expanding integration of artificial intelligence into computational modeling may present opportunities for novel approaches to constructionist learning. Formal real-world educational studies will be required to accumulate empirical learner data in order to confirm the constructionist nature of systems modeling.

Effect of gait retraining in minimalist footwear or barefoot on running footstrike and cadence: a systematic review

Research in Sports Medicine · 2025-08-05

Gait retraining programs take a structured approach to altering a runner's gait, often with the goal of decreasing footstrike angle and increasing cadence, as these outcomes have been correlated to a reduced rate of injury and optimal performance. Minimalist footwear, or running barefoot entirely, has been explored as a tool for gait adjustment in runners, largely due to the increased feedback from ground forces experienced by the runner. This systematic review aims to decipher the effect of gait retraining with minimalist footwear or barefoot running on footstrike angle and cadence. The comparison group included runners that underwent gait retraining in traditional footwear. Results showed a statistically significant decrease in footstrike angle, indicating more forefoot striking, in the experimental group, but no significant changes in cadence. This demonstrates promise in utilizing minimalist footwear or barefoot running as an adjunct to gait retraining in runners.

Improving Healthcare Efficiency and Patient Outcomes Through Proactive Insight to Action: A Sickle Cell Disease Case Example

Journal of Patient Experience · 2025-12-01

As healthcare systems grapple with simultaneous challenges of patient engagement, access for services, and growing clinician burnout, we share an approach to quality improvement focused on equipping integrated care teams with methods for proactive insight and action to manage patients. This approach offers a way to deliver outcomes that value-based care arrangements look to achieve, and which can alleviate clinician burnout and improve satisfaction across care teams. We illustrate our experience with a program managing patients with sickle cell disease in Southeast Pennsylvania that has delivered improved outcomes, including improvements around the provision of important medication therapies and completion of annual screening tests, for a population that historically faces many health inequities. These tools and workflows are still widely in use today. Improving the care of a patient longitudinally requires an approach across the continuum of care and inevitably requires a team-based model with a multidisciplinary emphasis to better engage patients outside of office visits and relieve burden on frontline clinicians.

Community Health Worker and Mobile Health Interventions for Quality of Life Among Young Adults With Sickle Cell Disease

JAMA Network Open · 2025-11-17 · 2 citations

Importance: Young adults with sickle cell disease (SCD) experience challenges transitioning from pediatric to adult care, leading to increased morbidity and mortality. Objective: To evaluate the effectiveness of community health worker (CHW) support or a mobile health application (mHealth) compared with enhanced usual care (EUC) in improving health-related quality of life (HRQOL) for young adults with SCD transitioning to adult care. Design, Setting, and Participants: The Community Health Workers and Mobile Health for Emerging Adults Transitioning Sickle Cell Disease Care study was an observer-blinded, multicenter, randomized clinical trial performed at 5 US children's hospitals with a recruitment period from January 15, 2019, to December 31, 2022, and data analysis performed from September 30, 2024, to June 30, 2025. Participants were 17 years or older with SCD. Interventions: Participants were randomized 1:1:1 to 6 months of EUC, CHW plus EUC, or mHealth plus EUC. Both interventions included goal setting, self-management, skill development, symptom tracking, and transition support. The CHW plus EUC intervention provided weekly synchronous support primarily via phone calls, while mHealth plus EUC offered virtual peer support via interaction with discussion boards. The EUC group received standard care consisting of a transition checklist for consistency across sites. Main Outcomes and Measures: The main outcome was HRQOL, assessed using the Pediatric Quality of Life Inventory (PedsQL) for SCD module. Clinically meaningful improvement was prespecified as a 10-point change. Secondary outcomes included SCD knowledge, transition readiness, and social support. All outcomes were collected at baseline and follow-ups at 6, 12, and 18 months. Results: Of the 700 eligible patients across the 5 sites, 405 were enrolled, and 375 participants with SCD were randomized, 191 (51.5%) of whom were women. The mean (SD) age was 18.9 (1.9) years; the median age was 18.0 (IQR, 17-20) years. Baseline demographic data, clinical characteristics, and markers of disease severity were comparable across the study groups. At 6 months, the CHW plus EUC group showed modest improvements in HRQOL compared with the EUC group at 2.67 (95% CI, 0.25-5.09) at 6 months; there was no change for the mHealth plus EUC group at 0.73 (95% CI, -1.48 to 2.93) at 6 months; and the EUC group had a decline of 2.58 (95% CI, -4.67 to -0.49). CHW support demonstrated the greatest improvement in PedsQL scores compared with EUC at 6 (5.25 [95% CI, 2.05-8.45] points), 12 (5.56 [95% CI, 1.52-9.61] points), and 18 (6.14 [95% CI, 1.75-10.54] points) months. The mHealth plus EUC intervention demonstrated improvement in PedsQL scores at 6 months only (3.31 [95% CI, 0.27-6.35] points). Throughout the study, the HRQOL for the EUC group declined. No significant differences were found in secondary outcomes. Conclusions and Relevance: Although neither intervention met the prespecified 10-point threshold for a large clinical effect, the CHW intervention produced a significant and durable improvement in HRQOL that halted the decline observed in EUC. This sustained effect during the 18 months of follow-up suggests that CHW support provides a clinically relevant benefit for young adults with SCD during their transition to adult care. Integrating such programs into routine care could improve outcomes for this vulnerable population. Trial Registration: ClinicalTrials.gov Identifier: NCT03648710.

Training young adults as community health workers specializing in pediatric to adult health care transition to support emerging adults with sickle cell disease

Health Care Transitions · 2024-01-01 · 5 citations

Background: Transition to adulthood is a vulnerable time for emerging adults (16-25 years of age) with sickle cell disease (SCD), as there is a seven-fold increase in mortality rates during the transition period. Emerging adults with SCD also have the highest rates of hospitalizations, emergency room visits, and hospital readmissions compared to other age groups. Community health worker (CHW) programs have been developed to address outcomes such as patient activation which includes an individual's knowledge, skill, and confidence for managing one's health and healthcare, quality of life, and healthcare utilization for patients with chronic illnesses. However, few programs specifically target transition-age patients with SCD. Methods: The aims of this study were to (1) create and adapt the existing Penn Center for Community Health Workers IMPaCT model trainings and materials to specifically support CHWs working with transition-age patients with SCD and (2) evaluate the feasibility of this adapted model to improve job readiness of the CHWs and perceived value of the CHWs by patients with SCD. A multidisciplinary workgroup defined specific goal-setting categories and developed a targeted CHW training curriculum. Additionally, the workgroup wrote a job manual including step-by-step guidelines with example talking points and defined an ongoing supervision of CHWs. Measures of implementation and impact on CHW job readiness included CHW training completion, job retention, knowledge evaluation, and patient reported CHW engagement. Results: 15 individuals completed CHW training with an average employment length of 1 year and 4 months. 7 (47%) CHWs had research experience, 8 (53%) had clinical experience, and 11 (73%) reported SCD experience. On post-training knowledge evaluations, CHWs successfully identified key aspects of SCD, role scope, and research ethics. Patients frequently reported that they reached their goals while working with trained CHWs. Conclusion: This CHW training program provides a novel adaptation to the evidence-based IMPaCT CHW model to support the needs of youth with SCD during the vulnerable time of transition from pediatric-focused to adulthood-focused healthcare.

The Feasibility of Positioning Electromagnetic Near Field Hotspots within a Resonant Cavity for Microwave Thermal Ablation

SAIEE Africa Research Journal · 2024-05-03

An investigation into moving electromagnetic nearfield hotspots inside a resonant cavity is presented. The investigation focused on simulating an alternative approach to microwave thermal ablation of tumours by manipulating the interaction between electromagnetic near fields instead of utilising an interstitial antenna. The methodology comprised comparing various electromagnetic field solvers, verifying the simulation techniques, characterising a rectangular resonant cavity, and attempting to manipulate the position of its hotspots by introducing a feed phase shift. The effects of dielectric media were also investigated. Progressive hotspot movement was achieved using input phase manipulation between 2.55 and 2.7 GHz with the feeds on opposite walls. No pattern change was evident at the system's eigenfrequencies, indicating a constant field pattern at its resonant peaks. Furthermore, it was determined that the characteristic modes of the system were narrowband, such that the addition of dielectric material altered the system's resonance. Therefore, the application of this method to thermal ablation, which requires high precision, accuracy and control, was deemed impractical. Future recommendations include using adjustable geometry to design field patterns, comparing dielectric media with significant thermal mass, and investigating the ‘inverse problem’ to create a specific current distribution around the resonant cavity and induce the desired hotspot patterns.

Implementing a Population-Based Social Determinants of Health Intervention: Early Lessons Learned from Collaboration between Clinical and Community Organizations

Journal of Health Care for the Poor and Underserved · 2024-08-01 · 3 citations

The purpose of this study was to understand the barriers and facilitators among diverse health care and community organization stakeholders implementing a populationbased social determinants of health (SDOH) intervention. The SDOH intervention included three core programs: SDOH screening, a community health worker program, and a digital referral platform. After one year of implementation, we conducted semi-structured qualitative interviews with clinical and community-based organization stakeholders about (1) the three SDOH programs, (2) organizational implementation strategies, (3) interactions with partner organizations, and (4) perceived target population needs. Findings from the first year of implementation highlighted several factors to consider when designing and implementing SDOH programming, including (1) the successful features of the three SDOH programs, (2) the local implementation strategies and challenges across organizations, (3) the impact of broader community needs and resource availability on implementation, and (4) the importance of intentionally fostering relationships and collaboration among partner organizations.

Novel Estimators for the Number of Susceptible Individuals in SIR Models of Infectious Epidemics

2024-12-03

Accurate estimation of model parameters early in infectious epidemics may improve planning and resource allocation in mitigating the adverse consequences on affected populations. By applying the Peano-Baker series formula and the Cauchy repeated integral formula, we present the development of three novel estimators which facilitate the estimation of the number of susceptible people as a function of time S(t) for an SIR model of an infectious epidemic. Association of these three estimators by combining them produces new estimators. We present the case for the new estimator, Ŝ<inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1,3</inf>, derived from the association of two of the original estimators, Ŝ<inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1</inf> and Ŝ<inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">3</inf> to estimate S(0). This produces an estimate based on the history of net infection rate, I′(t), from time 0 to t. By assuming parameters for the spread of COVID-19 in Wuhan from the literature, we run numerical simulations starting with an infection rate I′(t) and adding filtered Gaussian noise. Discretization produces inaccuracy in bias and variance, however Ŝ<inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1</inf> and Ŝ<inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">3</inf> yield accurate figures for S(t), despite noise contamination. Ŝ<inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1,3</inf> also yields accurate figures for S(0), with improvements as more observations are accumulated. We plan to investigate other novel estimators and further study their performance with real-world data.

Pediatric Population Management Classification for Children with Medical Complexity

Population Health Management · 2024-04-13

Improving the overall care of children with medical complexity (CMC) is often beset by challenges in proactively identifying the population most in need of clinical management and quality improvement. The objective of the current study was to create a system to better capture longitudinal risk for sustained and elevated utilization across time using real-time electronic health record (EHR) data. A new Pediatric Population Management Classification (PPMC), drawn from visit diagnoses and continuity problem lists within the EHR of a tristate health system, was compared with an existing complex chronic conditions (CCC) system for agreement (with weighted κ) on identifying CCMC, as well as persistence of elevated charges and utilization from 2016 to 2019. Agreement of assignment PPMC was lower among primary care provider (PCP) populations than among other children traversing the health system for specialty or hospital services only (weighted κ 62% for PCP vs. 82% for non-PCP). The PPMC classification scheme, displaying greater precision in identifying CMC with persistently high utilization and charges for those who receive primary care within a large integrated health network, may offer a more pragmatic approach to selecting children with CMC for longitudinal care management.