Bibliometric and network analysis of the dissemination of health systems science in medical education.

Abstract

Societal concerns regarding the outcomes of the U.S. healthcare system served as an impetus to incorporate a third pillar, health systems science (HSS), into medical education, complementing the basic and clinical sciences. Similar to the creation of the basic sciences as a unified construct, multiple fields were brought together under the HSS framework. The extent of adoption and dissemination of this construct is unknown. This study sought to determine the dissemination, adoption, and connections of HSS through bibliographic and social network analysis. Starting with 5 foundational HSS articles, the authors conducted bibliometric and social network analysis of HSS-related publications using data from Web of Science, excluding books, book chapters, and conference abstracts. Bibliometric performance and science mapping metrics for 269 papers published January 2017-November 2025 were analyzed including publication productivity, citation impact, and author/institution contributions. Social network analysis was used to assess the structure, growth, and interconnectedness of the HSS scholarly network for 235 papers published from 2017-October 2024. Bibliometric analysis found 100 journals representing over 1087 authors at 296 institutions. The network showed consistent annual growth with increasing interconnectivity and decreasing network density, suggesting diffusion beyond early adopters. Academic Medicine was the most frequent publication outlet (59/269, 22%). Seven of the top 10 contributing institutions were part of the original AMA Accelerating Change in Medical Education Consortium. PageRank and citation analysis revealed high-impact articles were closely linked to early HSS curricular work. Social network metrics demonstrated a maturing scholarly community around HSS. This bibliometric analysis starting with 5 foundational articles found dissemination through an expanding network of scholarship, sustained citation of foundational papers, and broad engagement across a diverse group of authors and institutions. As HSS becomes embedded in medical education, future research should explore how its evolution meets emerging health system challenges.