Table 2.

Examples of PBL case verbiage leading to identification of Health Systems Science Domains

	Cases where HSS issues identified on student problem list	Cases where HSS issues NOT identified on student problem list
Acuity of complaint: SUB-ACUTE	Maria Gomez is a 67-year-old woman who presented to her primary care physician with 2 months of progressive dyspnea on exertion and 2 days of nocturnal dyspnea. Spanish is her primary languagei but speaks English well enough to function on her own	Ann Neiman is a 54-year-old woman with a past medical history significant for borderline hypertension, chronic anemia, and heavy cigarette smoking. She has been seen by her primary care physicianii for a 2-month history of coughing up blood-streaked sputum (hemoptysis). She notes progressive shortness of breath, decreased appetite, and a 10-lb weight loss over the last month
Identified by student	HSS Domain: iPopulation, Public, and Social Determinants of Health	HSS Domain: None
Identified by faculty	HSS Domain: iPopulation, Public, and Social Determinants of Health	HSS Domain: iiHealth Care Structure and Process
Acuity of complaint: ACUTE ON CHRONIC	James Randolph is a 45-year-old male with a 15-year history of type 2 diabetesi. He goes to see a new primary care doctor, Dr. Sick, because of “frothy” urine. Mr. Randolph is not regularly screenedii, iii for complications of diabetes; but 5 years ago he visited a clinic and tested negative for microalbuminuriaiv	Bernice Matthews is a 61-year-old woman admitted to the general medicine service for vomiting and diarrhea. She was in her usual state of health until 2 days ago when she began to complain of nausea, which rapidly developed into frequent vomiting and diarrhea several times a day. She has been unable to keep anything down and is now lightheaded and too weak to walk without help
Identified by student	HSS Domain: iiHealth Care Structure and Process	HSS Domain: None
Identified by faculty	HSS Domains: iPopulation, Public, and Social Determinants of Health iiHealth Care Structure and Process iiiHealth System Improvement ivValue in Health Care	HSS Domain: None